It is difficult to watch television without seeing ads for Medicare plans that promise that they are the best plan you if you just call now! But what is the real story? Does everyone have to make a change or re-elect their plan? It can all be overwhelming and confusing!
So, here is information on the different enrollment periods that may shed light on and what you need to know!
Annual Election Period (AEP) – October 15 – December 7
Beneficiaries can leave their current MA or MAPD plan and elect to go to another MA or MAPD plan or return to Original Medicare. Beneficiaries with a Medicare Supplement plan and a separate Medicare Part D Prescription Drug Plan can also change their Part D plan at this time.
Beneficiaries who are satisfied with their current plan can stay on their current plan – no action required!
Each year the companies that provide Medicare Advantage plans send out an Annual Notice of Change (ANOC) that outlines changes to the plan. If there are any changes to your plan, make sure that your medications are still covered, that your care providers are still in the network, and that the Deductibles and Co-Pays work with your budget.
Even if there are no significant changes to your existing plan, it is a good idea to review your Medicare Advantage (Part C) Plan every year to make sure it covers your current medications and that your care providers are still in the network. If the Plan for the coming year will meet your needs, then there is no need to change. However, if your current plan will not meet your needs for the upcoming year, contact us to learn what plans are available in your area.
Beneficiaries can make more than one Medicare Advantage plan election during AEP. The last Medicare Advantage plan enrolled in when AEP ends is the plan that will be effective on January 1.
Open Enrollment Period (OEP) – January 1 – March 31
Beneficiaries with a MA or MAPD plan may change from their current plan to a different MA or MAPD plan or disenroll from their current Medicare Advantage plan, return to Original Medicare, and enroll in a Part D Drug Plan. The Open Enrollment Period is limited to beneficiaries already enrolled in MA & MAPD plans.
Initial Coverage Enrollment Period (ICEP & IEP) – Timing varies by date of eligibility
ICEP is a 7-month period around the time when a beneficiary turns 65. ICEP begins 3 months prior to the eligibility month, the eligibility month, and 3 months after the eligibility month.
During ICEP a beneficiary can enroll in Original Medicare and get their Prescription Drug coverage from a Part D Drug Plan or enroll in an MA or a MAPD plan that includes Prescription Drugs.
5-Star Special Enrollment Period
Medicare plans are rated using a 5-Star system ranging from 1-Star to 5-Stars. Medicare uses information from customer satisfaction surveys to determine the ratings. Some plans may not have a Star rating because they are new so therefore were not included in the surveys. A plan with a 5-Star rating is considered excellent. These ratings help you compare plans based on their quality and performance. The Centers for Medicare and Medicaid Services (CMS) updates these ratings each fall for the following plan year. If a Medicare Advantage Plan, Medicare Part D Prescription Drug plan, or Medicare Cost Plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period to switch from your current plan to a one with a 5-Star rating. NOTE: You can use this Special Enrollment Period only once between December 8 and November 30.
Special Enrollment Period (SEP) – Qualifying Event
There are additional Special Enrollment Periods that are based on life events. Some of these Special Enrollment Periods are listed below.
- No Longer Working and Losing Coverage
If you did not enroll in Medicare Part A, Part B, and Part D because you were covered by your employer’s plan but now plan to retire, you have a Special Enrollment Period of 8 Months to enroll in Medicare Part A and Part B without late enrollment penalties. If you are leaving an employer or union plan you have 2 months from the loss of coverage to enroll in a Medicare Advantage and/or Part D plan. If you are joining an employer or union plan you can drop your Medicare Advantage and/or Part D coverage when your employer or union coverage is in force.
- You move to a New Address and are no longer in the Plan’s Service Area
Moving may qualify you for a Special Enrollment Period if you move to a new home that is not in the service area of your current plan, you can switch to another Medicare Advantage plan that provides coverage in your new location or go back to Original Medicare and select a new Part D plan. This Special Enrollment Period starts when you move and lasts 2 months.
- Eligible for a Special Needs Plan or loss of a Special Needs Plan (SNP)
If you become newly eligible for a Special Needs Plan, you can leave your Medicare Advantage plan at any time. Conversely, if you are no longer eligible for the Special Needs Plan, you have 3 months to enroll in a Medicare Advantage plan.
- You become eligible for Medicaid or lose Medicaid eligibility
Gaining or losing Medicaid coverage allows you to add, change or drop your Medicare Advantage plan or your Medicare Part D Prescription Drug plan. You can change your plans once during each of three periods: January – March, April – June, and July – September.
Once you make the change your coverage on the new plan will start on the first day of the following month.
- The Medicare Advantage or Part D Plan does not renew its contract with Medicare.
If your current plan will not be renewing their contract with Medicare, you have a Special Enrollment Period starting 2 months before the end of the contract and ending 1 month after the contract ends.