Medicare Advantage plans, also known as Medicare Part C, are popular choices for seniors who want Additional benefits not offered by Original Medicare. However, choosing the right plan means understanding the enrollment periods, each of which has specific rules and dates. Here’s a breakdown of the Medicare Advantage enrollment periods and who is eligible to use them.
IEP (Initial Enrollment Period)
The Initial Enrollment Period is the first opportunity for beneficiaries to enroll in a Medicare Advantage plan. The IEP is a seven-month period is when beneficiaries first become eligible for Medicare, which generally happens when they turn 65. It includes:
- The three months before their 65th birthday month
- Their birthday month
- The three months that follow their birthday month
During this time, they can enroll in Medicare Parts A and B and a Once both are in place, they may decide to enroll in a Medicare Advantage plan. This period is very important to ensure beneficiaries enroll in coverage that includes Part D (prescription drug) coverage to avoid facing potential penalties. One way to avoid this is to include an MAPD (Medicare Advantage Prescription Drug Plan).
AEP (Annual Enrollment Period)
The Annual Enrollment Period, often called the Open Enrollment Period, runs from October 15 to December 7 each year. During AEP, Medicare plan enrollees can make changes to their Medicare Advantage, prescription drug plans, or Medicare Supplement plans including:
- Switching from Original Medicare to a Medicare Advantage plan
- Changing from one Medicare Advantage plan to another
- Moving from a Medicare Advantage plan back to Original Medicare
- Changing from one Prescription plan to another
This period allows enrollees to review and adjust healthcare coverage based on current health needs and changes to the following year’s Medicare plan options.
MA-OEP (Medicare Advantage Open Enrollment Period)
The Medicare Advantage Open Enrollment Period takes place annually from January 1 to March 31. However, this period is only available to individuals who are already enrolled in a Medicare Advantage plan. This period It allows for limited changes, including:
- Switching to a different Medicare Advantage plan
- Dropping a Medicare Advantage plan and returning to Original Medicare (with the option to add a Part D prescription drug plan)
Please note; during the MA-OEP, enrollees can only make one change and cannot switch from Original Medicare to a Medicare Advantage plan. This period is a great way to change plan choices for those who discover their current Medicare Advantage plan doesn’t meet their coverage needs.
SEPs (Special Enrollment Periods)
Special Enrollment Periods are triggered by specific life events, these events provide an opportunity to make changes outside the regular enrollment periods. Common scenarios that qualify for SEPs include:
- Moving: Enrollees who move to a new address outside their plan’s service area, can switch to a plan in the new service area
- Loss of employer coverage: Those who lose employer-based health coverage qualify for an SEP
- Qualifying for financial assistance: Enrollees who qualify for some financial assistance programs such as Medicaid or Part D Extra Help, may be eligible for an enrollment period
- Moving in or out of a nursing home
- Enrollees whose plan goes out of business
- Weather or disaster related emergencies that cause enrollees to miss a valid enrollment period
These SEPs allow enrollees to adjust their Medicare Advantage coverage to meet their needs. This ensures beneficiaries are not left without the necessary coverage.
Five-Star SEP
All Medicare Advantage and PDP plans are rated on a scale of one to five stars, with five stars representing the highest quality. Beneficiaries can switch to a five-star Medicare Advantage plan if there is one is available in their area. They can do this even when they are outside a normal enrollment period. Enrollees can use this opportunity only once per year, from December 8 through November 30.
This SEP encourages beneficiaries to look for the highest rated plans. This encourages plan providers to provide higher levels of service and benefits.
Click here to download medicare.gov understanding Medicare Advantage Plans booklet
How to make the most of the Medicare Advantage enrollment periods
- Review coverage annually: Health needs and plan costs change year-to-year, so it’s beneficial to reassess coverage options every AEP.
- Consider budget and health needs: Look closely at premiums, out-of-pocket costs, the provider network and medication coverage (if appropriate) when evaluating plans.
- Use SEP opportunities wisely: Major life changes can unlock SEP opportunities. Be sure to act within the timeframe allotted when these events occur.
- Compare plan ratings: Medicare’s plan rating system provide insight into quality and satisfaction levels of available plans. Switching to 5-star plan can give enrollees peace of mind.
Navigating Medicare Advantage enrollment periods may seem overwhelming, but understanding these opportunities can help ensure that enrollees are in the best possible plan for their healthcare needs.
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