Medicare Enrollment Periods

By Lara Anderson

Initial, general, open, special—Medicare enrollment periods can be confusing. Let’s take the guesswork out of these important dates and provide better understanding of their importance. Mark your calendar and plan ahead to help prevent a lapse in health coverage as well as costly penalties.

Initial Enrollment Period (the seven months surrounding your 65^th birthday)

You can enroll in Original Medicare (Parts A and B), Medicare Advantage (Part C) and Part D during your Initial Enrollment Period.

Your Initial Enrollment Period is unique to you and your birthday. It is a seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. Be sure to sign up early in the seven-month period to avoid delays in coverage.

Special Enrollment Period (if you are covered under a large group employee policy, or other special circumstances)

In certain circumstances, you can enroll in Original Medicare (Parts A and B), Medicare Advantage (Part C) and Part D during a Special Enrollment Period.

A Special Enrollment Period is a window of time to apply for Part A and/or Part B without incurring late penalties after the Initial Enrollment Period has expired. If your employer has 20 or more employees, and you are covered under your employer’s group health plan, you may choose to postpone signing up for Part A (if you have to buy it) or Part B when you first become eligible. A Special Enrollment Period allows you to sign up for Part A and/or Part B anytime you’re still covered by the group plan or during the eight-month period that starts the month after employment ends or the coverage ends, whichever happens first. It is important to note that COBRA, retiree health plans, and individual health coverage are not considered coverage based on current employment. Therefore, you are not eligible for a Special Enrollment Period when that coverage ends.

You may also qualify for special enrollment if:

·        You move.

·        You’re eligible for Medicaid.

·        You qualify for the Extra Help program for Medicare prescription drug costs.

·        You’re getting care in an institution, like a skilled nursing facility or long‑term care hospital.

·       See more special circumstances here.

General Enrollment Period (if you are signing up late)

You can enroll in Original Medicare (Parts A and B) during your General Enrollment Period. If you already have Part A and enroll in Part B during this period, you can also enroll in Medicare Advantage (Part C) and Part D plans at this time.

If you didn’t sign up for Part A and/or Part B and Part D during your Initial Enrollment Period, and you don’t qualify for a Special Enrollment Period, you can sign up during the annual General Enrollment Period. These dates are January 1 – March 31. Your coverage won’t start until July 1 of that year, and you may have to pay higher premiums for late enrollment.

Open Enrollment Period (if you want to change plans)

You can enroll in or change Medicare Advantage (Part C) and Part D during the Open Enrollment Period.

This may be the only opportunity to change your Medicare health or prescription drug coverage for the upcoming year. October 15 – December 7 marks the dates for Open Enrollment, with coverage beginning January 1 of the following year. Medicare health plans and prescription drug plans can make changes each year, so it is important to review materials the plan sends you to be sure it meets your anticipated needs for the following year.

Medigap Open Enrollment Period (avoid being denied coverage)

Your Medigap Open Enrollment Period is the best time to buy a Medigap policy. This six-month period begins on the first day of the month in which you are enrolled in Part B (Some states have additional Open Enrollment Periods). After this enrollment period, you are subject to health underwriting and insurers may deny you a Medigap policy, or it may cost more. 


If you delay enrolling in Part B because you have group health coverage based on your (or your spouse’s) current employment, your Medigap Open Enrollment Period won’t begin until you sign up for Part B.

Confused? Hopefully not! Understanding Medicare enrollment periods empowers you to make better, more informed choices about your healthcare. If you would like to learn more,  visit Medicare.gov.

The MOON has risen on Medicare Outpatient Observation

By Lara Anderson

This month marks the beginning of the Medicare Outpatient Observation Notice (MOON). The MOON is a standardized notice used to inform Medicare beneficiaries if they are staying in the hospital under observation status and are not formally admitted as inpatients in the hospital.

Most people assume that if they spend the night in the hospital, they have been admitted as inpatients, but this can create costly misunderstandings with financial consequences for Medicare patients.

The new law is intended to protect Medicare beneficiaries and requires hospitals to explain the MOON to individuals who receive observation services for more than 24 hours without being formally admitted. The patient or patient’s representative must acknowledge receiving the form by confirming with a signature. According to the Centers for Medicare & Medicaid Services, the MOON will inform more than one million Medicare beneficiaries every year of the reasons they are considered outpatients under observation and the potential out-of-pocket costs associated with this status. 

Hospitals are cautious about formally admitting patients because Medicare auditors can financially penalize them for inappropriate admissions. Private companies hired by the government to review Medicare claims often question decisions by doctors to formally admit patients to a hospital.

For individuals with Original Medicare, outpatient status is covered under Part B, which may not offer coverage as complete as Part A hospital benefits. When spending time in the hospital as an outpatient, the 20% deductible patients need to pay under Part B can quickly add up. Medigap policies can help pay the gaps in Part B coverage, but patients often haven’t purchased this additional protection.

Also, Original Medicare (Parts A and B) will not pay for a skilled nursing facility or non-custodial nursing home care after a hospital stay if a patient was not admitted to the hospital for three midnights as an inpatient. Instead, the costs would have to be paid solely by the patient. An incident like this can have enormous financial consequences for someone at such a vulnerable stage in life. See relevant stories in The New York Times and NBC here.

There are protections in place for Medicare beneficiaries, and doctors are often very supportive of ensuring their patients are covered. If a patient disagrees with the observation status, the individual can request that the doctor change the status if the patient meets hospital admission criteria. Another option is to ask his or her own doctor to contact the treating physicians in the hospital to try to get the status changed. 

If the status is not changed, a patient may follow the appeal process outlined in the Medicare Summary Notice received after the hospital stay. I called the Centers for Medicare and Medicaid Services and was informed that patients do have the right to appeal any Medicare coverage determinations. And while this action is not a guarantee a hospital stay will be billed as inpatient care, at least there is a chance when appealed.

This new law is an important step in clarifying Medicare rules for patients in an effort to protect their financial well being and provide the best treatment for their individual needs. I look forward to writing a follow-up article that will review the MOON’s effect on Medicare patients, and the impact it has had on hospitals and the Medicare system.