It is crucial for Medicare beneficiaries to be aware of and keep track of the various enrollment periods that apply to different Medicare plans. Missing these enrollment periods can result in penalties and missed opportunities for coverage. Therefore, it is important to understand the different enrollment periods that apply to Medicare Advantage Plans, Original Medicare, Medicare supplements, and Part D prescription drug plans. By keeping track of these dates, you can stay up to date with your insurance benefits and avoid any negative consequences.
Available Medicare Advantage Plans
Special Needs Plans
Part C Medicare Advantage Enrollment Periods
There are four enrollment periods that pertain to Medicare Advantage plans, and it’s essential to understand them to ensure that you don’t miss out on coverage. While you may not be eligible for all these enrollment periods, it’s still important to be aware of them.
Once you make sure you are eligible for Medicare Advantage, these are the four Part C enrollment periods during which you can enroll in.
Initial Coverage Election Period (ICEP)
During the time around your 65th birthday, you will have an Initial Enrollment Period, which starts three months before your birthday and ends three months after your birthday. Within this period, you can enroll in Original Medicare – Parts A and B – as well as a Part D prescription drug plan.
For Medicare Advantage plans, there is an Initial Coverage Election Period which is similar. It also starts three months prior to your 65th birthday, but it ends on the last day of the month before you enroll in Medicare Part B or on the last day of your IEP, whichever comes later.
Medicare Part B Delayed Enrollment
There are some situations where individuals choose to delay their enrollment in Medicare, such as if they continue working and receive health coverage through their employer. If this is the case, they may delay enrollment in Medicare Part B without incurring penalties. Instead, they can enroll in Part B once they retire or lose their employer’s coverage.
Once their employer’s coverage ends, they will have an 8-month Special Enrollment Period to enroll in Medicare Part B and a Medicare Advantage plan. To ensure that they do not experience a gap in coverage, it’s important to submit their applications prior to their group health plan’s termination date.
Annual Enrollment Period (AEP)
If you miss your Initial Coverage Election Period, you can enroll in a Medicare Advantage plan during the Annual Enrollment Period that occurs from October 15 to December 7 each year. Any enrollments that occur during this time will take effect on January 1 of the following year.
During the AEP, you have several options. You can switch from one Medicare Advantage plan to another, switch from Original Medicare to Medicare Advantage, or switch from Medicare Advantage back to Original Medicare. You can also make changes to your Part D prescription drug plan if you have one.
It is important to note that any changes you make during the AEP will not take effect until January 1.
Open Enrollment Period (OEP)
If you weren’t able to make changes to your Medicare Advantage plan during the Annual Enrollment Period, there is still an opportunity to do so during the Medicare Advantage Open Enrollment Period. This period runs from January 1 to March 31 every year, and allows you to make a one-time change to your current Medicare Advantage plan.
It’s important to note that the Medicare Advantage Open Enrollment Period is only for those who are already enrolled in a Part C plan. This means that individuals who do not have a Medicare Advantage plan cannot use this period to enroll in one. Additionally, Part C plan holders can also opt to switch back to Original Medicare during this time.
Special Enrollment Periods (SEP)
Let’s look at some of the events that may make an individual eligible for a Special Enrollment Period to enroll in or change their current Medicare Advantage plan.
Special Enrollment Periods for Limited Incomes
If you have a limited income, you may be eligible for several different Special Enrollment Periods.
Medicare Advantage Dual Eligibility SEP
When an individual is eligible for both Medicare and Medicaid, it’s known as “dual eligibility.” If you become dual eligible, you’ll be granted a Special Enrollment Period during which you can enroll, disenroll, or switch Medicare Advantage plans one time per quarter in the first three quarters of your dual eligibility. However, during the fourth quarter, you must use the Annual Enrollment Period to make any changes. If you lose your Medicaid coverage at any time, your SEP will end two months after the loss of coverage.
