When Can I Enroll in a Medicare Advantage Plan?

When Can You Sign Up For Medicare Advantage Plans?

Medicare Advantage (aka, Medicare Part CMedicare Part C is Medicare's private health plan option. Also known as Medicare Advantage, Medicare Part C plans are a type of Medicare health plan offered by companies that contract with Medicare to provide all...) and Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plans have several different enrollment periodsEnrollment periods are designated time periods to enroll or disenroll from the various parts of Medicare. There are six Medicare 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 periodThe General Enrollment Period (GEP) allows beneficiaries to enroll in Medicare Part A and Part B  from January 1 to March 31 if they missed their Initial Enrollment Period. Beneficiaries can also enroll in a..., Medicare beneficiaries can join plans, change plans, and drop plans to go back to Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage..

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:

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 periodDuring the Medicare Open Enrollment Period, Medicare Advantage and Part D plan members can change, switch, or drop a plan they chose during the Annual Election Period. OEP starts on January 1 and ends on March 31., you can buy a Medicare supplement insurance policy (Medigap plan). However, be aware that insurance companies may ask you health questions or send your application through medical underwriting. The exceptionIn a Medicare Part D plan, an exception is a type of prescription drug coverage determination. You must request an exception, and your doctor must send a supporting statement explaining the medical reason for the... to this is when you’re first eligible for Medicare when you have Medicare supplementMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. guaranteed-issue rights and can’t be turned down.

What Is The Medicare Advantage Special Enrollment Period?

Medicare has several reasons for granting a special enrollment periodSpecial Enrollment Periods (SEPs) allow beneficiaries to change their Medicare Advantage and Part D plans due to a special circumstance. Common reasons for a SEP include moving, losing employer coverage, and Medicaid eligibility, to name.... Generally, Medicare lets you make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen, for example, if you move or you 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 you need a SEP.

How Do I Sign Up For A Medicare Advantage Plan?

If you are new to Medicare, and you have both Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services., you can join a Medicare Advantage planMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). during your initial enrollment periodThe Initial Enrollment Period is a seven-month period when new beneficiaries can enroll in Medicare without a penalty. Most people enroll in Medicare at age 65.. Your IEP is a 7 month period that starts 3 months before the month 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, and 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 you get 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.

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 ESRDEnd-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age..

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 premiumA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , deductibleA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., or copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.. Changes you make during open enrollmentIn health insurance, open enrollment is a period during which a person may enroll in or change their selection of health plan benefits. Health plan enrollment is ordinarily subject to restrictions. will take effect the first day of the month in January.

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.

Can I Get Medicare Advantage If I Have Medicaid?

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

Dual-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program.... people (those with both Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States.) 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

• Find a Medicare plan
  https://www.medicare.gov/plan-compare/
• Medicare.gov: the official U.S. government site for Medicare | Medicare
  https://www.medicare.gov/
• Medicare Advantage Plans | Medicare
  https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/…

cms.gov

• https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Medicare…
• CMS 40B | CMS
  http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS017339.html
• https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-h…

ssa.gov

• Medicare Benefits | SSA
  https://www.ssa.gov/benefits/medicare/
• Latest Cost-of-Living Adjustment
  https://www.ssa.gov/oact/cola/latestCOLA.html
• Medicare Benefits | SSA
  https://www.ssa.gov/medicare/

This article was written by David Bynon and was last updated on April 14, 2021.