Windows of opportunity

Windows of opportunity

Remember the simplicity of signing up for Selective Service? You hit 18, you filled out the paperwork, and bam! You were done.

It’s a shame it can’t be that easy to deal with Medicare and health coverage. 

A mountain of deadlines, enrollment periods and windows of opportunity affect how and where you get your care – and how much you pay for it. Miss these deadlines and you could experience coverage gaps, miss the chance to update your plan and end up digging deeper – sometimes much deeper – into your wallet.

Initially, you’ll have to decide whether Original Medicare or a Medicare Advantage plan works best for you. But as you’ll see, the decision isn’t permanent. If you opt for Original Medicare, you may want to add a Medicare Supplement Insurance (Medigap) policy to cover some of the costs not covered by Medicare.  

In either case, you’ll need suitable coverage for prescription drugs – either included as part of your Medicare Advantage plan or by enrolling in a separate Medicare prescription drug plan (Part D). Of course, if you retired from the military, you’ll have access to TRICARE for Life, but to use that program you must still sign up for Medicare parts A and B.

So if you’re contemplating the future, evaluating where you stand or looking to make a change to your coverage, here’s an attempt to simplify the deadlines and enrollment periods associated with Medicare:

Automatic Medicare Enrollment Generally, if you’re receiving Social Security or Railroad Retirement Board benefits, on the first day of the month you turn 65 you’ll be automatically enrolled in Medicare parts A and B. 

Medicare Initial Enrollment Period If you aren’t automatically brought on board, you can sign up during the seven-month window that begins three months before the month you turn 65. The window closes at the end of the month three months after the month you turn 65. If you miss this sign-up and are not eligible for a special enrollment period, you will pay the price in the form of higher premiums for the rest of your life. You don’t want to miss this one.

Special Enrollment Period If your coverage through an employer ends, you generally have an eight-month period to sign up for Medicare without a premium penalty. Other events can also trigger a special enrollment period. For example, you could move out of an area covered by your Medicare Advantage plan, participate in a plan that is sanctioned or terminated by Medicare or return to the United States from a foreign country. Check Medicare.gov for the details on your specific situation.

General Enrollment Period (Jan. 1- March 31) If you missed your initial signup and weren’t eligible for a special enrollment period, you can sign up for Medicare during the General Enrollment Period. Your coverage becomes effective July 1. Again, you must pay a permanent 10 percent premium penalty for each full 12-month period you waited to sign up.

Annual Enrollment Period (Oct. 15-Dec. 7) You don’t need to sign up annually, but during this period you can change prescription drug plans and change or sign up for a Medicare Advantage plan. All changes are effective Jan. 1.

Medicare Supplement Open Enrollment
If you choose to use Original Medicare and supplement the coverage with Medicare Supplement Insurance, there’s yet another enrollment period. This one begins when you turn 65 and enroll in Medicare Part B, and it lasts an additional five months. Note: there is no underwriting during this open enrollment period. Although Medicare Supplement policies offer services in accordance with plan names, prices can vary, so it could pay to shop around. 

Medicare Advantage Disenrollment Period (Jan. 1-Feb. 14) Each year, you have an opportunity to leave your Medicare Advantage plan by switching back to Original Medicare and signing up for a stand-alone prescription drug plan. If you make this move, you may also want to consider a Medicare Supplement policy.

Clearly, Medicare isn’t as simple as signing up and forgetting about it. Check out all the information available at Medicare.gov, and mark these dates on your calendar so you can time your moves.  

 

J.J. Montanaro is a certified financial planner with USAA Financial Planning Services, one of the USAA family of companies. USAA is The American Legion’s preferred provider of financial services.