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Medicare Advantage Enrollment: Signing Up for an MA Plan
By Chris Gasparini
Chris Gasparini has been a licensed insurance agent since 2005. He enjoys helping Medicare beneficiaries navigate their options to find the best solution for their unique needs. Chris feels as though ...his work truly helps people. Because he represents multiple insurance companies and plan types, Chris is able to help Medicare beneficiaries find the most cost-effective plan. Every day, he leaves work knowing he did what was right for each and every client he serves.Read more
Sep 08, 2020
The Medicare Advantage Open Enrollment Period (OEP) occurs every year from January 1 through March 31. It is available to all Medicare beneficiaries who are currently enrolled in a Medicare Advantage plan.
What Is the Medicare Advantage Open Enrollment Period?
The Medicare Advantage (MA) Open Enrollment Period allows all current Medicare Advantage enrollees to either change to a new plan or return to Original Medicare. If making that change results in you losing your prescription drug coverage, you may also join a standalone Medicare Part D plan.
The Medicare Advantage deadline is March 31. If you do not make your desired changes during OEP, you must wait for Annual Enrollment, which occurs every year from October 15 through December 7. Or, if you experience certain life events (known as special circumstances), you may qualify for a Special Enrollment Period (SEP). There are dozens of ways to qualify for an SEP. The full list is available on Medicare.gov.
Can You Participate in Open Enrollment if You Don't Have an Advantage Plan?
No. If you do not currently have an Advantage plan, you must wait for the Annual Enrollment Period (AEP) to join one.
The Best Time to Sign Up for Medicare
The Initial Enrollment Period (IEP) is the best time to sign up for Medicare. Once you have Medicare Part A and Medicare Part B (Original Medicare), you may join an Advantage plan.
Your IEP occurs during the 7 months surrounding your Medicare eligibility date. If you age into the Medicare program (i.e. turn 65), your Initial Enrollment Period begins 3 months before the month of your birthday and ends 3 months after your birth month. If you qualify for Medicare due to a disability, your IEP begins 3 months before your 25th month of collecting Railroad Retirement Board (RRB) or Social Security benefits.
So, if your birthday or 25th month of collecting disability benefits occurs in June, your IEP begins March 1 and ends September 30. The only difference is if your birthday is on the first of the month. In that case, your IEP begins and ends one month earlier (February 1 through August 31 if you turn 65 on June 1).
You are only automatically enrolled in Medicare if you began collecting Social Security benefits at least 4 months before your 65th birthday. Everyone else has to apply for Medicare through Social Security.
What Can You Do During Your Initial Enrollment Period?
You face numerous decisions during your IEP, starting with whether you want to keep Original Medicare or sign up for a Medicare Advantage plan (also known as Medicare Part C).
There are two parts to Original Medicare. Part A covers inpatient services received at a hospital or skilled nursing facility (SNF) as well as hospice care. Medicare Part B covers outpatient services like doctor visits and lab work.
Medicare Part C plans provide the same benefits as Original Medicare with the exception of hospice care. That is still included with your Medicare Part A coverage. However, most MA plans provide additional benefits. For example, around 90 percent of Advantage plans include prescription drug coverage. Other common extra benefits include routine vision services, dental care, fitness programs, and hearing aids.
Other Ways to Supplement Your Medicare Coverage
If you decide to stay with Original Medicare, we recommend joining a Medicare Supplement plan. Commonly known as Medigap, these insurance plans help pay for a variety of healthcare costs. Your Medigap Open Enrollment Period starts the day you are both age 65 or older AND enrolled in Original Medicare. If you apply for a Medigap policy during your OEP, you cannot be denied coverage for any reason – even if you have preexisting medical conditions. Outside of your Medigap OEP, your application goes through medical underwriting, which may result in you being denied coverage or charged a higher premium.
You cannot have both Medigap and a Medicare Advantage plan.
Learn more in our What Is Medigap article.
When Is the Medicare Annual Enrollment Period?
Medicare Annual Enrollment starts on October 15 and ends December 7. Unlike the MA OEP, all current Medicare beneficiaries may participate in the annual election period.
During Annual Enrollment, you may make pretty much any desired change to your Medicare coverage. This includes:
- Switching to a new Medicare Advantage plan
- Leaving Original Medicare to join an Advantage plan
- Leaving an Advantage plan to return to Original Medicare
- Joining, leaving, or switching to a new Medicare Part D plan
Any changes made during AEP will take effect on January 1. If you do not make any changes, your current Medicare coverage simply rolls over to next year.
What Happens if You Miss Your Initial Enrollment Period?
If you didn’t sign up for Medicare during your Initial Enrollment Period, you may do so during the General Enrollment Period. Or, depending on your unique situation, you may qualify for a Special Enrollment Period.
The Medicare General Enrollment Period
The Medicare General Enrollment Period occurs every year between January 1 and March 31. It is for anyone who qualifies for but does not have both parts of Original Medicare (Parts A and B).
During General Enrollment, your only option is signing up for Medicare Part A and/or Part B. Then, from April 1 through June 30, you may join a Medicare Part D and/or an Advantage plan.
All coverage choices made during General Enrollment will begin on July 1.
Special Enrollment Periods
If you qualify, Special Enrollment Periods allow you to make changes to your Medicare coverage outside of the annual and MA open enrollment periods. The most common special circumstances are losing your current coverage and moving outside your plan's service area.
You may also qualify for an SEP if you become dual eligible (i.e. qualify for both Medicaid and Medicare) OR if you lose dual eligibility. Medicare beneficiaries who are dual eligible also qualify for Extra Help paying their Medicare Part D costs. There are several levels of Extra Help available. Discover whether you qualify by clicking here.
How to Compare Your Medicare Plan Options
When comparing Medicare Advantage plans, you should look at both costs and benefits.
Your out-of-pocket costs with Medicare Advantage may include monthly premiums, deductibles, and copays or coinsurance. Private insurance companies provide these plans, so costs vary. Please note that, even if you join an Advantage plan, you still have to pay the Medicare Part B premium ($148.50 in 2021).
Benefits also vary according to the plan and insurance company you choose. Any extras you get with an MA plan help put the plan's out-of-pocket costs in perspective. The average premium for a Medicare Advantage Prescription Drug plan is between $25 and $70 per month. Around 60 percent of MA plans have a $0 premium.
Comparing your Medicare options easy with our Find a Plan tool. Just enter your location and coverage start date to review Medicare plans in your area.
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