If you are a beneficiary of Original Medicare and are thinking about switching to a Medicare Advantage plan, also known as Medicare Part C, you can only do it at specific periods in the year allotted for enrollment. Existing Medicare Advantage plan holders who are not entirely satisfied with their plan and want to make a switch to another one also have to wait for specific periods earmarked for them to make this change.
Read on to find out the right time to enroll in, switch from, or discontinue your Medicare Advantage plan. You will also understand how certain circumstances can qualify you to make plan changes exclusive of these periods as well.
What is the Initial Enrollment Period?
This refers to a period when you are reaching your 65th birthday and are deemed eligible to first apply for the plan. The initial enrollment period covers seven months, beginning three months before your 65th birthday and stretching to three months after your birthday month. During this period, you can sign up for a Medicare Advantage plan of your choice. Alternatively, if you already have a Medicare Advantage plan and wish to switch to another one, this period offers you the flexibility to do this as well.
For those who have a disability and are recipients of Social Security benefits, the Initial Enrollment Period for Medicare Advantage also extends for 7 months. It starts 3 months before the 25th month of receiving Social Security benefits and continues for another 3 months.
After you have done your research about Medicare Advantage plans and are ready to make an informed decision, you can choose to apply for a plan in a few different ways. You can apply online, speak to an insurance agent over the phone, or fill out a paper enrollment form given to you by a plan sponsor. Keep your Medicare card handy as you may be required to state your Medicare number and the exact dates from when your coverage began.
What is the Medicare Annual Election Period (AEP)?
Some people refer to this as the Medicare Open Enrollment Period, and it is usually fixed between October 15 and December 7 every year. During this time, a person can make changes to their plans:
- They can sign up for a Medicare Advantage plan from Original Medicare
- They can switch from their present Medicare Advantage plan to Original Medicare
- They can drop their current Medicare Advantage plan and enroll in another one, irrespective of whether the plan has drug coverage
- They can apply and enroll in a Part D prescription drug plan
- They can switch Part D plans
- They can drop a Part D plan and discontinue coverage
The changes usually take effect from the 1st of January the following year.
What is the Medicare Advantage Open Enrollment Period?
This enrollment period, which was introduced in 2019, now replaces the Medicare Advantage Disenrollment Period (January 1 to February 14) and runs from January 1 to March 31. It allows Medicare Advantage or Part C beneficiaries to make the following changes:
- Choose an alternate Medicare Advantage plan and switch from their current one
- Switch from Medicare Advantage to Original Medicare (Parts A and B)
- Apply for a stand-alone drug plan if they return to Original Medicare.
Unlike the Annual Election Period, the Medicare Advantage Open Enrollment Period typically allows a person to make only one change to their plan in a year. It also doesn’t allow anyone to change from one Part D drug plan to another during this time. A person would have to wait until the Annual Election period to do this. In addition, if one isn’t already a beneficiary of a Medicare Advantage plan, they would not be allowed to sign up for one during this time.
Once a person chooses to disenroll from a Medicare Advantage plan, their Original Medicare coverage would usually begin on the month following the request for new enrollment.
An individualized Medicare Advantage Open Enrollment Period also exists for new Medicare beneficiaries. If they have enrolled for a Medicare Advantage plan during their Initial Election Period, they have a 3 month window to change these plans. They can also choose to go back to Original Medicare with a Part D plan.
What is a Special Election Period?
There are specific situations that qualify a person to make changes to their Medicare Advantage plans during a Special Election Period, also known as a Special Enrollment Period (SEP). These include a change in
- Their residential address to an area out of the plan’s network
- If they move to a location with a different insurance plan that offers alternate coverage
- If they need to live in a long-term or skilled nursing institution
- Medicare decides to end their contract with the plan they are on.
Can you Enroll in Medicare Advantage if you are 65 and disabled?
If you have been getting Social Security benefits or are a beneficiary of a Railroad Retirement Board for 21 full months, you should be eligible to enroll in a Medicare Advantage plan. Your enrollment period will generally open up for 7 months. The plan coverage typically begins from the 25th month of receiving disability benefits. If you have Amyotrophic Lateral Sclerosis (ALS), you become eligible to apply for Medicare Advantage plans right from when you begin to get your disability benefits. In most cases, people suffering from End Stage Renal Disease cannot apply for a Medicare Advantage plan.
What are some of the reasons why people switch plans?
Every person chooses medical insurance coverage based on their individual health circumstances. Medicare Advantage plans have several advantages in the form of coverage for prescription drugs; additional benefits in the form of fitness programs, and so on. Certain plans have zero premiums while others set a limit on how much a person pays from their own pocket for medical expenses.
However, people switch between Medicare Advantage plans based on their medical needs and patterns of using medical services. Some of these reasons can include:
- To lower their out-of-pocket costs in the face of a costly medical surgery
- To increase dental benefits because of the frequency of dental visits
- To have only minimal coverage and pay low premiums since their use of medical facilities and services are limited
- To switch to an HMO plan from a PPO plan
- To lower the costs of taking prescription drugs
Once a person chooses a new plan to enroll in, they will be no longer be a part of their old plan once the new medical coverage begins. This usually happens automatically.
When is the Medicare Advantage Disenrollment Period?
This period used to run from January 1 to February 14 but has been replaced by the Medicare Advantage Open Enrollment Period as stated above. With different periods during the year during which you can make changes to your Medicare Advantage plans, it can sometimes get a little confusing. However, depending on whether you are signing up for a plan for the first time or deciding to switch to a plan that works better for you, keep a check on when your specific enrollment period begins. If you decide your plan isn’t suitable for your medical needs and you choose to disenroll, be aware of how long you are covered for, so you don’t lose out on any benefits.