There are so many Medicare health plans in the marketplace, but so little time during enrollment periods to choose the right plan for you. It’s important to understand Medicare enrollment periods to confidently choose plans that are best tailored to fit your needs.
Initial Enrollment Period: Medicare’s On-ramp
When you approach age 65, you have a seven-month window (centered around the month you were born) to enroll in Medicare. This period, known as the Initial Enrollment Period (IEP), is the first time most people become eligible for Medicare. Coverage can begin the first day of your birthday month, but you can enroll up to three months before or three months after.
Original Medicare includes Part A (hospital) and Part B (medical) coverage. During the initial enrollment period, you may also join a Medicare Advantage (Part C) or a Prescription Drug Plan (Part D) that go beyond original Medicare and are smart choices for many people.
You may sign up for Medicare while still covered by an employer plan. If you miss one of the sign-up windows and enroll later, you may have to pay more for your Part B long-term. Payroll taxes qualify recipients for free premium Part A coverage, and there are options to people with limited incomes pay their Part B premium.
Medicare Annual Enrollment Period: Join, Drop or Switch Health Plans
The Medicare Annual Enrollment Period (AEP), held each year from Oct. 15 through Dec. 7, allows eligible beneficiaries to join, drop, or switch their Medicare plans. Changes made during this period take effect Jan. 1 of the following year.
Plan benefits and member cost-shares change every year, just like your health priorities; AEP is a time when you can make adjustments to meet your evolving wellness needs. It is also during AEP when anyone covered under Medicare Part A and B can choose to enroll in Medicare Advantage (MA)—plans with extra benefits not typically covered by traditional Medicare, often without extra premium costs.
“Medicare Advantage can cover not only prescription drugs, but also dental, vision, hearing and other critical benefits such as transportation and a monthly grocery allowance,” explained Saadia Selvie, Zing Health’s vice president of sales and marketing. “Also, Medicare Advantage can support seniors’ health and wellness and care for chronic medical conditions.”
Medicare Advantage Open Enrollment Period: One More Time
If you are enrolled in a Medicare Advantage plan, whether you joined it during the recent AEP or in years before, you have another annual opportunity to change plans. The Medicare Advantage Open Enrollment Period (MA-OEP) is held each year from Jan. 1 through March 31. During this period, if you are already enrolled in a MA plan, you again have the option to change your plan. Alternatively, during this time you can choose to revert back to original Medicare, which is why MA-OEP is also referred to as the Medicare Advantage Disenrollment Period.
Medicare Special Enrollment Periods
Outside of these regular enrollment periods, certain special events qualify you to change plans, such as leaving an employer health plan or losing coverage after age 65. A Special Enrollment Period (SEP) covers such changes, including moving into or out of a plan’s service area or qualifying for ExtraHelp. Once a new plan gets a request, changes take effect the first day of the next month.
“From April 1 to basically Sept. 30, before marketing begins on new plans, is called the lock-in period,” Selvie said. “The only time someone can opt into a plan is if they have some type of special election, or if they’re new to Medicare.”
Special Needs Plans
Two-thirds of Medicare enrollees have multiple chronic conditions which often require coordination of care among primary providers, medical and mental health specialists, and inpatient or outpatient facilities. Medicare beneficiaries experiencing these severe and often disabling conditions can enroll in a Chronic Condition Special Needs Plan (C-SNP). C-SNPs are a type of Medicare Advantage plan specifically designed to provide targeted care to beneficiaries with specific conditions, such as diabetes or cardiovascular disease.
Medicare beneficiaries who also receive full Medicaid benefits through their state may also be eligible for Dual Special Needs Plans (D-SNP). These plans provide even more cost relief than Medicare or Medicaid alone, along with coordination between both plans.
“During the lock-in period, or even during AEP or the Medicare Advantage Disenrollment Period, individuals who qualify for a chronic special needs plan or a dual special needs plan for Medicaid can opt into a Medicare Advantage plan,” Selvie said.
Helpful Medicare Advantage Resources
Whether beneficiaries are preparing to enroll in Medicare Advantage for the first time or are trying to change their health plans, there are resources that can help simplify the process.
“Anyone can contact our customer service department and be transferred to a Medicare adviser,” Selvie said. “They can help people evaluate their current coverage and let them know their options.”