While opportunity knocks five times for enrollment in Medicare Advantage Plans, timing is key and misinterpreting the rules can cost you dearly.
The five Medicare Advantage Plan enrollment periods:
- The Initial Enrollment Period (IEP)
- The Initial Coverage Enrollment Period (ICEP)
- The Medicare Advantage Annual Enrollment Period (AEP)
- The Open Enrollment Period for Medicare Advantage (OEP)
- All Special Enrollment Periods (SEPs)
IEP refers to both the Original Medicare Initial Enrollment Period for Parts A and B and a specific Medicare Advantage Enrollment Period (AEP). The IEP is a seven-month period that includes the three months before you turn 65, the month you turn 65, and the three months after you turn 65. You must be eligible to enroll in Parts A and B of Medicare. If you enroll in both Part A and Part B during this period, your IEP to enroll in a Medicare Advantage Plan with prescription coverage (MA-PD Plan) will also occur during this seven-month period.
For most people, the ICEP occurs at the same time as their IEP for Original Medicare, Parts A and B.
However, if you delay Part B and enroll outside of your IEP, your ICEP for Medicare Advantage is shortened to the three-month period before your Part B start date and ends the last day of the month before your Part B coverage starts.
The ICEP is often misunderstood because its timing depends on whether you have delayed your Part B enrollment. If you’ve delayed Part B enrollment and don’t catch the three-month period before your Part B start date, it may delay Medicare Advantage Plan enrollment for many months.
From October 15 through December 7 each year, you can enroll in, disenroll from, or change your Medicare Advantage Plan or Prescription Drug Plan (PDP). You can submit more than one application during the AEP and the last application filed before the end of the AEP on December 7 will take effect on January 1. AEP is the only time when those on Original Medicare (Parts A & B) may enroll in a Medicare Advantage Plan, and the only time those in a PDP plan may change their coverage.
The Medicare Advantage Open Enrollment Period (MA-OEP) runs from January 1 through March 31 every year. If you are enrolled in a Medicare Advantage Plan, you will have an annual opportunity during the first quarter of every year to switch to a different Medicare Advantage Plan.
Options during MA-OEP:
- MA members have the option to leave Medicare Advantage and return to Original Medicare (Plans A and B).
- Those who return to Original Medicare will have an opportunity to enroll in a Part D Plan.
- Individuals enrolled in either MA-PD or MA-only Plans may switch to another MA-PD or MA-only Plan. The new plan would become effective the following month.
- Non-MA Plan members enrolled in Original Medicare may not join an MA Plan during MA-OEP.
- Those enrolled in Part D stand-alone Plans may not change their Part D coverage.
- MA-OEP is not available for those enrolled in Medicare Savings Accounts (MSAs), Cost Plans, or PACE Plans.
Medicare Special Enrollment Periods (SEPs)
Special Enrollment Periods (SEPs) allow Medicare members to make changes to their coverage outside of normal enrollment periods. The length of the SEP and the effective date of your new coverage will vary depending on the circumstances that trigger your SEP. The plan and ultimately the Centers for Medicare and Medicaid Services (CMS) determine whether you qualify for a SEP.
The SEPs in the tables below will allow you to change your Medicare Advantage Plan, Medicare Drug Plan, or both. The rules for changing Medicare Drug Plans may vary depending on whether you are in a stand-alone drug plan that only covers drugs or a Medicare Advantage Plan that includes both health care and prescriptions.
The changes you can make during the SEP depend on the situation and can include:
- Switching from Original Medicare to a Medicare Advantage Plan
- Switching Medicare Advantage Plans
- Switching Medicare PDPs
- Disenrolling from a Medicare Advantage Plan and returning to Original Medicare
When you may qualify for a SEP under these circumstances:
- Changes in where you live
- Changes causing you to lose your current coverage
- You have a chance to get other coverage
- Changes in your plan’s contract with Medicare
- Changes in your plan due to other special situations
Each of these SEPs will have specific rules governing the scope of changes that may be made, and the length and timing in which you must make those changes.