As if figuring out which type of Medicare Plan wasn’t confusing enough, now you realize you need to make changes or swap plans. When can you do this?
Different types of Medicare plans have different enrollment windows based on the specific characteristics of that plan and the needs of those eligible for that plan.
Don’t worry about trying to figure it out for yourself. The independent agents at Braden Insurance have the answers to when the Medicare Annual Enrollment Period is and everything you need to know surrounding it.
What is Medicare Open Enrollment?
The Medicare Annual Enrollment Period, also referred to as AEP, is the time for those who are already enrolled in Medicare to make decisions regarding whether to join, switch, or drop Medicare plans. Some of the things you can do during this window include:
- Drop Original Medicare and enroll in a Medicare Advantage plan
- Drop your Medicare Advantage plan and enroll in Original Medicare
- Change from one Medicare Advantage plan and enroll in a different Medicare Advantage Plan
- Change from one Prescription Drug Plan (PDP) to a different one
In addition to the Medicare Annual Enrollment Period, there are other enrollment windows that are specific to different Medicare plans and situations. These other windows include:
- Initial Enrollment Period
- General Enrollment Period
- Open Enrollment Period or Annual Election Period
- Special Enrollment Period for the Working Aged and Working Disabled
- Medicare Advantage Disenrollment Period
- Medigap Open Enrollment Period
We will touch more on these enrollment windows in the following sections.
Simple out, the Medicare Annual Enrollment Period is designed for individuals who are already enrolled in Medicare to make changes to their current policy. You will want to take advantage of the annual enrollment period to review, change, or adjust your Medicare plan.
When is the AEP?
The Medicare Annual Enrollment Period is a six week window that lasts from October 15th through December 7th. Any changes or new policies will take effect January 1st of the following year.
The other enrollment periods each have their own dates for eligible recipients to sign up and make changes. Here is a quick reference chart that has the type of enrollment period, when the period is, and when changes/enrollments will take effect.
|Acronym||Definition||Medicare Enrollment Dates||Effective Dates|
|IEP||Initial Enrollment Period||7 months surrounding your 65th birthday||No sooner than your birthday month, or 25th month of disability benefit entitlement|
|GEP||General Enrollment Period||January 1 through March 31||July 1|
|OEP or AEP||Open Enrollment Period or Annual Election Period||October 15 through December 7||January 1 of the following year|
|SEP||Special Enrollment Period||For Original Medicare: 8 months after you retire or lose creditable coverage|
For Medicare Advantage: 63 days after the loss of employer coverage
|Coverage state date varies|
|MADP||Medicare Advantage Disenrollment Period||January 1 through February 14||The first day of the month after your enrollment form is received|
|Medigap OEP||Medigap Open Enrollment Period||6 months starting the month you're 65 or older and enrolled in Medicare Part B||Can vary, but usually begins the first day of the month after you apply|
Changes You Can Make During the Medicare AEP
Are you a Medicare recipient, but find that the plan and choices you previously made are not currently suiting your needs? Then during the Medicare Annual Enrollment Period is your opportunity to make changes to your current policy.
During the AEP, you can make any of the following changes, unless you qualify for an exception throughout the rest of the year:
You may add, drop or change your Medicare Part D prescription drug coverage
Medicare prescription drug plans can change the drugs it covers during the course of the year with 60 days notice to affected parties. While your plan will continue to cover the drug until the end of the calendar year, you might lose coverage in January.
You may add, drop or change Medicare Advantage plans (Part C)
During the AEP you enroll in Medicare Advantage, make changes to your current plan, or sign up for a different plan. If you wish to disenroll and swap back to Original Medicare, you can do so during the Medicare Advantage Disenrollment Period. We will discuss this in later section.
Switch from Original Medicare (Medicare Parts A and B) to a Medicare Advantage plan.
Switch from a Medicare Advantage plan to Original Medicare
Original Medicare covers hospital and doctor visits including emergency and urgent care. Medicare Advantage is provided through an HMO or PPO. Medicare Advantage Plans cover vision, hearing, dental and general healthcare but require you to choose a primary care physician and use only doctors, hospitals, and other medical facilities that are part of that health plan’s provider network. Medicare will pay for your advantage plan up to a fixed amount, but it may require an additional co-payment, premium or out-of-pocket expense.
How to Prepare for the Medicare Enrollment Period
As the Medicare Annual Enrollment Period draws near, it’s important to review your current Medicare coverage. You may consider the following questions to determine if you have the right coverage for your needs and budget.
1. Has your health status changed in any way that will require more, or fewer, health care services in the coming year? Do you foresee needing any procedures or surgeries in the coming year?
Anytime you have surgery, a procedure, or new diagnosis, your prescriptions and the services you might need may change. You should definitely take a careful look at your current plan to make sure that it covers everything you may possibly need in the coming year. If you are in good health and you don’t foresee any major changes, great! But it might be a good idea to ensure you have adequate coverage for the “just-in-case” scenarios.
2. Does your current plan cover all the services you use or did you have to pay for things that you’d like to have coverage for?
Talk to you insurance agent about the services that you use that are not covered and which plan would provide the best coverage for those services. If you think your plan fits your needs, you are probably good to stay where you are, but be sure to consider any services you might need in the future.
3. Does your current plan cover services that you don’t use or no longer need?
If you’re paying for services that you don’t need, you might consider changing to a plan that offers less coverage so that you aren’t paying for extra coverage that you are not using. Nobody wants to pay for things they don’t need so take a look at your current plan and evaluate whether it’s still the right one for you.
