If you’re unhappy with your current Medicare Advantage plan, the Medicare Advantage Open Enrollment Period is a once a year window where you can make a one-time change.
Time and time again, we hear how beneficiaries decided to go with a Medicare Advantage plan without fully understanding how these plans work.
It happens when beneficiaries try to take on the task of enrolling in a plan without an agent. Or with an agent who didn’t have their clients’ best interest in mind.
If you fall into at least one of the above categories, then keep reading. The video below also goes over this enrollment period in depth.
The Medicare Advantage Open Enrollment Period Explained for 2020
The Medicare Advantage Open Enrollment Period runs annually between January 1st and March 31st.
During this window, a current Medicare Advantage enrollee can do one of two things:
- Switch from one Medicare Advantage plan to another.
- Disenroll from a Medicare Advantage plan and return to Original Medicare, with or without a Prescription Drug plan.
If you have an MAPD, you can switch to another MAPD. Or, you could switch from MAPD to PDP.
You can only make one change to your healthcare coverage during this time, so choose wisely. Once you make that change, you cannot make another change until the Medicare Annual Enrollment Period outside of qualify for a Special Enrollment Period.
This enrollment period is ONLY for beneficiaries currently enrolled in a Medicare Advantage plan.
Who the Medicare Advantage Open Enrollment Period is NOT For
This enrollment period is NOT for new beneficiaries trying to enroll in Part A or Part B.
It’s NOT for new beneficiaries seeking to join in a Part D plan who are not currently on a Medicare Advantage or MAPD plan.
It’s also NOT for those seeking to switch their PDP to another PDP.
As stated above, this enrollment period is only for those beneficiaries who are currently enrolled in a Medicare Advantage plan.
For those familiar with Medicare, you may remember this time as the Medicare Advantage Disenrollment Period or MADP.[embedyt] https://www.youtube.com/watch?v=-rI6cg97tN0[/embedyt]
Why Discontinuing the Medicare Advantage Disenrollment Period Was a Bad Idea
The Medicare Advantage Disenrollment Period ran annually between January 1st-February 14th. The ACA legislation discontinued the Medicare Advantage Disenrollment Period back in 2010.
The problem with discontinuing the Medicare Advantage Disenrollment Period is it was forcing beneficiaries to keep a plan they didn’t want, or that didn’t fit their healthcare needs for an entire year.
Many times, the beneficiary has the misconception that their Medicare Advantage plan is, or is the same as, a supplement plan, which could not be further from the truth.
How Legislation is Attempting to Fix the Problem
The plan’s Summary of Benefits now highlights the fact that it’s a Medicare Advantage plan and not a supplement throughout. Protecting both the beneficiary as well as the agent.
Renaming & Reinstating the OEP
By discontinuing the MADP, the legislation eliminated the only other opt-out period, outside the AEP, for beneficiaries to get out of a Medicare Advantage plan.
It locked the beneficiary into a plan for an entire year that didn’t provide them with the healthcare coverage they wanted.
The solution? After eight years, they renamed & reinstated the Medicare Open Enrollment Period.
The Disadvantage of Zero-Dollar Premium Medicare Advantage Plans
There is a TON of hype about zero-dollar premium Medicare Advantage plans, especially around the Annual Enrollment Period, when most beneficiaries make changes to their Medicare coverage.
After AEP, when beneficiaries who recently enrolled in one of these plans go to use their benefits for the first time at the beginning of the new year, they’re not prepared for the out of pocket costs.
What most don’t realize is those zero-dollar premium plans have high out of pocket costs. These costs fall under copays, coinsurance, and deductibles.
Not all Advantage plans have zero-dollar premiums. However, those that do tend to have higher out of pocket costs compared to those that have a low monthly premium.
The other disadvantage of zero-dollar premium Medicare Advantage plans their limited doctor network. Unfortunately, most beneficiaries don’t realize this until they go to see their current primary care physician, and they find out that they’re not included in the Advantage plans network of doctors.
Medicare Advantage Disenrollment Period vs. Medicare Advantage Open Enrollment Period
The differences between these enrollment periods were the changes you were allowed to make, as well as the time frame given to make those changes.
With the Medicare Advantage Disenrollment Period, you could only disenroll from your Medicare Advantage plan and switch back to Original Medicare.
With the Medicare Advantage Open Enrollment Period, you’re allowed to either switch back to Original Medicare or switch to another Medicare Advantage plan.
Another benefit of the new revised Medicare Advantage Open Enrollment Period was the window of time to make these changes. Before, you only had six weeks. Now, you have twelve weeks to make changes.
Policy Effective Dates
If you enroll in a policy during the Medicare Advantage Open Enrollment Period, coverage starts on the 1st day of the month following the date of the new enrollment request.
For example, those requests in January become effective on February 1st. Applications in February become effective March 1st.
You can only drop or switch your Medicare Advantage plans once between January 1st through March 31st.
