Blog

Medicare Advantage Enrollment: When and How to Join a Plan

Medicare Advantage (also known as Medicare Part C) is a popular alternative to Original Medicare, offering coverage through private insurance companies approved by CMS. These plans often include additional benefits like dental, vision, hearing, and prescription drugs. For anyone considering Medicare Advantage enrollment, it’s essential to understand the different enrollment periods and special situations that may qualify you for coverage; including the Medicare Advantage Trial Right.

Enroll in Medicare Advantage

There are a few windows when beneficiaries can sign up for a Medicare Advantage plan:

1. Initial Enrollment Period (IEP)

When an individual first becomes eligible for Medicare, they have a 7-month window to enroll:

• Begins 3 months before the month they turn 65
• Includes their birthday month
• Ends 3 months after their birthday month

When an individual qualifies for Medicare due to a disability, their IEP will begin three months before the 25th month of disability benefits and end three months after that month.

2. Annual Enrollment Period (AEP): October 15 – December 7

During AEP, anyone with Medicare can:

• Join a Medicare Advantage Plan
• Switch from one plan to another
• Drop their Medicare Advantage Plan and return to Original Medicare

Changes made during AEP take effect on January 1 of the following year.

Watch a YouTube Video on Medicare AEP Marketing Rules

3. Medicare Advantage Open Enrollment Period (MA OEP): January 1 – March 31

This period is for individuals who are already enrolled in a Medicare Advantage Plan. During MA OEP, you can:

• Switch to a different Medicare Advantage Plan
• Drop your plan and return to Original Medicare (with or without a Part D plan)

Click here to learn more about MA OEP

Special Enrollment Periods (SEPs)

Life happens and Medicare understands that. That’s why certain life events qualify beneficiaries for a Special Enrollment Period (SEP), allowing you to make changes outside the usual windows.

You may qualify for an SEP if:

• You move to a new address that isn’t in your plan’s service area
• You lose other coverage, such as employer, union, or Medicaid coverage
• Your plan is no longer available
• You get coverage through Medicaid or a State Pharmaceutical Assistance Program (SPAP)
• You’re diagnosed with certain conditions, allowing you to enroll in a Special Needs Plan (SNP)
• You’re released from incarceration
• You live in, move into, or move out of a nursing home or other long-term care facility

Each SEP has its own rules and timeframe, typically lasting 2 to 3 months around the qualifying event.

Medicare Advantage Trial Right

The Medicare Advantage Trial Right is a special protection for those trying a Medicare Advantage Plan for the first time. Here’s how it works:

Who Qualifies:

You qualify if:

1. You joined a Medicare Advantage Plan when you were first eligible for Medicare at age 65, and
2. Within the first 12 months, you decide you want to go back to Original Medicare
3. You dropped a Medigap (Medicare Supplement) policy to try a Medicare Advantage Plan for the first time, and within 12 months you want to switch back.

What You Can Do:

• Return to Original Medicare
• Enroll in a Part D prescription drug plan if needed
• In most cases, buy the same Medigap policy you had before, even if the insurance company normally wouldn’t sell it to you

Note: The Trial Right is only available once in your lifetime. It’s designed to offer peace of mind for those unsure whether a Medicare Advantage Plan is the best choice.

Are you a licensed Medicare agent; join our team at Crowe – click here for online contract

How to Enroll

Enroll in a Medicare Advantage Plan:

• Online at Medicare.gov
• Directly with a carrier – there are a couple ways to do this including: online or over the phone
• Through a licensed Medicare agent or broker, who can help compare options and guide you through the process. This is our favorite option and the service is free!

Be sure to have:

• Your Medicare number
• The effective dates for Parts A and B

Medicare Advantage Plans offer convenience, extra benefits, and sometimes lower costs, but it’s important to choose the plan that fits health needs and lifestyle. Knowing enrollment rights and timing windows helps avoid penalties, gaps in coverage, or being locked out of better options.

Agents; click here for updated events and information.

Medicare Advantage Trial Right Rules: What You Need to Know

For beneficiaries who understand the Medicare Advantage Trial Right Rules, this SEP provides a second chance to find a plan to best fit their needs. Switching health plans is stressful; especially if you’re not sure whether your new Medicare Advantage (MA) plan will meet your needs. Fortunately, Medicare offers a special protection called the Trial Right. This provides MA plan enrollees a one-time opportunity to go back to Original Medicare and Medigap as well as a PDP plan if their MA plan isn’t a good fit.