4. Are there changes being made to your current plan in the coming year, such as adding or deleting services or an increase in price?
Be sure you are educated about what changes are being made to your current Medicare plan. Review your prescriptions and your prescription coverage to see if any of your drugs are no longer covered in the coming year.
5. What were your out-of-pocket health care costs this year? Are you comfortable with your current plan premiums, deductibles, co-pays, and coinsurance? Would a plan with a higher or lower premium or deductible better meet your needs?
It is always a good idea to double check your budget, and run the numbers on your income and expenses in the coming year. Unexpected changes can always occur, but it is a good idea to be sure your budget can handle your Medicare costs.
What Happens If You Miss Medicare Annual Enrollment Deadline?
You may be the most organized person in the world, but for some unforeseeable reason, the Medicare AEP just flies past you. Many life events can cause you to miss the AEP deadline.
- An unexpected trip
- Family emergency
- Death of a family member or friend
- Sudden work crisis
For most Medicare recipients, you will have to remain with your current plan and wait until the following year when the Medicare Annual Enrollment Period rolls around again. For some qualified Medicare individuals, there are other enrollment periods in which you can add, drop, or make changes to your current plan.
Medicare Special Enrollment Period (SEP)
You can qualify for SEP if you experience one or more of the following situations:
- You moved outside of your current plan’s service area
- You moved to an area inside your current plan’s service area, but this area offers access to new plan options
- You moved back to the U.S. after living outside the country
- You just moved into or out of a skilled nursing facility or long-term care hospital
- You were just released from prison
- You were affected by natural disasters specified by the Centers for Medicare & Medicaid Services
- You left coverage from your employer
- You have a new opportunity for coverage through an employer or union
- Medicare has taken official action (“sanction”) against your current plan or terminates their contract with Medicare
- You are diagnosed with a chronic illness or condition that qualifies you for a Special Needs Plan (SNP) that serves Medicare beneficiaries with that specific condition
These different scenarios can have different lengths of enrollment periods, so it’s important to talk to an independent Medicare agent who can help you through the process.
5-Star Special Enrollment Period
Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. Plans can receive a rating from 1 to 5. A 5-star rating is considered to be the top rating and is awarded a label of excellence. These ratings can help individuals compare different plans based on quality and performance. Each autumn, the ratings are re-evaluated and could change for the upcoming year.
This enrollment period lasts from December 8th, the day after AEO is over, through November 30th of the following year.
You can only switch to a 5-Star Medicare plan is one is available in your area. So talk to an agent at Braden Insurance to see if you can sign up for a 5-Star plan.
Medicare Supplement (Medigap) Enrollment
Medigap plans may have a separate enrollment period in some states. These open enrollments allow you to update or change your MediGap health coverage without medical underwriting. This option may change from state to state, so it’s important to understand the individual rules in your state in order to make a change outside of AEP by contacting an independent agent.
In Louisville, KY, the enrollment window is six months and starts the month you turn 65 and are enrolled in Medicare Part B.
Special Needs Plans (SNPs)
Medicare SNPs are a type of Medicare Advantage Plan for people with specific diseases or characteristics.
If you qualify for a SNP, you can enroll at any time, provided one is available in your area.
The Medicare Advantage Disenrollment Period
The Medicare Advantage Disenrollment Period is commonly referred to as MADP. This is the time when those who are enrolled in the Medicare Advantage plan have the option to switch back to Original Medicare.
This period is only six weeks long and it runs from January 1st through February 14th. Depending on what you plan to do during this time, there are some important things to remember.
For those who want to swap from a Medicare Advantage Plan to Original Medicare:
This time period is designed specifically for those who want to switch from Medicare Advantage or Original Medicare. It is not designed for any other changes to your policy.
In order to disenroll during MADP, you must make a request. All requests are processed the first of the following month. Meaning, if you want to disenroll on January 1st, you must make a request by December 1st. If you make a request in January, you will still have time to disenroll on February 1st.
It’s important to note that this time is not an additional enrollment period, which means that you cannot enroll in Medicare Advantage or switch between Medicare Advantage options. However, if you are planning to disenroll from Medicare Advantage, you may use this opportunity to enroll in a Medicare Supplement policy upon returning to Original Medicare.
For those who want to make changes to Prescription Plans:
Although this is not an additional enrollment period, you can make the necessary changes to your prescription plan if you choose to disenroll from Medicare Advantage. Those enrolled in a Medicare Advantage Prescription Drug plan, also called MA-PD, may disenroll from MA-PD at this time as well.
This gives you the opportunity to enroll in a stand alone Prescription Drug Plan. However, those members with a MA-PD plan who choose to enroll in a stand alone Prescription Drug Plan during this time will not have the option of enrolling in another Medicare Advantage Plan.
All changes to your prescription plan must be complete by February 14th, so it’s important to talk to an independent Medicare agent so you don’t find yourself without coverage. If you currently have a stand alone Prescription Drug Plan, you cannot make changes to your plan during this time. Those changes can be made during the next open enrollment period.
Braden Insurance Can Guide You Through The AEP
As the Medicare Annual Enrollment Period rolls around, it can be a stressful couple of weeks. When it comes to their Medicare coverage, not everyone knows exactly what that have, what they need, and what they don’t need. Having everything organized ahead of time will make you feel better about your decision.
Regardless if you are a Medicare pro or have no clue what you are doing, then talking to one of our friendly independent agents at Braden Insurance can put your mind at ease. Give us a call today and we will get you prepared for your next Medicare enrollment window.