Understanding The Medicare Advantage Open Enrollment Period

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Understanding The Medicare Advantage Open Enrollment Period

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As a U.S. citizen, you are generally eligible for Medicare benefits when you turn 65, but don’t assume your Medicare card will automatically arrive. If you receive Social Security disability or Railroad Retirement Board benefits, you will be automatically enrolled. But if not, you must be proactive! That’s why it’s important for everyone to get to know more about Medicare open enrollment and the different enrollment periods that might apply as they enroll or make changes in coverage.

When we talk about the Medicare enrollment period, there are actually four periods that come into play:

1. Initial Enrollment Period (IEP): Starts three months before the month you turn 65 through three months after the month you turn 65.

2. Medicare Advantage Open Enrollment Period (MAOEP): January 1 to March 31.   

3. Annual Enrollment Period (AEP): October 15 to December 7.

4. Special Enrollment Period (SEP): This open period is based on qualified life events.

What Changes Can Be Made During the Annual Enrollment Period

During the Medicare Annual Enrollment Period, which runs from October 15 to December 7, people can make changes to their Medicare coverage choices that will go into effect the following January 1. The AEP is your time to join a Medicare Advantage (Part C) plan or add a standalone Medicare Part D plan for prescription drug coverage if you’re currently enrolled in Original Medicare, or Medicare Part A and B. If you already have Original Medicare and Medicare Part D, during this period, you can join a Medicare Advantage plan or switch or drop your prescription drug coverage.

For people who already are covered by a Medicare Advantage plan, the AEP is a chance to switch to another Medicare Advantage plan, add a Medicare Part D plan (if your plan doesn’t already include prescription drug benefits), or switch back to Original Medicare.

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Tips to Maximize Medicare Initial Enrollment

Enrollment periods will vary by individual. If you are enrolling in Medicare for the first time, you will have an Initial Enrollment Period.  (IEP) For most people, this period starts three months before the month in which you turn 65 to three months after you turn 65. 

For example, if you turn 65 in July, you can apply three months before your birthday month, so April, May, and June. And your IEP continues through 3 months after your birthday, so August, September, and October. If you happened to be born on the first of the month, you could enroll four months before your birth month and up to two months following your birth month.

If you are eligible for Part A but miss your IEP window, you can still apply at any time, and receive retroactive benefits for six months, if it has been six months since your eligibility date. 

You’ll want to enroll as early as possible to ensure your benefits start in your birth month. Remember, signing up after your 65th birthday month will create a delay in when your Medicare coverage starts. 

You can apply for your Medicare benefits online at www.socialsecurity.gov or on the phone by calling 1-800-772-1213. They can answer your questions about eligibility and will help you enroll. The Medicare.gov website also has a great tool to help you determine if and when you are eligible for Medicare called the Medicare Eligibility Tool, which will give you an estimate of when you are eligible and your estimated premium amount.

If you work for a company that has 20 or more employees, you may want to enroll in Medicare even if you are covered under your employer’s health plan. If your Part A plan is free of any premium, this can add another level of coverage for you. Your employee coverage becomes your primary insurance, and your Medicare Part A becomes secondary. Medicare enrollment for Part B is not premium-free and could be an expensive option. If your employer has less than 20 employees, you may be required to sign up for Medicare at age 65. That would become your primary insurance, and Medicare Part B enrollment becomes a better option.

How Health Plus Life Can Assist After Your Medicare Enrollment

Each enrollment period has different guidelines, so be sure to review them carefully or discuss them with your Health Plus Life professional.

Your initial enrollment in Original Medicare will go through the Social Security Administration, but after that, Health Plus Life is here for all your Medicare questions and needs. We’ll help evaluate your health and financial situation and recommend the best combination of Medicare plans for you. 

What Happens After the Annual Enrollment Period

Special Enrollment Periods (SEP) provide additional enrollment periods outside of your Initial Enrollment Period and can be beneficial for people who have missed the Annual Enrollment Period — but not everyone will qualify for this special period to make changes to their Medicare coverage or enroll in a plan.

Qualifications for SEPs can vary based on your specific situation, but here are some common reasons:

• Relocation: If you have moved to an address outside of your current plan’s service area, you may qualify for a SEP.

• Loss of coverage: If you have lost your existing health coverage, such as employer-sponsored health insurance, you may qualify.

• Assistance: If you become eligible for other assistance programs such as Medicaid or Extra Help prescription drug costs. You may qualify.

• Other: Some other special circumstances, such as a natural disaster or being incarcerated, may make you eligible for a SEP.

Frequently Asked Questions About Medicare Effective Dates

What day of the month does Medicare become effective?

Medicare becomes effective on the first day of the month.

Is Medicare Advantage effective immediately?

In general, Medicare Advantage plans often have specific enrollment dates during which you can join or switch plans. When you enroll, you will be informed of your new plan’s effective date.

Does Medicare start the month you turn 65 or the month after?

Medicare eligibility typically begins on the first day of the month you turn 65, but you can apply up to 3 or 4 months prior, depending on your birth date.

Are Medicare benefits ever retroactive to my application date?

If you are eligible for premium-free Part A Medicare. Part A will backdate (retroactively) to 6 months from when you signed up, but not earlier than when you first became eligible for Medicare. 

Are there any benefits to delaying Medicare enrollment?

There are pros and cons to delaying enrollment. For those who have Extended Employer Coverage, they can continue enjoying these benefits and avoid any potential gaps in coverage by delaying enrollment. They can also save by delaying Medicare premiums, deductibles, or out-of-pocket costs.

It may be beneficial if your spouse is still working and covered by employer health insurance. This lets you coordinate your enrollment with spousal coverage and optimize your health coverage as a couple.

Are there downsides to delaying Medicare enrollment?

If you delay enrollment beyond your Initial Enrollment Period and do not qualify for a Special Enrollment Period, you may face late enrollment penalties. If you delay, you may face a gap in medical insurance coverage and potentially high healthcare costs. You may be exposed to unforeseen health events requiring unexpected out-of-pocket expenses that Medicare may have covered.