Medicare – Components, Enrollment Periods and More!

When planning for retirement, Medicare is an important piece with considerations such as protecting your retirement income, managing future costs, and making sure your health coverage aligns with your financial goals.

If you aren’t yet enrolled in Medicare, this article will review the enrollment periods as well as the coverage options to help you be prepared for signup once eligible. If you’re already enrolled, Medicare Open Enrollment season is from October 15 – December 7 so now is a good time to review your current coverage. 

Who is Eligible for Medicare?

You are generally eligible for Medicare if:

• You are age 65 or older
• You are younger than 65 but have a qualifying disability
• You have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)

What are the Different Parts of Medicare?

Part A: Hospital Insurance

• Covers inpatient hospital care, skilled nursing facility care, hospice, and some home health care.
• Most people don’t pay a premium for Part A if they’ve paid Medicare taxes for at least 10 years.

Part B: Medical Insurance

• Covers doctor visits, outpatient care, preventive services, and durable medical equipment.
• You pay a monthly premium for Part B (cost varies by income).

Part C: Medicare Advantage

• Offered by private insurance companies approved by Medicare.
• Combines Part A and Part B and often includes Part D (prescription drugs).
• May offer extra benefits like vision, dental, and hearing coverage.

Part D: Prescription Drug Coverage

• Helps cover the cost of prescription medications.
• Available as a standalone plan (with Medicare Parts A & B) or bundled in many Medicare Advantage plans.

What is Medigap (Medicare Supplemental Insurance)?

• Medigap policies are sold by private insurers to help cover out-of-pocket costs such as copayments, coinsurance, and deductibles.
• You must be enrolled in Medicare Parts A & B to buy a Medigap policy.
• Medigap does not include prescription drug coverage (you would need a separate Part D plan).

What are the Medicare Enrollment Periods?

Initial Enrollment Period (IEP)

• Your IEP is a seven-month window: three months before you turn 65, your birthday month, and three months after.
• During this time, you can sign up for Part A and/or Part B.
• If you are covered by your own or spousal employer plan at age 65, you can delay Medicare enrollment without a penalty. See Special Enrollment Period below.

General Enrollment Period (GEP)

• Runs January 1 – March 31 each year.
• If you missed your Initial Enrollment Period and didn’t qualify for Special Enrollment, you can sign up during the General Enrollment Period. Coverage starts July 1.
• Late enrollment penalties may apply.

Medicare Open Enrollment

• Runs October 15 – December 7 each year
• Any changes you make will take effect on January 1 of the following year.
• During this period you can:
  • Switch from Original Medicare (Part A & B) to a Medicare Advantage (Part C) plan
  • Switch from Medicare Advantage (Part C) back to Original Medicare (Part A & B)
  • Join, drop, or change a Medicare Part D prescription drug plan
  • Review your current coverage and make changes for the upcoming year

Special Enrollment Period (SEP)

• If you’re still working past 65 and covered under employer health insurance, you may delay enrolling in Part B without penalty.
• You’ll have an eight-month Special Enrollment Period (SEP) to sign up, starting the month after your employment or coverage ends.
• Other life events (such as moving or losing coverage) may also qualify you for an SEP.

Why is Medicare Open Enrollment Important?

Health needs, plan costs, and coverage options can change from year to year. Reviewing your Medicare plan during Open Enrollment ensures you:

• Aren’t paying more than necessary
• Have coverage that matches your current health needs
• Can take advantage of new plan options or benefits

Medicare decisions are more than just health care choices — they’re financial decisions that can impact your retirement income, taxes, and long-term security. For a quick overview of Medicare basics, explore our Medicare Infographic. As you review your options during Open Enrollment, consider working with your financial planner to make sure your coverage aligns with your broader financial plan and gives you confidence for the years ahead.