You Missed Medicare Annual Open Enrollment — Now What?

There are limited ways you can change your Original Medicare elections after annual open enrollment has closed.

Closeup of Medicare enrollment form and pen
(Image credit: Getty Images)

Open enrollment for Medicare runs every year from October 15 through December 7. If you failed to make or change an election by the deadline, you are mostly stuck with that election for the year. There are only limited opportunities for Original Medicare beneficiaries to make coverage changes after that period ends. It will typically depend on circumstances and if you qualify for the special enrollment period.   

You may qualify for the general enrollment period if you missed your initial Medicare enrollment window to enroll in Medicare Parts A and B. If you are enrolling in Medicare for the first time during the general enrollment period your coverage will begin July 1, and you may have to pay a late enrollment penalty. 

What are the different enrollment periods?

Each of the four Medicare enrollment periods — initial, annual, special and general — serves a different purpose, and you may qualify for more than one at different times in your life. 

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The annual open enrollment period  and other opportunities to switch coverage are distinct from the initial enrollment period for people who are newly enrolling in Medicare, which begins three months before a person’s 65th birthday and ends three months after it.

The general enrollment period is the time period every year from January 1 to March 31 when you can enroll in Medicare Part B for the first time if you missed your initial enrollment period and do not qualify for the Part B special enrollment period.

The annual Medicare open enrollment period runs from October 15th to December 7th each year. During this time, people with Medicare can review features of Medicare plans offered in their area and make changes to their Medicare coverage, which go into effect on January 1st of the following year.

You qualify for a special enrollment period if you've had certain life events, including losing health coverage, moving, getting married or if your household income is below a certain amount. You can make changes to your Medicare Advantage and Medicare drug coverage Part D during this period. The types of changes you can make and the timing depend on your life event.  

What is the general enrollment period?

Anyone may use the Medicare general enrollment period to enroll at any time during January, February, or March. Your coverage starts the first day of the month after you sign up. If you signing up for Part B for the first time after not enrolling during your initial enrollment period, your coverage will start on July 1. That’s one of the many reasons why it’s so important to sign up for Medicare when first entitled to do so.

If you have to pay for Part A but don’t sign up for it and/or don’t sign up for Part B (for which you must pay premiums) during your initial enrollment period, and you don’t qualify for a special enrollment period, you can sign up during the general enrollment period from January 1–March 31 each year. 

You may have to pay a higher Part A and/or Part B premium for late enrollment. When you enroll during the general enrollment period, coverage begins the first of the month after you enroll. For example, if you enroll in January, your coverage begins February 1.

What’s the Part A late enrollment penalty?  

If you are eligible only for Part A with a premium, you should know that there is also a late enrollment penalty if you do not voluntarily enroll in Part A within 12 months of your initial enrollment period. 

The penalty is calculated as 10% of the current Part A premium, and although the Part A is not a lifetime penalty like the Part B penalty, you will have to pay the Part A penalty for twice the number of years that you should have enrolled in Part A but didn’t.

What’s the Part B late enrollment penalty?  

If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Part B. Your monthly Part B premium may go up 10% for each full 12 months in the period that you could’ve had Part B, but didn’t sign up. If you’re allowed to sign up for Part B during a Special Enrollment Period, you usually don’t pay a late enrollment penalty. 

Example: Mrs. Green’s initial enrollment period ended December 2020. She waited until March 2023 (during the general enrollment period) to sign up for Part B. Her Part B premium penalty is 20%, and she’ll have to pay this penalty in addition to her standard Part B premium for as long as she has Part B. (Even though Mrs. Green didn’t have Part B for 27 months, this included only 2 full 12-month periods.)

In most cases, you will have to pay that penalty every month for as long as you have Medicare. If you are enrolled in Medicare because of a disability and currently pay premium penalties, once you turn 65 you will no longer have to pay the premium penalty.

Although your Part B premium amount is based on your income, your penalty is calculated based on the base Part B premium. The penalty is then added to your actual premium amount. 

What is special enrollment?  

After your initial enrollment period is over, you may have a chance to sign up for Medicare during a special enrollment period. If you experience a qualifying life event, you may be able to enroll or change a selection and possibly do so without having to pay a late enrollment penalty. The Medicare site offers a Q&A on how to qualify for the special enrollment period to give you a general explanation of qualifying circumstances.

 Qualifying life events for special enrollment:

  •  You change where you live 
  •  You lose your current coverage 
  •  You have a chance to get other coverage 
  •  Your plan changes its contract with Medicare 
  • Exceptional situations for a special enrollment period — You may be eligible if you miss an enrollment period because of certain exceptional circumstances, like being impacted by a natural disaster or an emergency, incarceration, employer or health plan error, losing Medicaid coverage, or other circumstances outside of your control that Medicare determines to be exceptional 

Starting January 1, 2024, if you sign up for Part A or Part B during a special enrollment period because of an exceptional condition, you’ll have 2 months to join a Medicare Advantage Plan (with or without drug coverage) or a Medicare drug plan Part D. Your coverage will start the first day of the month after the Medicare Advantage Plan gets your request to join.

Waiver of the Part B enrollment penalty. If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Part B. Your monthly Part B premium may go up 10% for each full 12 months in the period that you could’ve had Part B, but didn’t sign up. If you’re allowed to sign up for Part B during a special enrollment period, you usually don’t pay a late enrollment penalty. 

Bottom line

You will save yourself stress and money if you enroll on time. Late initial enrollment will result in penalties and some are applied for the entire time you are enrolled in Medicare. Qualifying for the special enrollment period is circumstantial and can’t be used if you simply forgot or changed your mind. Mark these important enrollment dates on your calendar and don’t forget that lack of action can be costly.  

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Personal Finance Writer

Donna joined Kiplinger as a personal finance writer in 2023. She spent more than a decade as the contributing editor of J.K.Lasser's Your Income Tax Guide and edited state specific legal treatises at ALM Media. She has shared her expertise as a guest on Bloomberg, CNN, Fox, NPR, CNBC and many other media outlets around the nation. Donna graduated from Brooklyn Law School and University at Buffalo.