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Medicare AEP versus OEP

By Ed Crowe | General Articles | 0 comment | 23 August, 2023 | 0

Medicare AEP versus OEP: What’s the Difference?

Even for savvy clients, the enrollment process for Medicare can be confusing. One of the reasons for this is the multiple enrollment periods. The two most important time periods for both beneficiaries and agents to know the details of are the Open Enrollment Period (OEP) and the Annual Enrollment Period (AEP). Let’s compare the two:

AEP vs OEP – Open Enrollment Period

This is the time during the year when anyone who is eligible for Medicare can enroll in, change coverage from, or unenroll from a Medicare Advantage Plan or a Medicare Part D (or prescription drug) plan. This is the time when beneficiaries can make choices about their Medicare coverage without restrictions. It usually runs from January 1st to March 31st each year. To be eligible to enroll in a Medicare Advantage plan during OEP.

AEP vs OEP – Annual Enrollment Period

This is the time period that is specifically designed for beneficiaries who are enrolled in Medicare Advantage plans to change their coverage. It occurs from October 15th to December 7th each year. There are some restrictions as to what beneficiaries can do during this time period, but those actions that they can take include enrolling in a different Medicare Advantage plan, switching to or back to Original Medicare (parts A and B), or enrolling in a Medicare Part D plan (prescription drug coverage). In order to be qualified to do any of those things, the beneficiary must already be enrolled in a Medicare Advantage plan.

It is of vital importance that beneficiaries are aware of these timelines. If they are not aware of the time periods, missing OEP or AEP and failure to act can cause them to have lapses in their healthcare coverage or miss their opportunity to enroll in a different plan for the coming year.

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Medicare Advantage Trial Rights

By Ed Crowe | General Articles | 0 comment | 27 July, 2023 | 0

Medicare Advantage Trial Rights

Sometimes, despite our best efforts, our clients need to update and change their coverage. Maybe their life or healthcare needs changed since enrolling, maybe they want to return to Original Medicare from a Medicare Advantage plan, or maybe they are just dissatisfied with their coverage. Regardless of the reason, there is a regulation in place for this situation called a Medicare Advantage Trial Right.

What are Medicare Advantage Trial Rights?

Medicare Advantage Trial Rights allow beneficiaries to update their coverage outside of the Annual Enrollment Period. Essentially, clients have a 12-month period to test out a MA plan. If they are satisfied with the plan and coverage at the end of the time period, they can keep the plan. If they are not satisfied, they can revert to Original Medicare and either return to their former Medicare Supplement or choose a new Medicare Supplement. What is permissible is dependent on some client-specific regulations and some state-specific regulations, as some places extend the Medicare Advantage trial right period or can offer additional guaranteed issue rights.

Who Qualifies for Medicare Advantage Trial Rights?

There are two types of clients who qualify.

MA clients who enrolled when they turned 65 (less than twelve months ago)

For example, if your client enrolled in Medicare Part A at the same time as their Medicare Advantage plan, they may switch to Original Medicare as long as that switch occurs within a year of enrollment. When the client uses this trial period, they can also choose a Medicare Part D plan (prescription drug) and a Medicare Supplement plan without having to pass any underwriting, depending on what is available in their area.

Medicare Supplement beneficiaries who switched to a Medicare Advantage plan for the first time less than twelve months ago

If the client chose a Medicare Supplement plan when they first turned 65 but then decided to try out a Medicare Advantage plan, they can still switch back to Original Medicare within the first year of the Medicare Advantage plan coverage. They have to return to their previous plan, however, and do not have the option to purchase a different one. If that insurance carrier no longer offers their previous plan, the client will be able to purchase a guaranteed issue plan offered by a different carrier.