Medicare Enrollment Periods – Do You Know the Difference?

More than 58 million people in the United States are enrolled in Medicare. But there is still medicare
a significant amount of confusion about how and when to make Medicare coverage choices. For information about the basics of Medicare and its different parts of coverage, read our Quick Guide to Medicare.

There are 4 separate enrollment periods that are important to getting access to Medicare coverage.

  1. The initial enrollment period happens once – when you are first eligible for
    Medicare. And, generally, it lasts 7 months (the 3 months before your 65th birthday, the month of your 65th birthday, and 3 months after your 65th birthday). If you are eligible for Medicare because you have received SSDI benefits for 24 months, your Medicare will begin in your 25th month of receiving SSDI benefits.
  1. And, each year, from October 15 to December 7, you can make changes to your Medicare coverage, which will begin on January 1. This is called the open enrollment period.
  1. If you are over the age of 65, but are still working, you have a special enrollment period of 8 months after your employer-sponsor group health plan or your retirement plan coverage ends.
  1. And finally, if you do not sign up for Medicare when you are first eligible during your initial enrollment period or your special enrollment period, then you can still enroll in Medicare, but you have to wait until the general enrollment period. The general enrollment period occurs each year from January 1 to March 31. Individuals can sign up for Part A and B during this time frame. Once enrolled in Part A and Part B, between April 1 and June 30, individuals can add a Part D plan or move to a Part C plan. However, even if you sign up for coverage on the first day of the general enrollment period, you still have to wait until July 1, for your coverage to begin.


And, because you didn’t sign up for Medicare when you were first eligible, you will likely have to pay a late enrollment penalty:

  • Part A: you must pay a 10% penalty for twice the number of years you were eligible, but didn’t sign up.
  • Part B: you must pay a 10% penalty for each full 12-month period you were eligible, but didn’t sign up. You must pay this penalty on your Part B premium for life!
  • Part D: you must pay a penalty of 1% of the national base monthly premium, times the number of full months you were eligible, but didn’t sign up. You must pay this penalty on your Part D premium for life!

Part B Penalty Example:

David’s initial enrollment period ended August 31, 2015, but waited to sign up for Part B until the general enrollment period in February 2018. David waited 30 months to sign up, but this only included 2 full 12-month periods. (2 full 12-month periods x 10% = 20% penalty). David will pay a 20% penalty, in addition to his monthly Part B premium, for life!

Waiting to enroll in Medicare coverage can cost you a lot over time, so it is important to understand your options. For more information about Medicare enrollment and penalties, visit

Graham-Cassidy Fails, But Health Care Protections Still at Risk

Last week a new version of an ACA ‘Repeal and Replace’ bill was unveiled in the U.S. Senate. This legislation has been dubbed “Graham-Cassidy” after the two main authors of the bill, Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.). In order for the bill to be passed under a process called Budget Reconciliation, the vote must occur before September 30, 2017.  The reason that Republicans are trying to advance the legislation through the reconciliation process is that debate time is limited, it cannot be blocked by a filibuster, and therefore, the legislation only needs 50 votes to pass. There are currently 52 Republican Senators. The Congressional Budget Office has only released a preliminary review of the potential impact of the bill, and found that millions of people would lose health insurance coverage under this bill.

Unfortunately, like previous proposals this bill would also take away consumer protections and ultimately leave people with pre-existing conditions unprotected. (read more about earlier proposals).

Triage Cancer is proud to stand with patient advocacy groups from across the country in opposition to the Graham-Cassidy bill.

Graham-Cassidy Fails

Also, in case you missed it, Triage Cancer’s CEO, Joanna Morales wrote an open letter to Alaska Senator Lisa Murkowski explaining why we at Triage Cancer, a non-partisan organization, are so concerned about any effort to limit access to health care coverage. Her letter was featured in the National Coalition for Cancer Survivorship’s blog.

In light of the fact that Senators John McCain (R-AZ), Rand Paul (R-KY) and Susan Collins (R-ME) have publicly stated that they would not support the Graham-Cassidy bill, Senate leadership has decided not to bring the bill for a vote this week. Today, President Trump announced that he now has the votes to pass the bill and will bring it up again during the next reconciliation period. That time period is unknown because the Senate would have to pass a new budget resolution that established a new reconciliation period.