In this blog, we explain Trial Rights, who qualifies, and how to use it so both Medicare agents and beneficiaries are well informed of all the options.

What is a Medicare Advantage Trial Right

The Trial Right is a federally protected enrollment right under Medicare. It allows certain individuals who try a Medicare Advantage plan for the first time to switch back to Original Medicare. When they switch to Original Medicare, in most cases, purchase a Medigap (Supplement) plan without medical underwriting.

This protection ensures that people aren’t stuck in a plan that doesn’t meet their healthcare needs, especially if they’re new to Medicare or trying out Medicare Advantage for the first time.

When Do Trial Rights Apply

There are the two situations when someone is entitled to a Medicare Advantage Trial Right:

Trial Right #1: First Time Joining a Medicare Advantage Plan

If a beneficiary joined a Medicare Advantage plan for the first time ever (at age 65 or older) and has been enrolled in that plan for less than 12 months, they can:

• Disenroll from the MA plan
• Return to Original Medicare (Part A & B)
• Purchase a Medigap plan (Medicare Supplement) with guaranteed issue rights; no medical underwriting
• Purchase a PDP plan to cover prescription drugs

Example:
Mary turned 65 and enrolled in a Medicare Advantage PPO instead of Original Medicare and Medigap. After 6 months, she realizes she prefers the flexibility of seeing any doctor and wants to switch. She has a trial right to go back to Original Medicare and buy a Medigap plan and PDP plan, even if she now has health issues.

Trial Right #2: Dropping a Medigap Plan to Try an MA Plan

If a beneficiary had a Medigap plan but switched to a Medicare Advantage plan for the first time, and it’s been less than 12 months, they can:

• Drop the MA plan
• Go back to Original Medicare
• Re-enroll in the same Medigap plan (if it’s still available) or buy a similar one from another company; with guaranteed issue rights

Example:
Joe had Plan G for two years, then switched to a Medicare Advantage HMO in January. By September, he misses his Medigap freedom. He can use his trial right to return to Original Medicare and get a Medigap plan without underwriting.

How to Use a Trial Right

Beneficiaries can typically switch during a valid election period such as:

• Annual Election Period (AEP) – Oct 15 to Dec 7
• Medicare Advantage Open Enrollment Period (MA OEP) – Jan 1 to Mar 31
• Special Enrollment Period (SEP) triggered by the trial right

Watch a YouTube video on Medicare OEP, SEPs and LEPs

Once the carrier process the disenrollment:

• Original Medicare (Parts A & B) coverage resumes
• The beneficiary can apply for a Medigap plan with guaranteed issue rights
• Beneficiaries must select Part D (drug coverage) separately, unless already built into the Medigap package

Agents, if you are ready to join the team at Crowe; click here for online contracting

Benefits of the Trial Right

• No medical underwriting for Medigap; even if you have pre-existing conditions
• A second chance to choose Original Medicare + Medigap coverage
• Ensures flexibility and peace of mind for new enrollees or first-time MA users

Important Rules and Limitations

• MA Plan enrollees must leave their current MA plan before the 12 months ends.
• It’s a one-time only right; once the beneficiary uses it, they cannot use it again.
• Your Medigap plan must still be available from the insurer, or you can choose another one. You must also apply for a Medigap plan as early as 60 days before the date your MA plan will end or no later than 63 day after your coverage ends.
• The beneficiary must consider prescription drug coverage:
  • If you return to Original Medicare, you’ll likely need to enroll in a standalone Part D plan.
• Not all agents are familiar with this rule; make sure your client knows their rights!

How Agents Can Use This in Sales

• Educate new-to-Medicare clients: They can try MA with confidence knowing they have a Trial Right.
• Use it as a consultative tool; not to push one product over another but to help the client choose what best fits their health and financial needs.
• Document Trial Right eligibility in your CRM or client file; especially if they switch from Medigap to MA.

Stay up-to-date on agent events and information – click here.

Medicare’s Trial Right protections give beneficiaries peace of mind when trying something new. As an agent, it’s your responsibility to educate clients on their rights and help them make informed decisions if their first choice doesn’t work out.

Helping a client use their Trial Right can be an important opportunity to show your value as a Medicare resource.

