Enrolling in Medicare, when and how to sign up

Before enrolling in any supplemental plan (Medicare Advantage, Medigap, or Part D), your parent needs:

• Medicare number and start dates for Parts A and/or B. Both are on the red-white-and-blue Medicare card.
• U.S. citizen or legal resident status.
• An address in the plan's service area.
• Active Parts A and B for Medicare Advantage and Medigap; at least one for Part D.

People who don't yet have Medicare enroll first through Social Security (ssa.gov/medicare), and only then choose supplemental plans.

Who it's for: people aging into Medicare for the first time, usually around their 65th birthday.

When it applies: a seven-month window around your parent's 65th birthday, three months before their birthday month, the birthday month itself, and three months after. If the birthday falls on the first of a month, the window shifts one month earlier.

What can be done in this window:

• Enroll in Medicare Advantage (requires active Parts A and B).
• Buy a Medigap policy (requires active Parts A and B).
• Enroll in a standalone Part D plan (requires active Part A or B).

When the plan starts: if the application is submitted before the Medicare start date, the plan begins on the Medicare start date. If submitted later, the plan starts the first day of the month after submission.

IEP is also the window for Part B enrollment. Delaying Part B without a valid reason (e.g., comparable employer coverage) triggers a lifetime penalty.

Who it's for: people who already had Part A but are only now activating Part B, for example, someone who delayed Part B because of employer coverage and is now retiring.

When it applies: three months before Parts A and B start, through two months after they take effect.

What can be done:

• Enroll in Medicare Advantage, with or without Part D.

When the plan starts: first day of the month after the application is submitted.

Who it's for: anyone already on Medicare.

What can be done in this window:

• Change from one Medicare Advantage plan to another.
• Drop Medicare Advantage and return to Original Medicare.
• Switch from Original Medicare to a Medicare Advantage plan.
• Enroll in a Part D plan, change it, or drop it.
• Add Part D to Original Medicare.

Why AEP matters so much: every year, plans change premiums, benefits, formularies, and network providers. What worked last year may not fit this year. We recommend an AEP review for every client, even when everything seems fine.

Who it's for: only people who already have a Medicare Advantage plan.

When it applies: January 1 to March 31 every year.

What can be done:

• One-time change from one Medicare Advantage plan to another, with or without Part D.
• Drop Medicare Advantage and return to Original Medicare, optionally adding Part D.

What CAN'T be done:

• First-time enrollment in Medicare Advantage (requires AEP or SEP).
• Change a Part D plan while on Original Medicare (requires AEP or SEP).
• Enroll in Medigap with guaranteed issue, unless a trial right applies after the first year on Advantage.

When the plan starts: first day of the month after the application is submitted.

Trial right after first year on Medicare Advantage: people who enrolled in their first Medicare Advantage plan get 12 months to change their mind and return to Original Medicare. In this window, guaranteed-issue rights apply to a Medigap policy with no medical underwriting. Worth a call before that 12-month mark.

Who it's for: people in specific life situations that trigger an enrollment right outside the standard windows.

SEPs exist for many specific situations. The most common:

• Moving. To a state where the current plan doesn't work, or outside its service area.
• Losing employer or union coverage. Loss of group coverage that had creditable coverage.
• Losing Medicaid. SEP applies for a limited time.
• Getting Medicaid or Extra Help. New eligibility opens a change window.
• Plan terminates its Medicare contract. Guaranteed right to switch.
• Returning to the U.S. After an extended stay abroad.
• Release from incarceration.
• 5-star plan. Once a year, allows switching to a 5-star rated plan, outside AEP and MA-OEP.
• Moving into or out of a long-term care facility.
• Misinformation or error by an agent or plan.

SEP length: varies by situation, usually 2-3 months from the triggering event.

When the plan starts: usually first day of the month after the application is submitted. There are exceptions, e.g., when coverage loss triggers the SEP, the plan can start on the day coverage was lost.

SEPs are too varied for a general description. If your parent might qualify, call us. We'll talk through the situation and confirm which window applies.

Step 1. Understand the needs. Who is your parent's primary care doctor and specialists? What medications do they take regularly? Where do they live most of the year? How often do they travel? What's the budget for healthcare?

Step 2. Compare available plans. Verify that doctors are in the plan's network, that medications are on the formulary at good tiers, calculate annual costs (not just monthly premiums), check the plan's CMS star rating.

Step 3. Enroll and follow up. Enrollment can be done directly at planenroll.com or through us. We help with the application and walk you through the process. Our work doesn't end at enrollment. We're available year-round.

For parents approaching 65, after recent loss of employer coverage, planning a move, or wanting an AEP review, we'll walk through their situation and confirm which enrollment window applies.

Jakub Słomczewski Licensed Insurance Agent A clean enrollment is an on-time one. Call early and we'll figure out the right window together.

Working with our agency costs your family nothing. Agents are paid directly by the insurance carriers.