Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period runs annually between January 1st and March 31st. But, there are plenty of Medicare Advantage Enrollment Periods you should understand.

During this window, a current Medicare Advantage enrollee can do one of two things:

1. Switch from one Medicare Advantage plan to another.
2. Disenroll from a Medicare Advantage plan and return to 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.

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.

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.

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.

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.

The Annual Enrollment Period is the open 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.

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.

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:

1. It’s your first time enrolling in a Medicare Advantage plan, and it’s been in effect for less than one year
2. If you left a Medigap plan to enroll in a Medicare Advantage plan within the last 12 months
3. 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.

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, you can use the MA OEP to make those changes.

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.