Medicare Advantage Extra Help & Low-Income Subsidy SEP
Individuals who meet certain income requirements may qualify for the Extra Help program, which helps pay for Medicare prescription drug costs. If you are eligible for Extra Help, you also receive the same Special Enrollment Periods as those who are dual eligible.
This means that you can change your Medicare Advantage plan once per quarter during the first three quarters of the year. Your SEP starts the month you become eligible for Extra Help. If you become ineligible for the program, your SEP will end 2 months later.
Medicare Advantage State Pharmaceutical Assistance Program SEP
The State Pharmaceutical Assistance Program is not available in all states. However, for those states that do participate, Medicare beneficiaries can take advantage of an additional opportunity to change their Part D prescription drug plans once a year. This is in addition to the regular Annual Enrollment Period which runs from October 15 to December 7 every year.
Medicare Advantage Enrollment Assistance
A licensed agent can assist you in selecting the most suitable Medicare policy. They will ask you questions about your lifestyle and health to determine your requirements, and then provide you with options that match those needs. As licensed agents have access to various plans from multiple carriers, they can help you choose the most appropriate plan.
Once you have made your choice, the agent will guide you through the enrollment process and handle all the necessary paperwork. Furthermore, they will follow up with you during critical enrollment periods to ensure that you still have the most optimal plan.
Special Enrollment Periods for Relocation
If you change your residence, your current Medicare Advantage plan may no longer be available in your new area. Typically, Medicare Advantage plans are limited to certain counties and networks, so you may need to enroll in a new plan that is accepted in your new location.
Fortunately, if you move, you will be granted a Special Enrollment Period. This period begins the month before the month you move and lasts for two months after you move. During this time, you can enroll in a new Medicare Advantage plan that is available in your new area.
Weather-Related Emergency or Major Disaster SEP
In the event of a major disaster declared by FEMA, you may be eligible for a Special Enrollment Period, even if you rely on the assistance of a family member residing in the affected area. This SEP begins at the time of the disaster and continues for four months thereafter.
SEPs for Institutionalized Individuals
Medicare beneficiaries living in nursing homes or long-term care facilities may be eligible for a Special Enrollment Period, which can allow them to change their Medicare Advantage plans. Eligible institutions include nursing homes, rehabilitation hospitals, psychiatric hospitals, or long-term care facilities.
In addition, if a Medicare beneficiary is admitted to a skilled nursing facility, they may also be eligible for an SEP to join a Medicare Advantage Special Needs Plan (SNP). The enrollment window starts in the month of admission and ends two months after the individual is discharged.
Special Needs Plans SEP
If you have a chronic condition, such as End-Stage Renal Disease (ESRD), cancer, dementia, or other similar conditions, you may qualify for a Special Enrollment Period in Medicare. However, it’s important to note that the plan you want to enroll in must be available in your area for you to be eligible for this SEP.
Medicare Advantage “Trial Period” & “Trial Right”
All Medicare Advantage plans offer a trial period for individuals to test out the plan and determine if it meets their healthcare needs. During the 12-month trial period that begins when you enroll in a Medicare Advantage plan during your Initial Coverage Election Period, you have the option to disenroll and switch back to Original Medicare.
Additionally, the trial period grants you guaranteed issue rights, meaning that you can enroll in a Medicare supplement plan without being denied coverage due to a pre-existing health condition. These rights last for 63 days after your disenrollment from the Medicare Advantage plan.
The “trial right” is a similar option for individuals who dropped a Medicare supplement plan to enroll in a Medicare Advantage plan. You have 12 months to change your mind and disenroll from the Medicare Advantage plan, and you still have guaranteed issue rights for 63 days to enroll in the same Medicare supplement plan you left to join the Medicare Advantage plan.
However, there are some limitations to the trial right. You can only enroll in the Medicare supplement plan that you left to join the Medicare Advantage plan, unless that plan is no longer offered in your area. If your previous Medicare supplement plan is no longer available, you may choose from Plans A, B, D, G, K, or L.