Medicare is a national government health insurance program that began in 1965 in the United States of America and is administered by the Centers for Medicare and Medicaid Services (CMS). Its primary role is to provide health insurance to Americans aged 65 and above and younger persons with certain medical conditions or disabilities.
The Medicare Program has four essential parts: Parts A, B, C, and D, covering medical expenses. The General Enrollment Period (GEP) is one of the essential periods for enrolling in Medicare, and it happens every year. It is, therefore, essential to understand the general enrollment period, when it takes place, who is eligible, and the benefits and downsides of signing up.
What is the Medicare General Enrollment Period?
The GEP is a window where individuals who missed their seven-month Initial Enrollment Period and don’t qualify for a Special Enrollment Period (SEP) can sign up for Medicare Parts A and B.
This period occurs annually from January 1st through March 31st, the new coverage begins July 1st. During this time, eligible people could enroll in the program, although they might pay higher premiums. To enroll, eligible persons must complete an application and provide their Social Security number and employment information.
Who is Eligible to Enroll During Medicare’s General Enrollment Period?
You can be eligible for the General Enrollment Period, if:
1. You are an American citizen who has lived in the country for at least five years.
2. You missed the Initial Enrollment Period.
3. You are not eligible for a Special Enrollment Period (SEP).
Suppose your current health care coverage comes from a private insurer or an employer who sponsors an insurance plan, as opposed to through government programs such as Medicaid or VA, or TRICARE. In that case, you may not be eligible for this period. When you enroll during the General Enrollment Period, your coverage will only be effective from the first day of July that year.
Enrolling in Medicare Advantage Plan and Part D
Medicare Advantage Plans, or Medicare Part C, are offered by private companies approved by Medicare. They help cover the costs of health care, medication coverage that Medicare does not provide, and private long-term care. Part D plans, known as Medicare prescription drug plans, are designed to help individuals with Medicare pay for prescription medication.
If you enroll in Part A and/or B during the General Enrollment Period, you can enroll in either of these programs if you aren’t already enrolled in one.
Late Enrollment Penalties for General Enrollment Period
If you enroll for Medicare during the General Enrollment Period, you will have to pay a late enrollment penalty which is added to your monthly premium.
If you enrolled for Medicare Part A during the GEP but didn’t enroll when you first became eligible, your monthly premium may increase by 10%. You will also have to pay this higher premium twice the years you were eligible. For instance, if you were eligible three years ago, you will pay the additional charge for the next six years.
For Part B, you will pay an additional 10% of the monthly premium for every 12-month period you were eligible for but did not enroll. Therefore, the longer you wait to sign up, the more it will cost. For instance, if your Initial Enrollment Period ended on January 2021, and you waited until January 2023 to sign up for Part B, your monthly premium penalty will be 20% higher. Therefore, applying for Medicare is vital when you first become eligible.
What Are the Benefits of Enrolling in Medicare During the General Enrollment Period?
Persons who missed the Initial Enrollment Period can benefit by signing up during the General Enrollment Period in the following ways:
1. Healthcare Access
Enrolling in Medicare Part A and/or Part B during the GEP ensures access to healthcare services. Additionally, it helps avoid paying expensive medical bills that may arise due to a medical condition or disability.
2. Access to Additional Medicare Benefits
When you sign up for Medicare Part A and/or Part B, you may be eligible for additional benefits, such as Medicare Advantage plans or prescription drug coverage (Part D).
3. Peace of Mind
The assurance that you will not need to pay for costly medical expenses gives you peace of mind and reduces stress, especially if you are retired or have serious health concerns.
What Are the Downsides of Enrolling in Medicare During the General Enrollment Period?
Every eligible person who enrolls during the GEP should be aware of these drawbacks:
1. Premiums Will Increase
Anyone who enrolls during the General Enrollment Period will have to pay higher premiums for their Medicare plans. However, this could be a good option for some people due to the need to have healthcare coverage regardless of any medical conditions or disabilities you may have.
2. Delay in Coverage
If you sign up for Medicare during the General Enrollment Period, your coverage may not begin until July 1st of that year. So, if you get a severe illness or get into an accident before July 1st and need medical care, you will be responsible for paying for the services out of pocket.
3. Lower-Quality Care and Missed Opportunities
In addition to paying higher premiums, beneficiaries who enroll during the General Enrollment Period may sometimes receive lower-quality care than those who sign up during their Initial Enrollment Periods. Additionally, they may miss out on Medicare Advantage or Part D prescription drug plans with different enrollment periods.
4. Less Time to Make Changes
If you sign up for Medicare during the General Enrollment Period, you will not have as much time to change your coverage until the next enrollment period.
In conclusion, the General Enrollment Period is a good option for Medicare-eligible people who still need to enroll in the program but need coverage or want to reap additional benefits. However, you should know the pros and cons to make an informed decision.