Enrollment into Medicare

Now that you understand the basic plan options that are available to you, lets discuss the various enrollment timeframes that might be available to you. Please note that you must enroll in Granite Alliance coverage directly through your employer. 

Am I eligible for Medicare?

Both U.S citizens and legal residents are eligible for Medicare. If you are a legal resident you must have lived in the U.S. for at least 5 years in a row. You must also meet one of the following requirements:

When can I enroll?

There are several different enrollment periods which allow you to enroll into Medicare. You may not need some of these enrollment options if you are enrolled in Granite Alliance, however it is important to understand they are available to you. 

Initial Enrollment Period: This is the “main” enrollment into Medicare and occurs when you’re turning 65. You are eligible to enroll three months before your birthday, during your birthday month, and the three months following your birthday. We recommend signing up once you are eligible, otherwise you can face penalties and pay higher premiums. This is known as the “Late Enrollment Penalty”.

• If you are already enrolled in Social Security you don’t have to do anything additional to enroll into Medicare – you will already be enrolled into Parts A and B. You only need to take action to enroll into additional coverage with either Part C or Part D.
• If you would like to enroll in a Medicare Supplement (Medi-Gap) plan you are eligible to do this during the six months after your 65th birthday month.

General Enrollment Period: If you miss your initial enrollment period, you may also enroll from January 1 to March 31 each year (into Part A and/or Part B).

Annual Enrollment Period: Every year Medicare establishes that you can make changes to your coverage from October 15th to December 7th. Your employer may also set up a separate Annual Enrollment Period for your EGWP coverage over different dates. You can change your Part C or Part D coverage during this time. Prior to your annual enrollment period each year we will send you materials explaining the benefits for the upcoming plan year so you can have a full understanding of your prescription drug coverage. The changes you make during this time will go into effect starting January 1st.

Special Enrollment Period: You may qualify for a special election period where you can enroll, or change coverage, outside of the standard enrollment periods. There are several different qualifications, with the most common being if you move out of your plans service area or if you lose existing insurance coverage (such as with an employer).

We strongly recommend enrolling in prescription drug coverage when you are eligible, or you may be subject to a “Late Enrollment Penalty” being assessed by Medicare. This penalty will be applied if you do not sign up for a plan within 63 days of your Initial Enrollment Period, or if you ever go a timeframe of more than 63 days without credible prescription drug coverage (such as employer coverage). 

Stages of Medicare

During the year you will pay different amounts for your medications, depending on what stage of coverage you are in. Your plan, Granite Alliance, will keep track of your costs throughout the year and move you through the different stages. Each month you will receive an Explanation of Benefits (EOB) that show your costs for the previous month, and indicates what stage you are currently in. The stages “reset” each year and you start over on January 1st. 

There are four different stages established by Medicare. Please note, the dollar amounts listed below may vary slightly for your Granite Alliance benefit. We recommend reviewing your Evidence of Coverage for information specific to your coverage.

• Stage 1: Deductible Stage
  • During this stage you pay 100% of the cost of the medication out-of-pocket
  • Medicare determines the standard deductible amount and it changes each year.
  • For 2023 the plan deductible is $505
    
    
• Stage 2: Initial Coverage Stage
  • Once you have met your deductible then the plan will start covering part of the cost of your medications.
  • You will be responsible for either copays or coinsurance during this time – depending on what tier your medication falls under.
  • The dollar amount you must reach to move into the next stage is pre-determined by Medicare and changes each year.
  • For 2023 – once your total drug costs equal $4,660 you will move into the next stage. This includes both your out-of-pocket costs plus what the plan has paid towards your medications.
    
    
• Stage 3: Coverage Gap Stage 
  • This stage is also known as the “Donut Hole”
  • This stage starts once you have reached $4,660 in drug costs and continues until your out-of-pocket costs reach $7,400.
  • During this stage you pay a 25% coinsurance for your generic medications
  • Each year the gap in coverage is reduced as the Affordable Care Act (ACA) shrinks the “donut hole”.
    
    
• Stage 4: Catastrophic Coverage Stage
  • Once your out-of-pocket costs for the year reach $7,400 you will be placed into this stage
  • During this stage the plan will pay most of your costs and you will only have a small copay or coinsurance.

Help for Medicare Costs

There are resources available to help with the costs that come with Medicare coverage – including premiums, deductibles, copays, and coinsurance.

• Medicaid: Medicaid pays for medical costs of people in certain groups who have very limited resources.
  
  
• Low-Income Subsidy: Medicare offers Extra Help to low income individuals who don’t necessarily qualify for Medicaid. It’s a federal program that helps pay for some of the out of pocket costs of Medicare prescription drug coverage.
  
  
• Medicare Savings Programs: If you do not qualify for the above options, but still have problems paying for health care you pay still be able to benefit from a MSP – a government run program that helps cover Medicare costs.
  
  
• State Pharmaceutical Assistance Programs: SPAPs are offered in some states to help individuals pay for their prescriptions. 

Information about these services can be found by reviewing the following resources:

Additional Resources

Do you have additional questions about your Medicare coverage? There are many resources available to help you.

• Contact Granite Alliance customer service directly at 855-586-2573 (TTY: 711). We are available 24 hours a day, 7 days a week.
  
  
• Review the official “Medicare and You” handbook found at