The 2026 Final Rule, released by CMS in April 2025, brings meaningful changes to Medicare Advantage (MA), Part D, and Special Needs Plans (SNPs). These updates aim to improve transparency, enhance care for high-needs populations, and modernize how payments are made to insurers. As a Medicare agent, staying informed helps you guide clients accurately and position your sales strategy for success

Key Changes Agents Should Know

1. Medicare Advantage Plan Payment Increase

CMS approved a 5.06% increase in average plan payments for 2026. This is expected to give insurers more room to offer richer benefits, reduce premiums, or expand supplemental services. Once the carriers release the 2026 plan designs, we will see if they have added enhancements.

2. Prescription Drug Reforms (Part D)

• Insulin Copays Capped: $35/month or 25% of the negotiated price; whichever is less.
• Vaccines: ACIP-recommended vaccines remain free (no deductible or cost-sharing).
• Prescription Payment Plan: Beneficiaries can spread out drug cost payments over the year.
  • New guidelines clarify enrollment, pharmacy coordination, and billing practices.

Agents; educate clients on enrolling in the payment plan; especially those with high drug costs.

3. Risk Adjustment Overhaul – Accuracy Takes Priority

CMS is completing its transition to the 2024 CMS-HCC risk adjustment model, which will be 100% in effect for 2026 MA plan payments. This model better reflects today’s healthcare needs by using updated diagnosis groupings and more current data.

Why It Matters:

• Plans with more chronically ill members (diabetes, COPD, heart failure) get higher CMS payments.
• Plans with healthier enrollees receive less.

Impact on Agents:

• Some plans may adjust benefits or premiums in response to expected payment changes.
• You may see enhanced offerings from plans that excel in care coordination and documentation.
• SNPs and plans serving dual-eligibles may experience meaningful shifts; pay attention to service area changes or new plan launches.

Bottom Line: This makes the system more fair, but you should monitor plan benefit designs closely in your key markets

Agents if you are ready to join the Crowe team, click here for online contracting.

4. D-SNP Simplification (Effective 2027)

CMS is improving integration for dual-eligible members with:

• One Medicare-Medicaid ID card
• Unified Health Risk Assessment (HRA)
• Faster HRA and care plan timelines

These changes make D-SNPs easier to explain and more attractive to clients. Prepare now by understanding how your D-SNP partners are adapting.

5. Inpatient Coverage Notification Rules

Plans must now notify both providers and beneficiaries at the same time about inpatient coverage decisions—helping ensure clear, real-time communication during hospital stays.

Watch a quick YouTube video on the Medicare 2026 Final Rule Proposal

6. What Didn’t Make the Cut

CMS did not finalize several proposed changes:

• No Part D coverage for anti-obesity drugs
• No new broker commission rules
• No restrictions on agent marketing or AI guardrails (yet)

Important: CMS has hinted that more agent-related changes may be proposed in the near future. Stay vigilant!

Updated 2026 Agent Commission Rates

CMS has announced significant increases in maximum allowable broker commissions for Medicare Advantage and Part D for Contract Year 2026 representing the largest MA commission bump in years

Click here for all the details

Action Steps for Agents

1. Study how your top plans may adjust benefits due to new risk adjustment payments.
2. Help clients understand the Prescription Payment Plan and insulin savings.
3. Stay tuned for more changes, especially around marketing, commissions, and AI regulations.
4. Start preparing D-SNP marketing materials ahead of the 2027 simplification rollout.

Find out about all the latest events and information for agents

Summary: CMS Final Rule 2026

Medicare OEP Open Enrollment Period

The Medicare Open Enrollment Period (OEP) runs annually from January 1 to March 31. It is specifically for individuals already enrolled in a Medicare Advantage (Part C) plan as of January 1.

This period does not apply to those with Original Medicare (Part A and B) only; it’s strictly for Medicare Advantage plan members who may want to make a one-time change.

