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When Can I Enroll in a Medicare Advantage Plan?

by David Bynon, last updated

When Can I Enroll in a Medicare Advantage Plan?

When Can You Sign Up For Medicare Advantage Plans?

Medicare Advantage (aka, Medicare Part C) and Medicare Part D plans have several different enrollment periods. The most well-known period is called the Annual Election Period, or AEP. It runs in the Fall from 15 October to 7 December. You’ll want to get started early so you have plenty of time to compare Medicare Advantage plans and your Medicare Part D options.

During AEP, often called open enrollment or the general enrollment period, Medicare beneficiaries can join, change, and drop plans to return to Original Medicare.

There are two other enrollment periods. The first is a beneficiary’s initial enrollment period (IEP) and the second is a special enrollment period (SEP).

In this article, we’ll answer the following popular questions about Medicare Advantage enrollment, and many more:

Unlike Medicare supplement insurance, which does not have a specific enrollment period, you are only allowed to enroll in a Medicare Advantage plan during the annual election period (AEP) or during your initial enrollment period (IEP) or a special enrollment period (SEP). It's critical that you mark these dates on your calendar. Read When Can I Enroll in a Medicare Advantage Plan? to get the details.

There are 7 common reasons that some Medicare beneficiaries, and many healthcare professionals, feel that Medicare Advantage plans are bad. They include higher costs, less freedom to choose healthcare providers, doctor referrals for most services, high maximum out-of-pocket limits, annual changes to health plan benefits, costs, and providers. Read Why Medicare Advantage Plans are Bad: 7 Top Complaints to discover all of the dirty secrets about Medicare Advantage plans.

The primary benefit of Medicare Advantage is extra benefits. And, if you are a healthy senior, the additional benefits and cost savings really add up. But, there are some serious disadvantages as well, including network provider limitations, costly inpatient copays, and no coverage traveling away from home. To discover all of the pros and cons, read: What are the Advantages and Disadvantages of Medicare Advantage Plans?

Can You Enroll In Medicare Supplement Plans At Any Time?

Yes. If you missed your Medicare Advantage IEP and need additional coverage before the next open enrollment period, you can buy a Medicare supplement insurance policy (Medigap plan). However,  insurance companies may ask you health questions or send your application through medical underwriting. The exception to this is when you’re first eligible for Medicare when you have Medicare supplement guaranteed-issue rights and can’t be turned down.

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What Is The Medicare Advantage Special Enrollment Period?

Medicare has several reasons for granting a special enrollment period. Generally, Medicare lets you change your Medicare Advantage and Medicare prescription drug coverage when certain events happen, for example, if you move or lose employer insurance coverage. The Medicare rules about when you can make changes and the type of changes you can make are different for each SEP. Call 1-800-MEDICARE (or the railroad retirement board) if you’ve had a significant change in your life and need a SEP.

How Do I Sign Up For A Medicare Advantage Plan?

If you are new to Medicare and have both Medicare Part A and Medicare Part B, you can join a Medicare Advantage plan during your initial enrollment period. Your IEP is a 7-month period that starts 3 months before you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.  In most cases, your Social Security office will send you a reminder.

To get enrolled, you will need the assistance of a licensed health insurance agent. Agents are contracted with insurance companies to walk members through the enrollment process. This includes both prescription drug plans and Part C plans.

Call 1-855-728-0510 (TTY 711) and speak with a licensed HealthCompare insurance agent. There’s no obligation; they offer more plan options than any other national agency.

If this is your first time signing up for a Medicare insurance plan because you’re disabled and under 65, you can sign up for a Medicare Advantage Plan or a Medicare Prescription Drug Plan starting 21 months after you get Social Security. Your Medicare coverage begins the 25th month after receiving your Social Security disability benefits. Your chance to enroll in an MA plan lasts through the 27th month after you get Social Security benefits, so don’t delay, or you risk losing your eligibility.

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What Qualifies You For A Medicare Advantage Plan?

In general, nearly everyone with Medicare Part A and Part B benefits qualifies for a Medicare Advantage plan. In fact, the only reason you could be turned down is if you have one of several chronic health conditions, like ESRD.

From the beginning, Medicare Advantage was designed to eliminate health insurance discrimination by insurance companies. You won’t be asked probing health questions when you enroll, and you can’t be charged more based on your health history.

Should I Make a Change During Medicare Advantage Open Enrollment Period?

It all depends on how well your current plan is serving your needs. Does your current plan offer the extra benefits you need? Are the copays affordable? Is your prescription drug coverage working? At a minimum, you should see what’s available and compare new plan options with what you have, particularly if your current plan increased its monthly premium, deductible, or copayments. Changes you make during open enrollment will take effect the first day of the month in January.

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How is Medicare Advantage Different From Medicare?

Original Medicare has two parts, A and B. Part A is hospital insurance and Part B is medical insurance. It’s a very simple system. You can use any Medicare-approved doctor (most primary care physicians are Medicare-approved) you want and Medicare will pay 80 percent of approved healthcare services. You must pay the remaining 20 percent out-of-pocket or buy additional coverage (e.g., Medigap).

When you join a Medicare Advantage plan, the health plan (HMO, PPO, etc.) you choose replaces your Medicare Parts A and B coverage. You get the same major health care benefits included with Parts A and B, but the plan’s copayments and coinsurance are different and they may require you to use their network of providers in the plan’s service area.

Another big difference is that the Centers for Medicare & Medicaid Services rates all Part C and Part D plans using a 5-star rating system. The ratings help beneficiaries choose a quality plan and help Medicare weed out the bad plans.

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Can I Get Medicare Advantage If I Have Medicaid?

Maybe. It all depends on the availability of plans in your area.

Dual-eligible people (those with both Medicare and Medicaid) should look into Medicare Advantage Special Needs Plans (SNPs) in their area. SNPs are Medicare Advantage plans created specifically for people with limited income and unique health needs (e.g., institutionalized, serious chronic illness, etc.). Use our SNP plan finder to see the plans available in your area.

Citations & References:

medicare.gov

cms.gov

ssa.gov

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