Another Medicare Annual Enrollment Period (AEP) has come and gone. Maybe you intended to review your current coverage, but, for any number of reasons, you just didn’t get around to it. What happens now? If you are happy with your plan, you don’t need to take any action – your current coverage will automatically renew for next year. But what if you intended to make a change during AEP? Are you locked into the plan you currently have for another year? That depends on several factors, including the type of coverage you have and what changes you want to make.
Medicare allows for changes during specific enrollment periods and for certain life events. Each enrollment period has its own rules and timelines.
Medicare Advantage Open Enrollment Period
If you have a Medicare Advantage plan, the next opportunity to make a change is the Open Enrollment Period (OEP), which runs from January 1st through March 31st. You can make one change during this time, which will be effective the first day of the following month.
During OEP you can:
- Switch to a different Medicare Advantage plan with or without drug coverage.
- Drop your current Medicare Advantage plan and return to Original Medicare and enroll in a Part D prescription drug plan.
If you return to Original Medicare, you might also want to enroll in a Medicare Supplement plan (also known as a Medigap plan). You can do this anytime, but it’s important to note that if you are outside your initial enrollment period for a Medigap plan (the six-month window that begins the first day of the month you turn 65), you may have to fill out a health questionnaire. If you have pre-existing health conditions, you may face a higher premium or be denied coverage altogether. This process is known as medical underwriting. Underwriting rules vary by state. You should allow plenty of time for the underwriting decision before you drop your Medicare Advantage plan.
Medicare does provide for certain exceptions in specific situations. These are known as guaranteed issue (GI) rights. GI rights allow you to enroll in a Medigap plan without underwriting, if you meet certain criteria. There are seven instances when you have GI Rights for a Medigap plan.
- First-year trial rights – You leave a Medigap plan to join a Medicare Advantage plan for the first time, you have been in the plan for less than a year and wish to go back to a Medigap plan, or you joined a Medicare Advantage plan at 65 and want to switch to a Medigap during the first year.
- Your Medicare Advantage plan is dropping coverage in your area or you’re moving out the plan’s service area.
- You have Medicare Select and move out of the plan’s service area.
- Your employer plan that supplements Medicare ends.
- Your Medicare company did not follow the rules or gave you misleading information.
- Your Medigap insurance company goes bankrupt.
Since GI Rights can vary by state, it’s important to know the rules in your state.
Special Enrollment Periods
Medicare recognizes that certain life events and special circumstances require a change in coverage. These are reflected in Special Enrollment Periods (SEPs). The type of changes you can make and the timing will depend on the specific event.
Some common reasons you might be eligible for an SEP are:
- Moving to another area where you are no longer eligible for your plan.
- Becoming eligible for Medicaid, Extra Help, or a Special Needs Plan.
- Losing eligibility for Medicaid, Extra Help, or a Special Needs Plan.
- Moving back to U.S. after living abroad.
- Moving into or out of an institution, such as a skilled nursing facility or long-term care hospital.
- The area you live in was impacted by an emergency or natural disaster.
Five-Star Special Enrollment Period
If there is a five-star Medicare Advantage plan in your area that you want to switch to, you can use the 5-star special enrollment period to change plans. You can take advantage of this opportunity just one time from Dec. 8th to Nov. 30th.
Healthcare Educators Can Help
Understanding Medicare’s enrollment windows is essential to ensuring you have the best coverage for your healthcare needs. The licensed local Medicare agents at Healthcare Educators can help you make the right decision and find the best Medicare plan for your individual situation. Contact us today.