What Changes Can You Make During OEP

Those enrolled in a Medicare Advantage plan, can make one change during the OEP. The options include:

• Switching to a different Medicare Advantage plan, with or without drug coverage
• Dropping your Medicare Advantage plan and returning to Original Medicare, with the option to add a Part D prescription drug plan

Changes You Cannot Make:

• Switch from Original Medicare to a Medicare Advantage plan
• Enroll in Part D drug coverage if you’re on Original Medicare and missed your IEP or AEP
• Make multiple changes; OEP only allows one switch

Watch a video on Medicare enrollment periods

Why Use the OEP

Here are a few common reasons beneficiaries take advantage of the Medicare OEP:

• Their current Medicare Advantage plan doesn’t cover a needed medication or provider
• They discovered higher costs or restrictions after using the plan in January
• They had a change in health and want a different plan with better specialist coverage
• They were unaware of better plan options during the Annual Enrollment Period (AEP), which runs from October 15 to December 7

How Is OEP Different from AEP

Important Considerations

• If you switch to Original Medicare during OEP, you may not be guaranteed Medigap (Medicare Supplement) coverage; unless you’re in a trial right or qualify for a Special Enrollment Period.
• Any changes made during the OEP become effective the first day of the month after the change is made (e.g., a change in February takes effect March 1).
• It’s important to review coverage early in the year to determine if your current plan still meets your needs.

Work with a Licensed Agent

The Medicare OEP is a valuable but limited opportunity to make corrections or improvements to your coverage. If you’re unsure whether your plan fits your health needs or budget, speak with a licensed Medicare agent. They can help you compare options, check provider networks and drug formularies, and make confident decisions about your healthcare.

Agents; if you are ready to join a winning team, click here for Crowe contracting!

Stay updated on agent information and events, click here

Medicare Commissions 2026 for Medicare Advantage & PDP Plans

As the Medicare industry evolves, so do the rules and compensation guidelines set by CMS. For 2026, CMS has released updated Medicare commissions 2026 for Medicare Advantage (MA) and Prescription Drug Plans (PDPs). Every Medicare agent needs to be aware of the new amounts and the policy changes behind them.

Below is a breakdown of what’s changing and how it impacts your commissions heading into the 2026 Annual Enrollment Period (AEP).

2026 Maximum Commission Rates

Each year CMS sets a fair market value (FMV) for agent compensation. These rates represent the maximum allowable compensation carriers can pay agents for enrollments and renewals of Medicare Advantage and Part D plans.

Medicare Advantage (MA) Initial Compensation:

• National base: $694 (up from $626 in 2025) this is the rate for any state not listed below.
• Renewal compensation: $347 per renewal (up from $313)

Connecticut, Pennsylvania, District of Columbia:

• Initial compensation: $781
• Renewal: $391

California and New Jersey:

• Initial compensation: $864
• Renewal: $432

Puerto Rico and U.S. Virgin Islands:

• Initial compensation: $474
• Renewal: $237

Prescription Drug Plan (PDP) Compensation:

• Initial enrollment: $114 (up from $100 in 2025)
• Renewal: $57

These are maximums. Carriers are not required to pay this amount but may do so depending on their policies and agent contracts.

Join the team at Crowe; click here for online contracting!

Why CMS Raised MA Commissions

The substantial increase in MA commissions; particularly the national base, is part of CMS’s broader effort to:

• Align compensation with the increased workload and compliance obligations placed on agents
• Encourage transparency and fair practices in marketing and enrollments
• Reflect rising healthcare costs and inflationary trends

Watch a video on Medicare commission payment details

Compliance Remains Critical

With higher compensation comes increased scrutiny. CMS continues to crack down on misleading marketing, aggressive sales tactics, and non-compliant enrollments.

Key compliance reminders for 2026:

• Scope of Appointment (SOA) forms must be completed 48 hours before most marketing appointments
• Call recordings of all Medicare-related sales calls are still required
• Third-party marketing organizations (TPMOs) must clearly disclose affiliations and limitations of plan representation

As commissions rise, expect CMS and carriers to take a firmer stance on agent conduct, training, and documentation.

Stay updated on agent events and information

Agent Tips to Maximize Success

1. Stay current on training: Complete your AHIP and carrier certifications early.
2. Educate your clients thoroughly: Higher commissions can mean more scrutiny, make sure clients understand their options.
3. Build long-term relationships: Renewal commissions continue to rise, rewarding agents who support their clients beyond initial enrollment.
4. Diversify your offerings: Include PDPs and Medigap plans or ancillary benefits where appropriate; some clients may benefit more from a supplement and drug plan.
5. Leverage compliant marketing: Use CMS-approved marketing materials and ensure your lead generation efforts are transparent and ethical.

