Medicare Basics
JOINING A PLAN & ENROLLMENT PERIODS
What is Medicare
& WHO IS ELIGIBLE TO JOIN?
Medicare is the Federal Health Insurance program for:
- Individuals who are 65 or older
- People under 65, if they’ve received Social Security Disability Insurance or certain Railroad Retirement Board disability benefits for at least 24 months.
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called (ESRD).
- For people with amyotrophic lateral sclerosis (ALS), there is no waiting period for Medicare.
- Our agents can check your Medicare eligibility.
What are the different parts of Medicare
& MEDICARE COSTS?
- Medicare Part A (Hospital Insurance): Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.
- Medicare Part B (Medical Insurance): Part B covers certain doctor’s services, outpatient care, medical supplies and preventative services.
- Medicare Part C (Medicare Advantage): A Medicare approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These bundled plans include Part A, Part B and usually Part D. In most cases you will need to use doctors who are in the plan's network.
- Medicare Part D (Prescription Drug Coverage): A plan that helps cover the cost of Prescription Drugs.
Most people do not pay a monthly premium for Part A
If you don’t qualify for a premium-free Part A, you can buy Part A
Everyone pays a monthly premium for Part B. In 2025, Medicare part B premium costs $185.00.
When can you join a Medicare Plan?
TO JOIN A MEDICARE PLAN, YOU MUST:
- Have Medicare Part A (Hospital Insurance)and Part B (Medical Insurance)
- Live in the service area of the plan you want to join.
- Be a U.S. citizen or lawfully present in the U.S.
- Have your Medicare Number and your Part A and/or Part B coverage start dates.
Enrollment Periods
An enrollment period is the only time you can join,
switch or drop a Medicare Advantage Plan or a
Stand Alone Prescription Drug Plan.
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- Initial Coverage Enrollment Period (ICEP): The period 3 months prior to the first day of your birthday month, your entire birthday month and 3 months after. If you have been on social security disability for more than 24 months that triggers an automatic PART A and B, giving you an initial coverage enrollment election.
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- Annual Enrollment Period ( AEP): October 15th to December 7th. This is a set time each year for changing your Medicare coverage. You can submit an unlimited number of applications during this period with your last application going into effect on January 1.
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- Open Enrollment Period ( OEP): January 1 to March 31st, this is where you can make a one-time change to your Medicare Advantage Prescription Drug Plan (MAPD). The plan will take effect the following month of when you apply. You can go from a Supplemental Plan to another Supplemental Plan or from an Advantage Plan to another Advantage Plan. You can also change a Prescription Drug Plan (PDP) to another Prescription Drug Plan or go back to Original Medicare and choose a Stand-Along PDP.
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- Special Election Period (SEP): This election is used if you gain or have any change of level in your Low Income Subsidy (LIS) or Medicaid status. It can be used if you move out of the plan’s service area or become eligible for a special needs plan for either adults with chronic condition or institutionalized adults. If you are in an area that is effected by a natural disaster, this can sometimes trigger a special election period.
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- 5 STAR PLAN: You can enroll ONE-TIME annually in a 5-STAR plan, outside of a valid election period, if one is offered in your service area.
Avoid Late Enrollment Penalties
NOTE: You must sign up for Medicare during your first Initial Enrollment Period, unless you already have credible coverage in place (Ex: your employer). If you do not have credible coverage and miss your enrollment period when you are first eligible, you may have a late enrollment penalty added to your monthly premium. These penalties are usually charged for as long as you have that type of coverage (for most people, that's a lifetime penalty).
1% PDP late enrollment penalty per month:
- If you do not get a drug plan when you first become eligible for Medicare (unless you have either credible coverage on a Group Plan or you are a Veteran) You will get a 1% Late enrollment penalty for every month you go without a drug plan. This is a lifetime penalty unless you get approved for a LOW INCOME SUBSIDY(LIS), then the penalty goes away.
10% Part B late enrollment penalty:
- If you do not enroll in Part B when you first become eligible, you may incur a 10% late enrollment penalty (unless you have credible coverage on a Group Plan or you qualify for Medicaid.)
- Some people stay on a Group Plan until they’re ready for retirement and can do this without receiving a penalty. When you are ready to retire and go on a Medicare Plan, then you must apply for Part B within 30 days prior and up to 60 days after loss of credible coverage.
Calling the number above will direct you to a licensed sales agent. The information above is a brief summer. Visit medicare.gov for more. The benefit information provided on this website is a brief summary, not a complete description of benefits and you must continue to pay your Medicare Part B premium. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network premium and/or copayments/co-insurance may change on January 1 of each year. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact State Health Insurance Program ( SHIP’s ) 1-877-839-2675, medicare.gov or 1-800-MEDICARE to get information on all your options. Carrier Plans are contracted with Medicare for HMO, PPO and PDP plans and with select State Medicaid programs. Enrollment in many Medicare Plans depends on contract renewal.