Enrolling in Medicare

You may have heard that signing up for Medicare is like navigating through a maze. That's a pretty good analogy. Medicare is complicated, and you will have many things to consider while making decisions about your coverage. The better you understand the parts, regulations and enrollment period limitations, the easier it will be to make the right choice at the right time.

We’re going to try to make things understandable for you. But if you’re still scratching your head, you're not alone. Just ask for a clarification.

Your Medicare options

Most people get their Medicare coverage in one of four ways:

Option One: Original Medicare, Parts A and B

Part A helps cover hospital and other inpatient costs. Part B helps cover doctor and other outpatient costs. Together, they are Original Medicare, available from the federal government. Currently the employee and employee each pay 1.45% tax of the employee’s income.

Option two: Original Medicare plus a Medicare Supplement plus a prescription drug plan.

Original Medicare is joined by a Medicare Supplement plan to cover costs not included in Original Medicare (such as copayments, co-insurance and deductibles) and by a prescription drug plan. Supplements and prescription drug plans are provided by private insurance companies. While you don't need to purchase a prescription drug plan (PDP) to purchase a supplement, putting off purchasing a PDP until a later date may make you liable for a Late Enrollment Penalty.

Option 3: Medicare Advantage Plan (MA)

An MA plan includes Parts A and B (you must continuer to pay your Part B Premium along with your MA premium. Prescription drug coverage (Part D) is usually included, as are additional benefits and services. MA plans are provided by private insurance companies.

Option four: Original Medicare plus a prescription drug plan

Prescription drug plans are provided by private insurance companies.

Special Needs Plan (SNP)

Medicare SNPs are a type of Medicare Advantage Plan that offer more focused and specialized healthcare benefits and drug lists designed to meet specific needs. SNPs include all Medicare Part A, B and D benefits.

To join a Medicare SNP, you must have Medicare Parts A and B and at least one of the following:

• A chronic condition, like diabetes or a heart condition
• Medical assistance from the state, such as Medicaid
• Residence in certain types of institutions (such as a nursing home), or a need for home nursing care.

Initial Enrollment Period

The Initial Enrollment Period is the first time you can sign up for Medicare. You may join Medicare Parts A, B, C and D during this time.

• The three months before your 65th birthday
• The month of your 65th birthday
• The three months following your 65th birthday month

When is my 7-month Initial Enrollment Period?

Your coverage will start no sooner than your birthday month, unless your birthday is on the first day of the month, in which case it can start the first day of the month before.

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When does Part B coverage begin?

The start date of your Part B coverage is dependent upon which month you enrolled in Part B during the Initial Enrollment Period. It’s important to enroll early.

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When does Part D Prescription Drug coverage begin?

The start of your Part D coverage depends on when you enroll. It is, however, not as punitive as Part B.

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When does a Special Enrollment Period come into play?

A Special Enrollment Period (SEP) applies when you are able to delay your enrollment in Medicare Parts A, B, C and D. SEPs are only available under certain circumstances

Special Enrollment for Parts A and B

You may have waited to sign up for Medicare Part A or Part B if you were working for an employer with more than 20 employees when you turned 65 and had healthcare coverage through your job, union or through your spouse’s job.

When is my Special Enrollment Period for Parts A and B?

You can get a Special Enrollment Period to sign up for Parts A and/or B:

• Any time you are still covered by the employer or union group health plan through you or your spouse’s current or active employment, or
• During the 8 months following the month the employer or union group health plan coverage ends, or when the employment ends (whichever comes first)
• If you wait longer than the allowed time you may have to pay a Late Enrollment Penalty of 10% for each full 12-month period you could have had Part B, but didn’t sign up
• If you are disabled and working — or you have coverage from a working family member — the Special Enrollment Period rules also apply

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Special Enrollment for Parts C and D

You may have waited to sign up for Medicare Part C or Part D if you were working for an employer with more than 20 employees when you turned 65 and had healthcare coverage through your job, union or through your spouse’s job. The Special Enrollment Period for Part C (Medicare Advantage Plan) and Part D (Prescription Drug Coverage) gives you two months to sign up after the loss of employer healthcare coverage.

When is my Special Enrollment Period
for Parts C and D?

If you are enrolled in Parts A and B you can take advantage of a Special Enrollment Period to sign up for Part C

• During the two months after the loss of employer or union group health plan coverage.

If you are enrolled in Parts A and B you can take advantage of a Special Enrollment Period to sign up for Part D

• Don’t go 63 days or more without a drug plan. If you had and lost drug coverage from a creditable provider (employer, union group, TRICARE, individual health coverage, etc.) you must join a new Medicare Part D drug plan in fewer than 63 days.