The 2026 updated commission amounts are great news for agents who work hard to serve the Medicare community. Higher commissions and a continued emphasis on compliance and ethics mean; it is a good time to refine your strategy, refresh your knowledge, and recommit to providing excellent service.

Understanding the Different Types of Medicare Advantage Plans

Medicare Advantage (Part C) plans offer an all-in-one alternative to Original Medicare, often including additional benefits like dental, vision, hearing, and even prescription drug coverage. These plans are offered by private insurance companies approved by Medicare. Whether you’re a Medicare beneficiary or an agent helping clients make informed decisions, understanding the different types of Medicare Advantage plans is essential.

There are many types of Medicare advantage plans to consider when choosing coverage that best fits your needs. Here’s a breakdown of the main types of MA plans available:

HMO (Health Maintenance Organization) Plans

Key Features:

• Requires members to use a network of doctors and hospitals.
• Members must choose a Primary Care Physician (PCP).
• Referrals are usually needed to see a specialist.
• Most HMO plans include prescription drug coverage (Part D).

Best for: People who are comfortable with a coordinated care approach and staying within a specific provider network to keep costs low.

PPO (Preferred Provider Organization) Plans

Key Features:

• Offers more flexibility in choosing healthcare providers.
• You can see out-of-network providers, usually at a higher cost.
• No need to choose a PCP or get referrals for specialists.
• Often includes Part D prescription drug coverage.

Best for: Those who want the freedom to see any doctor or specialist without a referral and are willing to possibly pay a bit more for that flexibility.

SNPs (Special Needs Plans)

Key Features:

• Tailored for individuals with specific diseases, health conditions, or financial needs.
• Types include:
  • C-SNPs: For people with chronic conditions (e.g., diabetes, heart disease).
  • D-SNPs: For dual-eligible individuals (Medicare and Medicaid).
  • I-SNPs: For people in institutional care (like nursing homes).
• Always includes prescription drug coverage.
• Offers care coordination and case management.

Best for: Individuals with specific medical, financial, or living circumstances who need a personalized care approach.

PFFS (Private Fee-for-Service) Plans

Key Features:

• Allows you to see any Medicare-approved provider who agrees to the plan’s payment terms.
• No need to choose a PCP or get referrals.
• Some PFFS plans include drug coverage; others don’t.

Best for: People who want flexibility and are comfortable checking whether their provider will accept the plan’s terms.

POS (Point of Service) Plans

Key Features:

• A hybrid of HMO and PPO.
• You can go out-of-network for certain services, often with higher copays or coinsurance.
• Requires a PCP and referrals for specialists (when in-network).
• May include drug coverage.

Best for: Beneficiaries who like the care coordination of an HMO but want some out-of-network flexibility.

If you are ready to join Crowe team; click here for online contracting

MSA (Medical Savings Account) Plans

Key Features:

• Combines a high-deductible health plan with a savings account that Medicare deposits money into.
• Funds can be used to pay for qualified medical expenses.
• Does not include Part D coverage; must be purchased separately.

Best for: Those who prefer managing their own health savings and expenses and are comfortable with high deductibles.

Watch a quick YouTube video on why agents should include ancillary products with MA sales

Choosing the Right Medicare Advantage Plan

When evaluating which type of plan is best for you or your client, consider:

• Provider access: Do you want to stay in-network or have more flexibility?
• Prescription needs: Is Part D coverage important?
• Cost preferences: Would you rather pay higher premiums for lower out-of-pocket costs or vice versa?
• Health conditions: Are there chronic conditions or Medicaid eligibility that might qualify for an SNP?

Each Medicare Advantage plan type offers different benefits, restrictions, and costs. Understanding these differences is the key to selecting the most suitable coverage.

Agents, stay up-to-date on the our latest webinars an agent events.

Medicare TrOOP Costs: What Beneficiaries and Agents Need to Know

When it comes to Medicare Part D prescription drug coverage, there’s one term that often causes confusion but plays a big role in how much a beneficiary pays: TrOOP. In this post, we explain Medicare Part D TrOOP Costs and their effect on the client’s costs for prescription medication.

Whether you’re a Medicare beneficiary trying to understand your coverage or a Medicare agent helping clients navigate their plans, understanding TrOOP is essential.

