Medicare Enrollment Windows and Timing

Pay attention to your Medicare enrollment window. If you miss it, you might have to pay a penalty, pay more for coverage or have fewer choices.

  Initial
Enrollment—
When
Initial
Enrollment —
How
Late
Enrollment
Making
Changes
Part A Anytime from three months before your 65th birthday to three months after the month of your 65th birthday. Automatic, if you're already receiving Social Security benefits. Otherwise, enroll at your Social Security Office. There are no penalties for signing up late, unless you pay a monthly premium for Part A. Renews each year automatically.
Part B Same as Part A. Automatic, if you're receiving Social Security benefits when you turn 65 or otherwise become eligible for Medicare. If you're not receiving Social Security benefits, sign up at your Social Security office. You can also refuse coverage at this office. If you enroll after the initial enrollment period, premiums will be higher unless you qualify for an exception. Renews each year automatically.
Part C (Medicare Advantage) Anytime from three months before your 65th birthday to three months after the month of your 65th birthday. Enroll through a private insurance company. During Medicare Open Enrollment, you can change your plan, including adding or dropping Medicare Part D drug coverage. This is the only time of year you can do this, unless you qualify for an exception.
Medicare Part D (prescription drug coverage) Anytime from three months before your 65th birthday to three months after the month of your 65th birthday. Enroll through a private insurance company. During Medicare Open Enrollment, you can add, drop or change your Part D coverage. This is the only time of year you can do this, unless you qualify for an exception.
Medicare Supplement Insurance When you turn 65 and enroll in Medicare Part B, you have a guaranteed right to buy a Medicare Supplement policy for six months. You buy Medicare Supplement Insurance through a private insurance company. If you miss the enrollment window you can apply at any time. But you may pay a higher rate or be rejected if you have a history of health problems. You can add or drop at any time. If you change policies, it's best to wait until the new policy is effective before dropping the old policy.

Exceptions and special enrollment periods

There are some exceptions to dates and deadlines described above. In some cases you will have the right to change your coverage without waiting until Medicare Open Enrollment.

For example, if you have a Medicare Advantage plan and you move out of your plan's service area, you can change your coverage without waiting for Medicare Open Enrollment.

If your circumstances change, don't assume you must wait until Medicare Open Enrollment. Call the Medicare Helpline at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week (TTY users, call: 1-877-486-2048) and ask if your situation qualifies you to make changes outside of the timing rules.

Medicare Advantage Disenrollment Period (MADP)

Medicare Advantage (MA) plan enrollees have an annual opportunity to disenroll from MA and return to Original Medicare between January 1 and February 14 of every year. The effective date of a disenrollment request made during the MADP will be the first of the month following receipt of the disenrollment request. For example, a request made in January will be effective February 1, and a request made in February will be effective March 1.

Regardless of whether the MA plan included Part D drug coverage, MA enrollees using the MADP to disenroll from MA from January 1 through February 14 are eligible for a special enrollment period (SEP) to enroll in a Prescription Drug Plan (PDP) during the same time frame. An individual may use this SEP to request enrollment in a PDP after having submitted a disenrollment request from the MA plan during the MADP. Or, they may simply request enrollment in the PDP, resulting in automatic disenrollment from the MA plan. Individuals enrolled in a Private Fee-For-Service (PFFS) plan without drug coverage must request disenrollment from their current plan prior to requesting enrollment in a PDP.

Questions? Call UnitedHealthcare at:
1-877-699-5710
(TTY 711)
Hours: 8 a.m.-8 p.m. local time,
7 days a week

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Optional supplemental service (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage and fitness programs.

Optional supplemental service (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage and fitness programs.

Optional supplemental plan (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage, vision and hearing coverage and fitness programs.

Creditable Coverage

Refers to prescription drug coverage that offers benefits the same as or better than coverage available through Medicare.

Tier 1: Preferred Generic. Lowest Copay.