Certain events trigger other Special Enrollment Periods for Part D plans. You can switch plans if:

• You move out of the area your current plan serves
• You are affected by a national emergency/disaster
• You enter, leave or live in a nursing home
• Your plan changes and no longer serves your area
• You are eligible for the Part D Low-Income Subsidy (LIS)/Extra Help or State Pharmaceutical Assistance Program (SPAP)

The Part D Prescription Drug Coverage monthly premium varies by plan. Like Part B, you will pay a "Late Enrollment Penalty" if you don’t have one of the following for 63 consecutive days after your Initial Enrollment Period is over:

• Medicare Prescription Drug Plan (Part D)
• Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage
• Creditable prescription drug coverage

The Part D LEP is 1% of the “national base beneficiary premium” ($36.78 in 2025) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

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What is the General Enrollment Period?

If you miss your Initial Enrollment Period and do not qualify for the Part B Special Enrollment Period, you get another chance to enroll. You can sign up for Medicare Parts A and B between January 1 and March 31 each year. Your Medicare coverage would begin on July 1 of the same year.

When is the General Enrollment Period

If you take advantage of the General Enrollment Period and need to buy Part A you must also enroll in Part B at this time.

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What is the Annual Election Period?

The Annual Election Period — also called the Open Enrollment Period or Annual Coordinated Enrollment Period — runs each year from October 15 to December 7.

When is the Annual Election Period?

During this time:

• Anyone with Original Medicare (Parts A and B) can switch to a Medicare Advantage Plan (Part C).
• Anyone with a Medicare Advantage Plan can change to a new Part C plan or return to Original Medicare.
• Anyone who has or is signing up for Medicare Parts A or B can join, drop or change a Part D Prescription Drug Plan.

Your coverage will start January 1 of the following year.

Annual Election Period Guidelines

September and October

• Review and Compare Medicare Advantage Plans.
• Review any notices from your plan about changes for next year.
• In October, use Medicare’s tools to find a plan that meets your needs.
• Beginning in October, plan information will be available to discuss with your insurance professional.

Between October 15 and December 7

This is the one time of year when ALL people with Medicare can make changes to their health and prescription drug plans for the next year.

January 1: coverage begins

Your new coverage begins if you switched to a new plan. If you stay with the same plan, any changes to coverage, benefits, or costs for the new year will begin on January 1.

Between January 1 and March 31

If you’re in a Medicare Advantage Plan (an HMO, PPO or PFFS), you can make one change to a different plan or return to Original Medicare (and join a stand-alone Medicare Prescription Drug Plan) once during this time period. Any changes you make will be effective the first of the month after the plan receives your request.

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Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period provides additional opportunities to change your Medicare Advantage plan outside the Annual Election Period (October 15 – December 7).

When Is the Medicare Advantage Open Enrollment Period?

The annual Medicare Advantage Open Enrollment Period (MA OEP) allows anyone enrolled in a Medicare Advantage plan on January 1 the opportunity to change plans. The annual MA OEP runs from January 1 to March 31. There is also an individual Medicare Advantage Open Enrollment Period that’s limited to new Medicare beneficiaries with both Medicare Part A and B who enroll in an MA plan during the Initial Election Period. These individuals have a three-month MA OEP to switch plans.

Both the annual and the individual MA OEP allow Medicare beneficiaries already enrolled in a Medicare Advantage plan to elect to either:

• Switch to a different MA plan
• Switch from a Medicare Advantage plan to Original Medicare with or without a standalone Part D plan

This enrollment period does not allow for Part D changes for individuals enrolled in Original Medicare.

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Medicare Supplement Open Enrollment

The best time to buy a Medicare Supplement Insurance Policy (Medigap) is during your 6-month Medigap Open Enrollment Period, which begins on the first day of the month in which you turn 65, are entitled to Part A, and are enrolled in Medicare Part B.

Why buy a Medicare Supplement During the Open Enrollment Period?

During this time you can buy any Medigap policy sold in your state, even if you have health problems.

• After this enrollment period, you may not be able to buy a Medigap policy. If you are able to buy one, it may cost more due to past or present health problems.
• Premium costs are determined by your age at the time you first purchase a Medigap plan.
• If you do not enroll in Part B when you first become eligible because you have group health coverage based on your (or your spouse’s) current employment, your Open Enrollment Period won’t begin until you enroll in Part B.
• Medicare Supplements may be changed at any time during the year.

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Click here or call 941/704-6343 to contact a licensed agent.

We do not offer every plan available in your area. Currently we represent nine organizations which offer 76 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.