What Is TrOOP

TrOOP (True Out-of-Pocket) costs refers to the amount a Medicare beneficiary pays for covered prescription drugs before reaching catastrophic coverage under a Part D plan. These costs include deductibles, copays, and coinsurance for medications covered by the plan.

TrOOP is used to track a beneficiary’s spending so that Medicare knows when to move them through the different Part D coverage phases.

What Counts Toward Medicare Part D TrOOP Costs

Not everything a beneficiary pays will count toward TrOOP. Only qualified out-of-pocket spending applies. Here’s what counts:

• Annual deductible (if applicable)
• Copays and coinsurance for formulary drugs (covered by your plan)
• Payments made by:
  • The beneficiary
  • A family member
  • State Pharmaceutical Assistance Programs (SPAPs) or the Federal Government’s Extra Help Program.

What Doesn’t Count Toward Medicare Part D TrOOP Costs

Some expenses don’t count toward your TrOOP total, including:

• Monthly premiums for the Part D plan
• Drugs not covered by the plan (not on the plan’s formulary). Although, if the drug is approved via exception or appeal, it does count towards the TrOOP
• Over-the-counter (OTC) drugs
• Drugs purchased outside of the U.S.
• Payments by other insurance (e.g., employer group plans or TRICARE)

TrOOP and the 3 Phases of Part D

To understand how TrOOP affects drug costs, it helps to review the stages of Medicare Part D:

1. Deductible Phase
   • The beneficiary pays 100% of their drug costs until they meet the deductible.
2. Initial Coverage Phase
   • Beneficiaries pay about 25% of the cost for formulary drugs in the form of copays or coinsurance until they reach $2,000 out of pocket (the initial coverage limit).
3. Catastrophic Coverage Phase
   • After TrOOP reaches a set amount ($2,000 in 2025, increasing in 2026), the beneficiary pays $0 for covered drugs once they have hit the TrOOP under the new 2025 rules.

Agents are you looking to join a supportive FMO; click here for Crowe contracting

Take a look at what we have to offer our agents – watch a quick YouTube video

Key Takeaways for Beneficiaries and Agents

• TrOOP helps Medicare track spending to determine when beneficiaries qualify for better cost-sharing.
• Only qualified out-of-pocket costs count.
• In 2025, TrOOP maxes out at $2,000; a major win for Medicare enrollees.
• Medicare agents should explain TrOOP carefully when helping clients compare drug plans or estimate yearly costs.

Agents stay updated on events and important information; click here

As a Medicare agent, mastering all the different enrollment periods is crucial to ensure smooth enrollment for your clients. It also helps you stay compliant and that is also very important. Understanding IEP vs ICEP is essential to anyone in Medicare sales. Although these two sound similar, they serve distinct purposes and apply to different parts of Medicare.

IEP (Initial Enrollment Period)

First we will go over The IEP. Most agents know that this is the first window of time when someone is eligible to enroll in Original Medicare; specifically Parts A and B.

• Who is eligible to apply: Individuals turning 65 who worked and paid Medicare taxes for a period of at least 10 years (40 quarters) or their spouse or ex-spouse. Those who are under 65 with a qualifying disability, ESRD or ALS are also eligible to enroll.
• Timing: For those who are turning 65; The IEP spans 7 months: it begins 3 months before their 65th birthday, includes their birth month and ends 3 months after the month they turn 65.
• Timing: Individuals who are under 65 and qualify due to a disability; the IEP begins 3 months before the 25th month of their disability benefit entitlement.

Example: If a client turns 65 in May, their IEP runs from February 1st to August 31st.

What beneficiaries can do during IEP

1. Enroll in Medicare Part A and/or Part B
2. Enroll in a Medicare Part D plan (if they have Part A and/or Part B)
3. If they enroll in both Part A & Part B, they may also opt for either a Medicare Advantage (Part C) plan or a Medicare Supplement (Medigap) plan.

ICEP (Initial Coverage Election Period)

When an individual is first eligible for Medicare, the ICEP can specifically be used to enroll in a Medicare Advantage (Part C) plan.

• Who can use the ICEP: Individuals who are first enrolling in both Medicare Part A and B, and want to join a Medicare Advantage plan.
• Timing: Usually, the ICEP coincides with the IEP. However if an individual delays Part B enrollment (e.g., due to employer coverage), the ICEP does not start until they have both Part A and Part B and ends the last day of the month before their Part B coverage begins.