This tier includes lower-cost, commonly used generic drugs. Use Tier 1 drugs for the lowest out-of-pocket costs.

Tier 2: Non-Preferred Generic. Low Copay.

This tier includes most generic drugs. Use Tier 2 drugs, instead of Tier 3 or 4, to help reduce your out-of-pocket costs.

Tier 5 : Specialty Tier. Coinsurance.

This tier includes unique and/or very high-cost drugs. You pay a percentage of the total drug cost, called coinsurance.

Tier 4: Non-Preferred Brand. Highest Copay.

This tier includes non-preferred generic and non-preferred brand drugs. Many Tier 4 drugs have lower-cost options in Tier 1, 2 or 3. Ask your doctor if you can switch to one of these drugs to help reduce your out-of-pocket costs.

Tier 3: Preferred Brand. Medium Copay.

This tier includes many common brand name drugs, called preferred brands, and some higher-cost generic drugs. Many Tier 3 drugs have lower-cost options in Tier 1 or 2. Ask your doctor if they could work for you.

Tier 4: Non-Preferred Brand. Highest Copay.

This tier includes non-preferred generic and non-preferred brand drugs. Many Tier 4 drugs have lower-cost options in Tier 1, 2 or 3. Ask your doctor if you can switch to one of these drugs to help reduce your out-of-pocket costs.

Drug List tool tip

A list of drugs covered by your Medicare Part D plan. A drug list may also be referred to as a covered prescription drugs list (CML), a preferred drug list (PDL), a select drug list or a formulary. These drugs are dispensed through participating network pharmacies to covered members. Drug lists may differ between Medicare prescription drug plans.


Carefully weigh the differences in drug lists against the plan costs and other features when choosing a plan that may best meet your needs. A drug list may change during the year.

Tier 2: Low Copay

This tier includes most generic drugs. Use Tier 2 drugs, instead of drugs in Tiers 3 or 4 to help reduce your out-of-pocket costs.

Coverage Gap Stage:

During the Coverage Gap Stage, you (or others on your behalf) will pay no more than 72% of the total cost for generic drugs or 47.5% of the total cost for brand name drugs, for any drug tier until the total amount you (or others on your behalf) have paid reaches $4,550 in year-to-date out-of-pocket costs.

You may pay less if your plan has better coverage in the gap.

Always use your Medicare Part D member ID card during the coverage gap to get the plan's discounted drug rates. The money you spend using your card counts toward your out-of-pocket costs.

Out-of-Pocket Costs:

The amount you (or others pay on your behalf) pay for prescription drugs starting January 1, 2013 not including premiums.

Premium (or monthly premium)

The monthly fee you pay for Medicare coverage.

Deductible/annual deductible

The pre-set, fixed amount you must pay for healthcare or prescription drug costs before Medicare or the plan begins to pay.

Deductible/Annual deductible

The pre-set, fixed amount you must pay for healthcare or prescription drugs costs before the insurance company or Medicare begins to pay.

Coinsurance

A kind of cost sharing where you pay a percentage of the cost of a service. For example, a plan might pay 75% and you would pay 25%. In Medicare Advantage, coinsurance varies depending on the plan.

Copay

A kind of cost sharing where you pay a predictable, pre-set amount for a service, such as an annual check-up.

Copay

A kind of cost sharing where you pay a predictable, pre-set amount for a service, such as an office visit.

Primary Care Physician's name and ID

Your primary care physician (PCP) plays an important role in your health care, and we want you to have the opportunity to select one you are comfortable with. Your PCP can:

  • Help you make good lifestyle choices to maintain and improve your health.
  • Serve as a direct point of contact in case of an emergency.
  • Manage the drugs prescribed to you and identify potential adverse interactions.
  • Coordinate the care of specialists who may diagnose and treat your conditions.
  • Help ensure that you are getting the care you need while helping to minimize your out-of-pocket costs.

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