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Springfield, Missouri

Advantage Enrollment Periods

Medicare Enrollment Periods

Enrollment periods are vitally important for Medicare beneficiaries to understand and keep track of. There are some that apply to Original Medicare, Medicare supplements, Part D prescription drug plans, and of course, Medicare Advantage Plans.

Missing one of the enrollment periods can cause you to be penalized, and you could miss out on coverage. Let’s talk about the different Medicare Advantage enrollment periods so you can mark your calendars and stay up-to-date with your insurance benefits.

Part C Medicare Advantage Enrollment Periods

There are four enrollment periods that relate to Medicare Advantage plans. You may not be eligible for all of them, but they are important to understand

The four Medicare Advantage enrollment periods are:

  1. Initial Coverage Election Period
  2. Annual Enrollment Period
  3. Medicare Advantage Open Enrollment Period
  4. Special Enrollment Period

Part C Medicare Advantage Enrollment Periods​

There are four enrollment periods that relate to Medicare Advantage plans. You may not be eligible for all of them, but they are important to understand

The four Medicare Advantage enrollment periods are:

ICEP

Initial Coverage Election Period

AEP

Annual Enrollment Period

OEP

Medicare Advantage Open Enrollment Period

SEP

Special Enrollment Period

Initial Coverage Election Period

ICEP

Around the time of your 65th birthday, you have an Initial Enrollment Period. This begins three months prior to your 65th birthday and ends three months after your birthday. During this time, you can enroll in Original Medicare – Parts A and B – and a Part D prescription drug plan.

The Initial Coverage Election Period for Medicare Advantage plans is similar. It begins three months prior to your 65th birthday. Unlike the IEP for Original Medicare, the ICEP ends on the last day of the month before you enroll in Medicare Part B or on the last day of your IEP, whichever is later.

Some adults do not enroll in Medicare right at age 65. If you choose to stay employed past 65 and your employer provides health coverage, you may be eligible to delay Medicare enrollment without any penalties. If that’s the case, you will not enroll in Medicare (at least Part B) until you decide to retire or lose your employer’s coverage.

When you no longer have coverage through an employer, you will have an 8-month Special Enrollment Period. You should submit your applications for Part B and a Medicare Advantage plan prior to your group health plan’s termination date so that you do not have a lapse in coverage.

Annual Enrollment Period

AEP

If you miss your Initial Coverage Election Period, your next opportunity to enroll in a Medicare Advantage plan is during the fall Annual Enrollment Period. This occurs annually from October 15 to December 7. Any enrollments that happen during this time become effective on January 1 of the upcoming year.

There are several things you can choose to do during the AEP. You can switch from one Medicare Advantage plan to another, switch from Original Medicare to Medicare Advantage, or switch from Medicare Advantage back to Original Medicare. This is also a good time to review and make changes to your Part D prescription drug plan if you have one.

No matter which changes you make, your new coverage will be effective on January 1.

Medicare Advantage Open Enrollment Period

OEP

If you missed the Annual Enrollment Period and want to make changes to your current Medicare Advantage plan, you may do so during the Medicare Advantage Open Enrollment Period.

This period happens every year from January 1 to March 31. During this time, you can make a one-time change to your current Medicare Advantage plan. This period does not allow Medicare beneficiaries who do not have a Medicare Advantage plan to enroll in one – it is only for those already enrolled in a Part C plan. Part C plan holders can also choose to switch back to Original Medicare during this time.

Medicare Advantage Special Enrollment Periods

SEP

There are some events that will allow Medicare beneficiaries to enroll in a Medicare Advantage plan or make changes to their current Medicare Advantage plan. If one of the qualifying events occurs, the individual is granted a Special Enrollment Period. These can occur at any time of the year.

Let’s review some of the events that may qualify an individual for a Special Enrollment Period.

Medicare Advantage “Trial Period” and “Trial Right”

All Medicare Advantage plans have a trial period. This gives individuals a chance to try a Medicare Advantage plan and decide if it works for their healthcare needs.

If you enroll in a Medicare Advantage plan during your Initial Coverage Election Period, you’ll be granted a trial period that lasts for 12 months. During this 12-month period, you can choose to disenroll from your Medicare Advantage plan and switch back to Original Medicare.

