What to Do If You Miss a Medicare Enrollment Deadline

Special Enrollment Period. If you’re still working at 65 and have health insurance from your employer, or you have insurance through your spouse’s employer, you don’t have to sign up for Medicare during the 7-month period initial enrollment period. You can delay your enrollment without penalty until you or your spouse stop working at the job providing coverage or you lose health insurance.

The special enrollment period is a window starting the month after the employment ends or the group health plan coverage ends. If you sign up during a special enrollment period, the late enrollment penalty will not apply.

The Special Enrollment Period for signing up for Parts A and B lasts for 8 months after you lose employer coverage, but you only get the first 2 months to enroll in Part C or Part D without penalty. If you enroll after the 2-month mark, you’ll face late enrollment penalties for Part D (regardless of whether you end up with a standalone Part D plan or a Medicare Advantage plan that includes drug coverage).

Missing the Deadline for an Existing Plan Change

The other period available for making changes or joining a Medicare Advantage plan or Part D plan is called the open enrollment period. It runs from Oct. 15 to Dec. 7 each year.

You can take advantage of this period only if you’re already enrolled in Medicare. Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to original Medicare for your health and drug coverage. Medicare Part D plans are Medicare-approved plans to provide prescription drugs. You enroll in a Part D plan in addition to Original Medicare to have drug coverage.

The open enrollment window is when you can:

• Change from Original Medicare to a Medicare Advantage Plan.
• Change from a Medicare Advantage Plan back to Original Medicare.
• Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
• Switch from a Medicare Advantage Plan without drug coverage to a Medicare Advantage Plan with drug coverage, or vice versa.
• Join a Medicare Part D drug plan.
• Switch from one Medicare drug plan to another Medicare drug plan.
• Drop your Medicare drug coverage completely.

Open enrollment is a good time to review your coverage and be sure you have what you need out of your plan. If you miss this window, you may not have to wait until open enrollment the following year. You may be able to:

• Enroll in a 5-star plan. Medicare rates certain plans based on information it collects from member satisfaction surveys, health care providers, and the plans themselves. Then it gives the plans a rating between one and five stars. Five stars is the highest rating.  If one is available in your area, you can usually qualify for a special enrollment period to sign up or switch to that plan between Dec. 8 and Nov. 30 of the next year.
• Qualify for a special enrollment period. There are many different life events that can make you eligible for a plan change, including:
  • You move out of your plan’s service area.
  • Your plan closes, stops serving the area where you live, significantly reduces its provider network, or your plan consistently receives low Medicare star ratings.
  • You move into or out of a qualified institutional facility, like a nursing home.
  • You are enrolled in or lose eligibility for a qualified State Pharmaceutical Assistance Program.
  • You have Medicare financial assistance such as Medicaid, a Medicare Savings Program or Extra Help, or you gain or lose eligibility for any of these.
  • You enroll in or leave the Program of All-Inclusive Care for Elderly (PACE).
  • You gain or lose eligibility for a Special Needs Plan.

Each circumstance has its own guidelines when it comes to joining or switching plans.