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  • MICHAEL KENNEDY

What Happens if You Miss Medicare Open Enrollment?

Updated: May 1

Key details to know about Medicare Annual Enrollment Period

The Medicare Annual Enrollment Period occurs from October 15 through December 7 each year, providing a valuable opportunity to review your current Medicare coverage. During this period, it's essential to ask yourself some key questions:

  • Does my current plan cover all of my prescriptions?

  • Can I afford the costs associated with my plan?

  • Are my preferred healthcare providers, including my doctor, part of the plan's provider network?

Taking the time to assess your coverage during the Annual Enrollment Period ensures that you have the right Medicare plan that meets your healthcare needs and preferences.


The Medicare AEP is different from the other enrollment periods for Medicare plans. The Medicare AEP lets you add, change, or drop Medicare Advantage plans or stand-alone Medicare Prescription Drug Plans. You can make certain other changes then, too such as:

  • Sign up for a Medicare Advantage plan

  • Change from one Medicare Advantage plan to another (whether or not the plans include prescription drug coverage)

  • Drop your Medicare Advantage plan and return to Original Medicare, Part A and Part B

  • Enroll in a stand-alone Medicare Part D Prescription Drug Plan*

  • Change from one stand-alone Medicare Part D Prescription Drug Plan to another

  • Drop your stand-alone Medicare Part D Prescription Drug Plan



*You generally can’t enroll in both a stand-alone Medicare Part D Prescription Drug Plan and a Medicare Advantage Prescription Drug plan.


Enrollment options: Comparing Original Medicare and Medicare Advantage

It’s crucial to understand that if you're considering a Medicare Advantage plan or a stand-alone Medicare Part D prescription drug plan, you generally can't enroll, switch plans, or drop plans at any time.

When you first become eligible for Medicare, you can typically enroll in a Medicare Advantage plan or a stand-alone Medicare Part D Prescription Drug Plan. However, once your Medicare Initial Enrollment Period is over, the Medicare Advantage Annual Enrollment Period becomes your primary opportunity to enroll in or make changes to these plans, unless you qualify for a Special Enrollment Period.


Consequences and Risks of Missing Medicare Open Enrollment


Late Medicare enrollment penalties

Medicare Late Enrollment penalties may apply if you delay signing up for Medicare.


The Part B late enrollment penalty increases your monthly premium for each 12-month period you were eligible but didn’t enroll. Similarly, the Part D late enrollment penalty applies if you don’t have creditable prescription drug coverage for 63 days or more after your Initial Enrollment Period.


These penalties are permanent and may result in higher costs for as long as you have Medicare. Therefore, it's crucial to enroll on time to avoid these penalties and ensure continuous coverage.


Coverage start date when you miss Medicare Annual Enrollment Period

If you miss the Medicare Annual Enrollment Period, your coverage start date may be delayed. Changes made during the Annual Enrollment Period typically become effective on January 1st of the following year.


However, if you miss this window, you may have to wait until the next Annual Enrollment Period to make changes to your Medicare coverage. It's crucial to be aware of the enrollment periods and deadlines to ensure that your coverage is in effect when you need it.


Limited coverage options outside of Medicare Annual Enrollment Period

If you miss the Medicare Annual  Enrollment Period, you may still have coverage options available to you. Special Enrollment Periods (SEPs) can be triggered by certain life events, such as losing employer coverage, moving to a new area, or qualifying for Extra Help. These SEPs allow you to enroll in or make changes to your Medicare coverage outside of the regular enrollment periods.


Higher out-of-pocket costs

When you miss the Medicare enrollment periods, you may face higher costs for coverage. Late enrollment penalties can be imposed if you delay enrolling in certain parts of Medicare, such as Part B or Part D. These penalties are added to your premium and can result in increased expenses over time. It’s crucial to understand the enrollment deadlines and take action promptly to avoid these penalties and potential financial burdens.


Late Enrollment Options: What to do if you miss Medicare Annual Enrollment Period


If you miss the Medicare Annual Enrollment Period, you have some options to get healthcare coverage.


Explore coverage options and finding suitable alternatives

Enrolling in a Medicare 5-star plan is an option worth considering if you’re looking for exceptional quality and performance in your Medicare coverage.


Medicare rates certain types of plans by assigning one through five stars, based on information it collects from member satisfaction surveys, health-care providers, and the plans themselves. Five stars is the highest rating.


You can typically get a Special Enrollment Period to sign up for (or switch to) a 5-star plan once between December 8 one year and November 30 the next year if one is available in your area. That’s a nearly yearlong window of opportunity every year.


The 5-star Special Enrollment Period applies to Medicare Advantage plans, stand-alone Medicare Part D Prescription Drug Plans, and Medicare Cost Plans.


Qualify for other Special Enrollment Periods

There are several situations where you may be able to make coverage changes outside the Medicare Annual Enrollment Period by qualifying for a Special Enrollment Period (SEP). Some of these situations involve losing your health-care coverage in one way or another. Here are a few examples of situations that might make you eligible for a Special Enrollment Period to sign up for a Medicare Advantage plan or stand-alone Medicare Part D prescription drug plan or change plans.


  • You moved out of your plan’s service area.

  • You moved into, out of, or still live in a skilled nursing facility, or another institution such as a long-term care hospital.

  • You left your employer-based or union-based health insurance.

  • You used to be eligible for Medicaid, but now you’re not.

  • You just got out of jail.

  • You’re moving back to the United States after living outside the country.

  • Your plan is losing or ending its contract with Medicare.


Remember, these are just examples. If you experience major changes to your plan, your coverage, or even your health, it might be worth checking with Medicare to see if you may qualify for a Special Enrollment Period to change your coverage.

Different SEPs may last for different amounts of time. In many cases, you’ll have at least two months to make the change, but it does depend on your circumstances.


Consider COBRA coverage or employer-based plan options

COBRA coverage, or the Consolidated Omnibus Budget Reconciliation Act, offers eligible individuals the opportunity to continue their employer-sponsored health insurance coverage for a limited period after experiencing certain qualifying events, such as job loss or a reduction in work hours. This coverage can serve as a temporary solution, bridging the gap until you find alternative health insurance options.

If eligible, you may have the option to remain on your employer’s health insurance coverage through a program called “active employee” coverage. This allows you to retain your current health benefits even after becoming eligible for Medicare. However, it's important to check with your employer to understand the specific rules and requirements for maintaining your employer’s coverage while also being eligible for Medicare.


Wait for the next Annual Enrollment Period

If you don’t qualify for any Special Enrollment Periods (SEPs) or other unique enrollment options, you'll have to wait until the next available enrollment period to make changes to your Medicare coverage. The main enrollment periods are the Annual Enrollment Period (AEP) and the Initial Enrollment Period (IEP), which occur once a year.


During these periods, you have the opportunity to make changes to your Medicare plan or enroll in a new plan for the upcoming year. It’s crucial to be aware of these enrollment periods and plan accordingly to ensure you have the coverage you need when you need it.

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