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GEP, IEP, Part A, Part B: The Maze of Medicare Enrollment

Oct 9, 2020


by Danielle Kunkle, Advocate for Mom and Dad

Medicare General Enrollment Period: 1/1 – 3/31.

While some people can qualify early for Medicare due to disability or certain health conditions, most new enrollees in Medicare are people aging in at 65.

This can be a confusing time. Most people have never had to make the health insurance choices that Medicare requires. Although Medicare sends a “Medicare and You Handbook” in the mail so you can learn the rules, many people are unfamiliar with the terminology, and some fail to read the handbook at all. This means that every year there are hundreds of individuals who miss their Initial Enrollment Period (IEP).

When this happens, you can enroll in Medicare at the next General Enrollment Period (GEP), but late penalties may apply. Let’s look at how IEP and GEP work.

The Initial Enrollment Period
Your Initial Enrollment Period begins 3 months before your 65th birthday month and runs for 3 months after your birthday month for a total of 7 months. Most people apply for Original Medicare during this period.

Original Medicare is made up of Part A: Hospital Insurance and Part B: Medical Insurance. Part A covers things like inpatient stays, skilled nursing and hospice. Part B covers outpatient services like doctor’s visits, lab-work, medical supplies, surgeries, and cancer treatments.

If you miss your IEP because you are still working and have creditable employer coverage, you can delay enrollment until you retire. At that point, you’ll be given a short Special Election Period (SEP) to enroll in Medicare as you are coming off your employer group insurance.

However, if you miss your IEP and don’t have any creditable employer coverage, the GEP is your next chance to enroll.

The General Enrollment Period
The Medicare General Enrollment Period runs from January 1st to March 31st every year. Think of this as a “make-up time” for your Medicare enrollment. You can use this period to enroll in Original Medicare Part A and B benefits via Social Security if you missed your IEP.

Your benefits will begin the following July 1st. Once you are enrolled and have your new Medicare card in hand, you can work on applying for a Medigap plan or Medicare Advantage plan to begin on July 1st as well.

It’s important to note that not everyone needs the GEP. As we mentioned before, people who are still working at age 65 can use a Special Election Period (SEP) to enroll in benefits that begin immediately after retirement.

The General Enrollment Period is more commonly used by people who for whatever reason missed their IEP and did not qualify for a Special Election Period or missed their IEP and missed their SEP.

Late Penalties
Missing earlier windows and enrolling during the GEP often results in late penalties for Parts A and/or B.

Most beneficiaries aging into Medicare qualify for zero-premium Medicare Part A. This is because people who have worked at least 10 years in the United States have paid Medicare taxes toward their future Part A benefits. If you yourself haven’t worked, but your spouse has, you can qualify for zero-premium Part A on their work history.

If you don’t qualify for premium-free Part A, you can purchase Part A. However, in this scenario, missing your IEP could make you incur a 10% penalty for delayed enrollment. The penalty is charged for twice the number of years that you could have been enrolled but were not. So, for example, if you enrolled one year late, you would pay the penalty for two years, and so on.

The Part B late enrollment penalty is calculated differently. You will pay a cumulative 10% penalty for every twelve-month period that you were eligible for Part B but did not enroll in it. So, waiting 5 years would result in a 60% penalty that you would pay for as long as you are enrolled in Medicare Part B. For most people, this means forever. Part B penalties are more common since so many people qualify for premium-free Part A.

Where to Enroll During the GEP
You can enroll during the General Enrollment Period in person at the Social Security office, or you can call them by phone at 1-800-772-1213. You can also visit their website at www.ssa.gov/medicare to enroll.

Be aware that applying by phone takes longer since an application must be mailed to you. If you are short on time, opt for enrolling in person or online.

To learn more about the various enrollment periods, you can visit this post.

Danielle Kunkle of Boomer Benefits

With thanks to contributing editor Danielle Kunkle.

Danielle is the co-founder of Boomer Benefits, a licensed insurance agency that helps baby boomers and seniors navigate Medicare.
Disclaimer: The material in this blog is for educational purposes only. It is not intended to replace, nor does it replace, consulting with a physician, lawyer, accountant, financial planner or other qualified professional.

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