With that said, make sure the changes you’re making are the right changes. Otherwise, you’ll have to wait until the Annual Enrollment Period to make changes again.
Open Enrollment Period vs. Annual Enrollment Period
The Annual Enrollment Period is the annual enrollment window during the fall, October 15th- December 7th.
During AEP, you can make changes more than once; the final enrollment is the one in effect.
The OEP is for people who chose a less than optimal plan during AEP. It’s a second shot at a better policy.
What if you Miss the AEP and the OEP?
If you missed the AEP and the OEP, you might qualify for another election period called the Special Election Period.
The Special Election Period allows individuals to enroll, disenroll, and switch plans in particular situations.
Such qualifications consist of the following:
- Have full Medicare AND Medicaid coverage
- Reside in a rehabilitation hospital, nursing home or Skilled Nursing Facility
- If a 5-Star Medicare Advantage plan is in your area
- When you qualify for the Low-Income Subsidy program
- If you move out of your plan’s service area
You only need one of the qualifications on the list for eligibility. When making changes during a SEP, coverage will start the first day of the month after the application submission and acceptance.
For example, if you applied for coverage on March 15th, the soonest you would have coverage would be April 1st. You may only use the same SEP once per year.
Medicare Advantage Trial Rights SEP
There’s a 12-month one-time get out of jail free card called the Trial Right.
Why 12 months? Because many beneficiaries are happy with their Medicare Advantage plan right up until the point of actually needing to use the benefits.
You qualify for a SEP Trial Right if:
- It’s your first time enrolling in a Medicare Advantage plan, and it’s been in effect for less than one year
- If you left a Medigap plan to enroll in a Medicare Advantage plan within the last 12 months
- If you joined a Medicare Advantage plan when you were first eligible for Medicare at age 65, you are allowed to switch back to Original Medicare at any time within the first 12 months.
Other Enrollment Periods vs. the Medicare Advantage Open Enrollment Period
The MA OEP takes priority over all different enrollment periods. That means if a beneficiary is eligible for another enrollment period during the MA OEP, they must use the MA OEP first.
After using their one-time election during the MA OEP, they can use any other enrollment period that they’re eligible for during that time to make changes.
Laments Terms Please
In laments terms, if you’re eligible for another enrollment period at the same time as the annual MA OEP, you need to use the MA OEP first. Then, if you need to make another change for any reason, you can use the other enrollment period to do so.
The Only Exception to this Rule
The only exception to this rule is the Initial Coverage Election Period. The ICEP is an open enrollment window for newly-eligible beneficiaries to enroll in a Medicare Advantage plan.
If the beneficiaries ICEP is occurring at the same time as the MA OEP, their ICEP will take priority.
So, you use your ICEP first. Then, if you need to make changes again, and you’re still within the MA OEP window, you can use the MA OEP to make those changes.
When can I disenroll from a Medicare Advantage plan?
You can disenroll during the Medicare Advantage Open Enrollment Period or the Annual Enrollment Period. You can also disenroll if you qualify for a Special Election Period.
If I Drop my Medicare Advantage plan and switch back to Original Medicare, would I be able to enroll in a Medigap plan?
Once you disenroll from a Medicare Advantage plan, you can enroll in a Medigap policy. It’s essential to make sure your advantage plan cancels BEFORE your Medigap plan application.
Why? Because it’s against the law to have an Advantage plan and a Medigap plan at the same time.
Switching from an Advantage plan to a Medigap plan is a time-sensitive matter, which is why it’s essential to have an agent by your side, helping you make these changes.
Also, unless you’re within your Medicare Supplement Open Enrollment Period window, or qualify for a SEP, you’ll have to answer health questions.
We have a great article that compares Medicare Advantage Plans vs. Medicare Supplements that’s exceptionally informative.
An individual can enroll in a Part C Medicare Advantage plan at what time?
If you’re new to Medicare than your ICEP is when you would first be eligible to enroll. When you miss your ICEP, you can use the AEP to enroll. If you’re currently enrolled and want to make changes, you can use the AEP or MA OEP.
How many Medicare Advantage plans are there?
Medicare Advantage plan availability is 100% dependent on where you live and is granular as to what county you live in. You may live in a county that offers many, but the county next to yours may offer only a few.
How to disenroll from a Medicare Advantage plan?
Use the MA OEP between 1/1-3/31 or the AEP between 10/15-12/7 to disenroll. Or, if you’re eligible for a SEP, you can also disenroll.
Are You Still Confused?
You’re not the only one. We know most beneficiaries are unaware of the multiple different enrollment periods. That’s where we can help!
If you’re looking to change your current Medicare Advantage plan, give us a call. Don’t use up your one-time election to get the wrong coverage… again.
We can help you get the coverage you needed from the beginning. Give us a call. You can also use our online rate form to see rates for all plans in your area.