Understanding the Medicare enrollment periods and rules is critical to avoiding lapses in coverage while also finding the best match.
Prudent beneficiaries should choose their plans carefully since it's likely they will not be able to change their plan again until the next open enrollment period.
The Special Enrollment Period is available to those to people with circumstances beyond their control.
Medicare carefully controls the times when beneficiaries can change their plans. Even when a plan doesn’t change year over year an enrollee’s needs may change. Unsurprisingly, hundreds of thousands of enrollees decide to change Medicare plans during a year. A good understanding of Medicare enrollment periods is helpful for individuals making changes to their coverage or joining Medicare for the first time.
Basics on Enrollment Periods – For Those Currently Enrolled
- Fall Open Enrollment Period (OEP): Every year, Medicare’s Open Enrollment runs from October 15th to December 7th. At this time, people can switch, join, or drop plans.
- Medicare Annual Election Period (AEP): This can also be referred to an open enrollment period, however it is purposed for making changes to your current Medicare Advantage or Part D plan. This time period is also between October 15th and December 7th. This period enables enrollees to make a greater number of changes vs the Medicare Advantage Open Enrollment Period (MAOEP).
- Medicare Advantage Open Enrollment Period (MAOEP): This limited Open Enrollment Period runs between January 1st and March 31st. Enrollees in MA plans can switch or drop Medicare Advantage to return to Original Medicare and enroll in a stand-alone Part D drug plan. This difference from AEP in the sense that you cannot make the following changes during this period: switch from Original Medicare to an MA plan, join a Medicare Part D (prescription plan) if on Original Medicare, or switch from one Part D plan to another if on Original Medicare.
- Medicare Supplement – Medigap Open Enrollment Period: This is a one-time only enrollment period. The best time to buy a Medigap policy is during your 6-month Medigap Open Enrollment Period. If you delay enrolling during this period individuals may not be able to purchase a Medigap policy. For individuals receiving Medicare Part B before their 65th birthday their Medigap OEP starts the first day of the month they turn 65. If there is an enrollment delay going past turning 65 then the Medigap OEP will automatically start the month of enrolling in Medicare Part B and it provides new beneficiaries with the Guaranteed Issue Rights to Medigap plans. More details regarding the Medigap Enrollment are supplied in the bullet list below.
Basics on Enrollment Periods – For Those Qualifying for the 1st Time
- Initial Enrollment Period (IEP): When beneficiaries first gain eligibility for Medicare Part A and B, they can join Medicare Advantage and Medicare Part D plans. This 7-month period timeframe starts 3 months before the month in which you turn 65 until three months after. Beneficiaries can enroll in Original Medicare, Medicare Part D, and a Medicare Advantage plan during this period.
- Medicare Advantage – Initial Coverage Election Period (ICEP): For individuals who are just qualifying into Medicare they can enroll in an MA plan during the Initial Coverage Election Period (ICEP) which occurs at the same time as the Initial Enrollment Period. There are other enrollment windows available depending on the individual’s situation, like during the Annual Election Period (AEP), Special Election Period, and for those already enrolled in a MA plan they can make changes during the Medicare Advantage Open Enrollment Period (MA OEP).
- Medicare Supplement – Medigap Open Enrollment Period: As mentioned this is a one-time only enrollment period, typically occurring when a person ages into Medicare at 65 providing new beneficiaries with the Guaranteed Issue Rights to Medigap plans. For individuals receiving Medicare Part B before their 65th birthday their Medigap OEP starts the first day of the month they turn 65 as well. If there is an enrollment delay going past turning 65 then the Medigap OEP will automatically start the month of enrolling in Medicare Part B.
The Specifics on Medigap
Medigap plans help broaden coverage provided by Original Medicare. Medicare.gov recommends that beneficiaries take advantage of the Medigap Open Enrollment Period. This period begins during the first month of Medicare Part B enrollment and extends for six months.
During this time, Medigap companies cannot increase rates or decline applications because of preexisting medical issues, but at other times, they can. Whether or not Medigap companies can increase rates or decline applications depends on whether guaranteed issue rights apply to the situation. Some people can delay Medicare Part B enrollment and Medigap Open enrollment because they have other creditable coverage.
According to Medicare.gov, a few unique circumstances may provide beneficiaries with limited guaranteed issue rights past Medigap Open Enrollment. For instance, some people may enroll in Medicare Advantage during the ICEP and change their minds within the first 12 months of having Medicare Part B. Some states also have rules that extend Guaranteed Issue Rights. For more information visit Understanding Medigap Protections or Guaranteed Issue Rights and Medicare Supplement Enrollment.
Changing Medicare Plans and the Special Enrollment Period
Enrollees with a Medicare Advantage plan or a Part D Plan can enroll in a new one during the appropriate enrollment periods previously outlined. Enrollees will get automatically disenrolled from the old plan on the effective date of the replacement. Beneficiaries who want to drop Medicare Advantage to rejoin Original Medicare should contact their plan representative for assistance.
The Open Enrollment Period is typically the most straightforward and best time for people to change Medicare plans and prudent beneficiaries should choose their plans carefully since it’s likely they will not be able to change their plan again until the next open enrollment period. However, the Special Enrollment Period (SEP) is available to individuals that may need to make a change due to extenuating circumstances. Here are a few common examples:
- When a beneficiary moves away from their plan’s service area, they can switch MA or Part D plans, or return to Original Medicare.
- When a beneficiary moves back to the United States after residing in another country they can enroll in MA or Part D.
- If a beneficiary loses health insurance from their employer or Medicaid they can enroll in MA or Part D.
- If Medicare terminates or sanctions the plan of a beneficiary, they can enroll in another MA or Part D plan.