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Understanding Medicare Enrollment Periods.

Did you know that there are more than twenty Medicare enrollment periods that can be used to enroll in a Medicare Advantage or Prescription Drug Plan if you qualify?

What are enrollment periods? 

Each year, Medicare provides several windows of time when people can enroll in a Medicare Advantage or Prescription Drug plan. Although each of these periods provide an opportunity to enroll, there are different qualifying factors, and the effective date of your coverage will depend on the rules of the enrollment period.

The Medicare Annual Enrollment Period (AEP) is often referred to as Medicare’s Fall Open Enrollment and that is because it occurs October 15 to December 7 each year.

This Medicare enrollment period is designed to allow people with Medicare to change their coverage. Common changes include:

  • Switching from Original Medicare to a Medicare Advantage plan
  • Joining or changing a Medicare Advantage plan
  • Joining or changing a Medicare Part D prescription drug plan

Changes made during the Annual Enrollment Period take effect on January 1 of the following year. 

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Medicare Advantage and Prescription Drug Plans

The Medicare Advantage Open Enrollment Period is every year from January 1 to March 31. During this time, anyone with a Medicare Advantage plan can make a one-time change to their coverage. This is extremely helpful if you were unable to modify your healthcare plans during the Annual Enrollment Period. Furthermore, if you are dissatisfied with your new Medicare Advantage plan coverage, this is the time to switch.

You can even return to Original Medicare during the Medicare Advantage Open Enrollment Period if you would like, but keep in mind that this enrollment period is only for people already on Medicare Advantage.

Does this enrollment period apply to you? 

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Initial Coverage Election Period

During the Initial Coverage Election Period you can enroll in a Medicare Advantage plan. The Initial Coverage Election Period is usually the same time period as your Initial Enrollment Period for Medicare if you enrolled in Medicare Part A and Medicare Part B when you are first eligible.

However, if you delay your enrollment in Medicare Part B, your initial coverage election period (ICEP) is only the three months before your Part B coverage takes effect. This means that you will want to fill out your enrollment application within the three months before your Medicare Part B is effective. Your Medicare Advantage plan will be effective the same month your Medicare Part B is effective.

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When certain life events occur, such as moving or losing other insurance coverage, you will be given a Special Enrollment Period (SEP) to enroll in a new plan. There are over twenty Special Enrollment Periods for Medicare Advantage and Prescription Drug plans! Each Special Enrollment Period is different. They have different timeframes and rules determining when the new plan will begin. Do you qualify for a Special Enrollment Period? Let’s find out.

If any of the following statements apply to you, then you might be eligible to enroll using a special enrollment period.

I am moving and have a Medicare Advantage or Prescription Drug plan.

If you are in a Medicare Advantage plan or Prescription Drug plan and move out of the plan’s service area you will have a special enrollment period to choose a new plan.

The enrollment period timeframe depends on when you notify your plan of the move.  If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move.  If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months.

With this enrollment period, you can choose your effective date up to three months after your completed enrollment application, but it cannot be before the date of your move.

For example, Jane is moving on March 14.  She tells her plan that she is moving in January.  Her enrollment period is February 1 – May 31.  She completes an enrollment application on Healthpilot’s website in March.  She can choose from the following effective dates: April 1, May 1, or June 1.

Fun fact:  If you are moving to a new address that is still in your plan’s service area but will have new plan options available to you, you can also use this enrollment period.

I moved back to the United States after living outside the country.

Now that you are back in the country, you should have your Medicare Parts A and B reinstated.  Once your coverage is reinstated, you can enroll in a new Medicare Advantage plan or Prescription Drug plan.  The enrollment period begins the month you move back and continues for two additional months.

I am moving into, currently live in or are moving out of an institution (such as a nursing home).

If you are moving into or currently live in an institution, you can choose to enroll in a new Medicare Advantage plan or Prescription Drug plan.  Your enrollment period will end 2 months after you move out.  Your new plan will begin the month after you complete your enrollment application.

I have or had coverage through my or my spouse’s employer, but:

I am discontinuing the coverage I get through my employer (including COBRA).

If you have employer group coverage (including COBRA) you can choose to discontinue the coverage through your employer and enroll in a Medicare Advantage plan or Prescription Drug plan using this special enrollment period.   You may choose your new plan’s effective date of up to three months after the month you complete the enrollment application.

I have been notified that I am losing my employer sponsored coverage

You can enroll in enroll in a Medicare Advantage plan or Prescription Drug plan.  Your enrollment period starts the day you are notified that you will lose coverage and ends two full calendar months after you received notice or after your coverage ends, whichever is later.