While the ACA is still law of the land, there are still some challenges with respect to access to health care:

  1. Insurers still face uncertainty over the status of the subsidy payments
  2. The 2018 open enrollment period has been significantly cut to a total of six weeks (November 1 – December 15, 2017). But, note that some states have chosen longer enrollment periods:
  • California – November 1 to January 31
  • Colorado – November 1 to January 12
  • D.C. – November 1 to January 31
  • Massachusetts – November 1 to January 31
  • Minnesota – November 1 to January 14
  • Washington – November 1 to January 1
  1. The Administration has cut funding for marketing and in-person assistors to help people enroll in coverage by 90%
  2. The Administration is impeding states’ ability to stabilize their health insurance marketplaces

Stay tuned for updates and follow us on Facebook and Twitter for late breaking news.

Triage Health Insurance: New Options in 6 days!

Health Insurance Marketplace stacked logo

In just a few short days, there will be a new way to purchase health insurance in this country thanks to the Patient Protection and Affordable Care Act (ACA), through State Health Insurance Marketplaces.  These “Marketplaces,” sometimes referred to as “Exchanges,” will vary state by state but in every state there will be four main categories of insurance plans available to individuals, families, and small businesses (under 50 full time employee equivalents).  These four levels of insurance plans are named Platinum, Gold, Silver, and Bronze.  The main difference between these categories lies in how much the insurance company will pay, and how much the individual will pay for their medical expenses (otherwise known as a “cost-share”).

With the Platinum plan, you would pay 10% of your medical costs and the insurance company would pay for 90%.  With the Gold plan, you would pay 20% of your medical costs and the plan would pay 80%.  With the Silver plan, you would pay 30% of your medical costs and the plan would pay 70%, and finally, in the Bronze plan, you would be responsible for 40% of your medical costs and the plan would pay the remaining 60%.  In most states, you will have several different plans offered by from different insurance companies within each of these categories to choose from.

There is also a fifth category of plan called the catastrophic plan. These very limited plans will only be available to individuals under 30 years old and those who qualify for the financial hardship exemption from the individual mandate.

One of the benefits to purchasing a plan in the Marketplace, is that for all levels of plans there is a maximum annual deductible of $2,000 for an individual and $4,000 for a family plan.  It is likely that the Platinum plans will have lower deductibles, whereas Bronze plans will have higher deductibles.

Additionally, the ACA puts a limit on how much consumers are required to pay out-of-pocket for medical expenses (other than their premiums) when they purchase health insurance plans in the Marketplaces.  In 2014, the cap on these expenses is $6,350 and for a family the cap is $12,700.  After these maximums are reached, insurance will cover 100% of the medical expenses. These caps will help keep out-of-pocket costs to a certain amount and stem the tide of people having to declare bankruptcy because of their medical bills.

People who buy plans in the Marketplaces may also qualify for financial assistance to help them pay for their health insurance.  This financial assistance is based on income and family size.  For example, individuals who have incomes between 138% of the Federal Poverty Level (FPL) and 400% of the FPL premium (in 2013, $15,856 and $45,960) may be eligible for a premium tax credit.  This tax credit would reduce the amount you pay monthly for your premium.  In addition, individuals who have incomes between 138% of the Federal Poverty Level (FPL) and 250% FPL (in 2013, $15,856 and $28,725) will also be eligible for cost-sharing subsidies.  These subsidies will reduce the cost of health care expenses an individual or family has to pay when they receive medical care (e.g., lowering the co-payment you make when you visit the doctor’s office).  When you apply for a health insurance plan in the Marketplace, you will be asked to include some of your financial information – this is so the Marketplace can determine if you are eligible for any of these financial assistance options.

The Marketplaces will be open for business starting October 1, 2013, however, the earliest coverage will begin is January 1, 2014.  In order to have coverage start on January 1, 2014, you must purchase a plan by December 15, 2013.  For this first year, open enrollment in the Marketplaces will extend from October 1, 2013, through March 31, 2014.

For more information about what is happening in your state or to begin completing an application for health insurance, visit