Example 1 (standard case): Client enrolls in A & B to begin July 1. Their ICEP runs from April 1 to June 30.

Example 2 (delayed Part B): Client took Part A at 65; delayed Part B until they retired at 67. Their ICEP begins when they enroll in Part B and ends the last day of the month before Part B becomes effective.

What beneficiaries can do during ICEP

1. Enroll in a Medicare Advantage (Part C) plan, with or without drug coverage (MAPD or MA-only).

Differences at a Glance

Why Understanding IEP vs ICEP Matters to Agents

Confusing IEP and ICEP could lead to enrollment mistakes, missed opportunities, and compliance issues. Knowing when each applies ensures:

• You recommend the right plans at the right time.
• You help clients avoid penalties for delayed Part D enrollment.
• You position yourself as a knowledgeable and trusted resource.

Watch a YouTube video on Medicare enrollment periods

Important: Always ask clients if they’ve enrolled in both Part A and B before discussing Medicare Advantage options. This small question helps determine whether they’re in their ICEP.

Ready to join the team at Crowe; Click here for online contracting

For many people trying to navigate Medicare, understanding how and when out-of-pocket costs apply can be overwhelming. The terminology “first dollar Medicare services” may cause confusion for some individuals. We will explain what it actually means and how they work in the context of Medicare services.

First Dollar Coverage

First dollar coverage refers to insurance benefits that begin immediately. The enrollee is not required to, pay a deductible, copay, or coinsurance before the carrier provides coverage for a medical service. This coverage literally begins from the “first dollar” of a medical bill providing the highest level of financial protection.

With Original Medicare (Parts A and B), this kind of coverage is not included by default, although it may be accessed through either supplemental plans or Medicare Advantage plans in some circumstances.

Original Medicare: No First Dollar Coverage

Medicare is divided into Part A (hospital insurance) and Part B (medical/outpatient insurance).

Original Medicare enrollees are responsible for the following out-of-pocket costs:

• Deductibles: Part A ($1,632 per benefit period in 2025); Part B ($240 annual)
• Coinsurance: 20% for most Part B services after the deductible
• Copays: Varies depending on the service or provider

Please note; although Medicare covers a significant portion of approved healthcare costs, it does not offer first dollar coverage when used on its own. Beneficiaries are responsible for cost-sharing amounts unless they purchase supplemental coverage.

First Dollar Coverage for Medicare Services

In general, there are two ways Medicare beneficiaries receive first dollar coverage:

1. Medicare Supplement (Medigap) Plans

The Medigap plans listed below cover most or all out-of-pocket costs after Original Medicare pays its share.

• Plan F: Offers true first dollar coverage. This plan covers both Part A and Part B deductibles as well as all coinsurance and copays for approved medical expenses as well as excess charges.
• Plan C: Similar to Plan F but doesn’t cover excess charges. Important: Plans F and C are not available to individuals who were eligible for Medicare after January 1, 2020.
• Plan G: Covers all approved Medicare expenses; except the Part B deductible, making this plan very close to first dollar coverage.

Beneficiaries enrolled in a Plan F shouldn’t have to pay anything out-of-pocket for Medicare covered services.

2. Some Medicare Advantage (Part C) Plans

Medicare Advantage plans are an alternative to Original Medicare. Some Medicare Advantage plans offer enrollees:

• $0 monthly premiums
• $0 copays for primary care, lab work, preventive services, or telehealth
• Reduced out-of-pocket costs through annual limits

Although technically they are not considered “first dollar” coverage, some plan benefits can effectively eliminate upfront costs for specific services, depending the plan design.

Keep in mind: Medicare Advantage plans may include networks, referrals, and prior authorization requirements.

Watch a quick YouTube video on Medicare enrollment periods

Examples of First Dollar Medicare Service

• Example 1: A Medigap Plan F enrollee visits the emergency room. The bill is fully covered; no deductible, no copay, no coinsurance. This is real first dollar coverage.
• Example 2: A Medicare Advantage plan enrollee has a $0 copay for a primary care visit. Although the plan may have a deductible for other services, this specific visit is a first dollar service.
• Example 3: A individual with Original Medicare and no supplemental coverage uses the services of a specialist. This individual must meet the Part B deductible and then pay 20% for all approved charges. In other words, this is not first dollar coverage.