This trial period also gives you guaranteed issue rights so that if you do choose to switch back to Original Medicare, you may also choose a Medicare supplement plan. “Guaranteed issue right” means that no Medicare supplement insurance company can deny coverage due to a pre-existing health condition. The guaranteed issue rights will last for 63 days after your Medicare Advantage disenrollment.

“Trial right” works in a similar manner. This applies to Medicare beneficiaries who dropped a Medicare supplement to enroll in a Medicare Advantage plan. Trial right can only be used the first time an individual does this.

In this case, you will have 12 months to change your mind and disenroll from the Medicare Advantage plan. As with the trial period, you’ll have 63 days to re-enroll in a Medicare supplement and still have guaranteed issue rights.

The trial right does have some limitations. The only Medicare supplement that you can re-enroll in with guaranteed issue rights is the plan that you left to go to Medicare Advantage. The only time you are allowed to choose a different plan is if that plan is no longer offered in your area. This is a rare occurrence.

If your Medicare supplement is no longer available, you’ll be able to choose from Plans A, B, D, G, K, or L.

Special Enrollment Periods for Limited Incomes

If you have a limited income, you may be eligible for several different Special Enrollment Periods.

Medicare Advantage Dual Eligibility SEP

In Medicare, “dual eligibility” means that the individual is eligible for both Medicare and Medicaid. If you become dual eligible at any time, you are granted a Special Enrollment Period during which you can enroll, disenroll, or switch Medicare Advantage plans one time per quarter during the first three quarters of your dual eligibility.

During the fourth quarter, you must use the Annual Enrollment Period to make any changes. If at any time you lose your Medicaid coverage, your SEP ends two months after.

Medicare Advantage Extra Help and Low-Income Subsidy SEP

Individuals with certain low incomes may be eligible for the Extra Help program. If you are admitted to the program, you are allowed the same Special Enrollment Periods as those who are dual eligible.

If you qualify for this, you can change Medicare Advantage plans once per quarter for the first three quarters of the year. The SEP begins the month you become eligible for Extra Help. If you become ineligible for the Extra Help program, your SEP will end 2 months later.

Medicare Advantage State Pharmaceutical Assistance Program SEP

Not all states participate in the State Pharmaceutical Assistance Program. In those that do, Medicare beneficiaries can change Part D prescription drug plans once during the calendar year. This is in addition to the Annual Enrollment Period which occurs each fall from October 12 to December 7.

Medicare Advantage

Enrollment Assistance

A licensed agent can help you choose the best type of Medicare policy. We’ll ask you some questions about your lifestyle and health, and then can give you options that will fit those needs. We’ll be able to look at different plans across many carriers, so you can choose the best possible plan.

After you choose, we’ll help you through the enrollment process and will file all the necessary paperwork. Our work doesn’t end there. We’ll reach out during important enrollment periods and make sure you still have the best plan available. All of these services come at no cost to you.

Special Enrollment Periods for Relocation

If you move to a new area of residence, it is likely that your current Medicare Advantage plan will not work. Medicare Advantage plans are usually specific to counties and certain networks, so if you relocate, your plan will likely not be accepted in your new location.

If you move, you’ll be granted a Special Enrollment Period. This period will begin the month prior to the month you move and will last for two months after you have moved.

Weather-Related Emergency or Major Disaster SEP

If a major disaster impacted your enrollment, you will be granted a Special Enrollment Period. A “major disaster” must have been declared by FEMA for this rule to apply.

Even if you rely on the help of a family member that lives in an impacted area, you can qualify for this SEP. The enrollment period will begin at the time of the disaster and will continue for four months following.

SEPs for Institutionalized Individuals

Individuals living in nursing homes or long-term care facilities can qualify for a Special Enrollment Period. This can give the individual the opportunity to change Medicare Advantage plans.

Institutions that will allow a person to qualify include nursing homes, rehabilitation hospitals, psychiatric hospitals, or long-term care facilities.

If a Medicare beneficiary is admitted to a skilled nursing facility, they are also eligible for an SEP. They will be allowed to join a Medicare Advantage Special Needs Plan (SNP). The enrollment window begins on the month of admission and ends two months after the individual is discharged.

Special Needs Plans SEP

Any Medicare beneficiary with a chronic condition can qualify for a Special Enrollment Period. This may include individuals with End-Stage Renal Disease (ESRD), cancer, dementia, etc. The plan must be available in the area for the person to apply.

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