The Medicare OEP is a confusing term. It can mean multiple different election periods. Recently, some election periods have been replaced by new ones. Below, we’ll dive into the various meanings for the Medicare OEPs as of 2020.
Medicare OEPs Explained in 2020
OEP stands for Open Enrollment Period.
Incorrect Medicare OEPs
The most commonly referred incorrect OEP is the Fall Annual Enrollment Period. To make it even more confusing, this is also known as the Annual Election Period. During AEP, you can make a change to your Medicare Advantage and Part D plan. However, this is not an OEP.
Most beneficiaries also incorrectly refer to their Initial Enrollment Period as their OEP. Your IEP is the 7-month enrollment period given when you turn 65.
Medicare Advantage OEP
Starting in 2019, Medicare recipients were given an additional OEP to make a one time change to their Medicare Advantage Plan. This period is called the Medicare Advantage Open Enrollment Period.
This OEP is nothing new. It was a part of every Medicare year until the ACA legislation discontinued it. The ACA law was signed back in 2010, which ended the Medicare OEP. It was replaced with the Medicare Advantage Disenrollment Period, which occurred annually between January 1st – February 14th.
However, the Medicare Advantage Disenrollment Period was different than the Medicare Advantage Open Enrollment Period. The disenrollment period only allowed beneficiaries to switch back to Original Medicare. Now, with the Medicare OEP, you can switch back to Original Medicare or switch to a different Medicare Advantage Plan. However, you can only make one change.
What is the Medicare OEP?
The Medicare OEP gives current Medicare Advantage enrollees a time frame to make a one-time change.
- Drop your Medicare Advantage Plan and return to Original Medicare. This can be with our without a Part D plan.
- Switch from one Medicare Advantage Plan to another Medicare Advantage Plan
During the Medicare OEP, you CANNOT change from one Part D plan to another. You can also only use this OEP once.
It’s better to use the Fall Open Enrollment to make coverage decisions. This is because if you wait to use the MA OEP, it could mean a later start date for essential changes to take effect.
Why the Medicare OEP Came Back
A lot of beneficiaries are not educated enough to make crucial decisions regarding their Medicare benefits. Even after working one on one with an agent, they still consider Advantage plans as supplements plans.
Many don’t realize that these plans require copays and have stringent network limitations. They end up late finding out that their current doctor doesn’t participate in their current Advantage plan.
Beneficiaries may also not check the drug formulary to confirm it covers all of their medications. Many get hung up on the fact that there’s a low premium and don’t take into consideration how the plan works. They end up with a hospital bill that’s over $1,600 and don’t understand why or how.
I Just Signed Up for my Medicare Advantage Plan, Why Would I Want to Change Already?
Some Advantage plans provide extra benefits that can change every year. These benefits may include dental, vision, and hearing benefits.
Sadly, it’s only for preventive coverage. In most cases, it’s challenging to find a dentist that will accept the plan.
A reason some may want to drop their plan is due to the constant network changes with doctors. What this means for a Medicare beneficiary is your doctor could suddenly be out of network.
These policies provide a lower monthly premium in exchange for a restricted physician network.
Case Example #1
Ms. Turner turns 65 in February. She enrolled in Original Medicare in January during her Initial Enrollment Period. She then decided in February to enroll in a Medicare Advantage Plan. Then in March, Ms. Turner goes to use her coverage and realizes that her doctor does not participate in Medicare Advantage. She can use the MA OEP to switch to another Advantage plan or go back to Original Medicare.
It’s important to know that any beneficiary eligible for other enrollment periods during the MA OEP must use the MA OEP. Once they use their one-time election period during the MA OEP, they can use any other enrollment period they qualify for.
Case Example #2
Mr. Benson has Extra Help. He uses the MA OEP to switch to a different Advantage plan. His plan will be in effect February 1st. A few weeks later, Mr. Benson finds out his pharmacy is out of network. Mr. Benson can use his quarterly Extra Help Special Enrollment Period to change plans in February, which will give him a March 1st effective date.
OEP for Medicare Supplements
In most states, the Medicare Supplement enrollment period begins the month you turn 65, and your Part B is in effect. During these six months, you can choose any Medicare Supplement plan without having to qualify medically.
There are a few states that have different OEPs. For example, New York and Connecticut have year-round open enrollment. On average, beneficiaries in one of these states should expect to pay a higher premium for coverage.
Honestly, Medicare could not make the terminology anymore confusing.
What if I Miss One of These Enrollment Periods?
Some situations occur outside of the above OEPs that allow for change.
A Special Enrollment Period will let you enroll outside of these enrollment periods.
Qualifying situations include:
- Moving out of your plan’s service area
- Receiving both Medicare and Medicaid
- Having any level of extra help or low-income subsidy
- Living in, moving to or from an Institution, such as a long-term care hospital or skilled nursing facility
How long is Open Enrollment for Medicare?
When talking about the Medicare Advantage Open Enrollment Period, it runs from January 1st-March 31st.
Can you go back to Original Medicare from an Advantage plan?
Yes, during the Medicare Advantage Open Enrollment Period. You also have a 12-month trial right that you can use the first time you enroll in a Medicare Advantage Plan.
Clear Up the Confusion
Local agents that come to your home usually only offer one or two carriers. That method of enrollment doesn’t benefit you. Which is why most Medicare plan enrollments happen over the phone.
The best practice is to contact an agency licensed nationwide with access to all your options. Contact an agent will ensure that you are well informed, understand your options, and any limitations. It will also guarantee you are not compromising your needs to obtain an affordable premium.
At MedicareFAQ, we treat you like family. We will never enroll you into a policy that we wouldn’t enter our family in. Plus, when you join us, you get unlimited support through our Client Care Team. Give us a call, or you can compare rates online in your area using our rate form.