Why First Dollar Coverage Matters

• Predictable healthcare costs
• Easier budgeting for individuals on fixed incomes
• Reduces the risk of surprise bills
• Encourages timely medical visits and screenings

Possible Downside

• Higher monthly premiums (especially with Medicare Supplement Plans)
• Less flexibility (if beneficiaries opt for a Medicare Advantage Plan) they must use specific provider networks.
• Limited plan availability for more recent enrollees (Medicare Supplement Plan F and Plan C enrollment restrictions).

First dollar Medicare services are about financial peace of mind. While Original Medicare doesn’t provide this level of coverage on its own, many beneficiaries learn that Medicare Supplements or Medicare Advantage plans reduce or eliminate the high price of medical care.

Beneficiaries who like predictable expenses and minimal out-of-pocket costs, may opt for a plan that offers first dollar coverage. As a licensed Medicare agent, it is important to understand your clients healthcare needs and budget to offer plan choices that provided the best benefit options.

Understanding Medicare Advantage enrollment periods; when to join, switch or leave a plan is crucial to receive necessary healthcare coverage. Although even if you know which plan you want, when you can enroll in a Medicare Advantage plan isn’t always straightforward.

In this post, we break down the Medicare Advantage enrollment periods so beneficiaries do not miss an opportunity to get teh coverage they need.

Medicare Advantage

Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. In other words, these plans provide coverage for Part A (hosptial) & Part B (medical) expenses. They are offered by private insurance companies that are approved by Medicare. The plans often include extra benefits like vision, dental, hearing, and Part D (prescription drug coverage).

However, individuals can’t just sign up any time they want to. There are specific rules that specific govern when individuals can join or make changes.

Initial Enrollment Period (IEP)

This enrollment period is for those who are either turning 65 or newly eligible for Medicare.

The Initial Enrollment Period is a 7-month window:

• Starts 3 months before the month individuals turn 65
• Includes the birthday month
• Ends 3 months after the birthday month

During this time, individuals can enroll in Original Medicare (Parts A and/or B). They can also choose to enroll in either a Medicare Advantage plan with or without Part D or a Medicare Supplement and a stand-alone Part D plan.

Annual Enrollment Period (AEP)

Medicare’s AEP runs from October 15 through December 7 each year. This enroll,ment period is a time whe anyone enrolled in a Medicare plan should meet with theor Medicare agent and go over their options for the coming year.

During this time, beneficiaries can:

• Switch from Original Medicare to a Medicare Advantage plan
• Switch from one Medicare Advantage plan to another
• Drop a Medicare Advantage plan and return to Original Medicare
• Join, drop, or switch a Part D prescription drug plan

Changes made during AEP take effect January 1 of the following year.

Medicare Advantage Open Enrollment Period (MA OEP)

Each year the MA OEP runs from January 1 through March 31. This enrollment period is available to those already enrolled in a Medicare Advantage plan

During this time, beneficiaries can:

• Switch to a different Medicare Advantage plan
• Drop Medicare Advantage and return to Original Medicare (and optionally join a Part D plan)

Please Note: Medicare beneficiaries cannot join a Medicare Advantage plan for the first time during MA OEP.

Watch a quick YouTube video on Medicare OEP best practices.

Special Enrollment Periods (SEPs)

Medicare SEP are available to beneficiaries who experience specific life events.

Individuals may qualify for an SEP ( Special Enrollment Period) if they:

• Move out of their plan’s service area
• Lose other health coverage (like employer sponsored insurance)
• Qualify for Extra Help or Medicaid
• Live in or move into a nursing home
• Miss a valid election period due to a FEMA declared emergency
• Experience plan contract changes (e.g., plan termination)

The time allowed to use an SEP varies. Therefore, it is important for eligible beneficiaries to act promptly so they don’t miss the enrollment opportunity.

5-Star Special Enrollment Period

If a Medicare Advantage plan earns a 5-star rating from CMS, beneficiaries can switch from their current plan to the 5 star plan from December 8 – November 30 of the following year. Plan enrollees can use this election period only once per calendar year.

This allows plan enrollees to move to a top-rated plan outside of the usual enrollment windows.

When it comes to Medicare Advantage enrollment, timing is important. Missing an enrollment window can mean waiting months for another opprotunity to change coverage. This can leave beneficiaries in a plan that no longer fits their coverage needs.