For example, Jane is notified on June 12 that her coverage will end July 31.  Her special enrollment period is June 12 through September 30.

I have been notified that my employer sponsored coverage is no longer going to be creditable.

You can enroll in enroll in a Medicare Advantage plan or Prescription Drug plan.  Your enrollment period starts the day you are notified that your coverage will no longer be creditable and ends two full calendar months after you received notice or after your creditable coverage status ends, whichever is later.

For example, Jane is notified on June 12 that her coverage will no longer be creditable starting July 31.  Her special enrollment period is June 12 through September 30.

Note: Did your employer fail to tell you that your coverage was not creditable, or did you learn of the loss of creditable coverage after the change took place?  You may also qualify for a special enrollment period.  Contact Healthpilot to learn more.

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You can enroll in a Medicare Advantage plan, Prescription Drug plan or a Dual-Eligible Special Needs Plan (D-SNP).  The special enrollment period starts the month you become eligible for Medicaid and have Medicare Parts A and B and lasts as long as you have both Medicare and Medicaid.

This enrollment period can be used once during each of the following time periods:

  • 1st Quarter: January – March
  • 2nd Quarter: April – June
  • 3rd Quarter: July – September

Your coverage will begin the first of the month after you complete your enrollment application.  So, if you complete an enrollment application on March 5, your coverage will begin April 1.

The enrollment period is considered “used” based on the month you complete the enrollment application.  For example, Jane completes an enrollment application in March (which would be effective April 1st), this counts as “using” the enrollment period for the 1st quarter, not the 2nd quarter.

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  • If you learn that your Medicaid level of assistance is changing, whether you qualify for more benefits or less benefits, you have an additional enrollment period available to you to enroll in a Medicare Advantage plan, Prescription Drug plan or a Dual-Eligible Special Needs Plan (D-SNP).

    The enrollment period can be used one time within three months of the change, or notification of a change, whichever is later.  Your new plan will begin the month after you complete your enrollment application.

    For example, Jane learns in June that she qualifies for more medical assistance.  The additional medical assistance starts July 5.  Her enrollment period is July through September 30.  If she completes her enrollment application in July, her new plan will begin on August 1.

  • If you learn that you are losing your Medicaid coverage, you will have an  enrollment period available to you to enroll in a Medicare Advantage plan or Prescription Drug plan.

    The enrollment period can be used one time within three months of the loss, or notification of the loss, whichever is later.  Your new plan will begin the month after you complete your enrollment application.

  • You have a special enrollment period that you can use to enroll in a Medicare Advantage plan or Prescription Drug plan.  This one-time enrollment period begins the month you are notified that you will be losing your plan and ends three calendar months after your Dual-Eligible Special Needs Plan coverage ends.  Your new plan will begin the month after you complete your enrollment application.

  • You have a special enrollment period that you can use to enroll in a Medicare Advantage plan or Prescription Drug plan.  The enrollment period starts the month you become eligible for Extra Help and lasts as long as you have Extra Help.

    This enrollment period can be used once during each of the following time periods:

    • 1st Quarter: January – March,
    • 2nd Quarter: April – June, and
    • 3rd Quarter: July – September.

    Your coverage will begin the first of the month after you complete your enrollment application.  So, if you complete an enrollment application on March 5, your coverage will begin April 1.

    The enrollment period is considered “used” based on the month you complete the enrollment application.  For example, Jane completes an enrollment application in March (which would be effective April 1st), this counts as “using” the enrollment period for the 1st quarter, not the 2nd quarter.

  • If you learn that your level of Extra Help is changing, whether you qualify for more benefits or less benefits, you have an additional enrollment period to enroll in a Medicare Advantage plan or Prescription Drug plan.

    The enrollment period can be used one time within three months of the change, or notification of a change, whichever is later.  Your new plan will begin the month after you complete your enrollment application.

    For example, Jane learns in June that she qualifies for more Extra Help.  The additional Extra Help starts July 1.  Her enrollment period is July through September 30.  If she completes her enrollment application in July, her new plan will begin August 1.

  • If you learn that you are losing your Extra Help, you will have an  enrollment period available to you to enroll in a Medicare Advantage plan or Prescription Drug plan.

    The enrollment period can be used one time within three months of the loss, or notification of the loss, whichever is later.  Your new plan will begin the month after you complete your enrollment application.

  • If you belong to a qualified State Pharmaceutical Assistance Program through your state, you are given one special enrollment period per year to enroll into a Medicare Advantage plan with prescription drug coverage or a Prescription Drug plan.

    Your new plan will begin the month after you complete your enrollment application.

  • This is not a complete listing of special enrollment periods.  That’s right, there’s more! Contact Healthpilot to learn more.

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