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.