Important Medicare Enrollment Periods You Need to Know!

Video: Important Medicare Enrollment Periods

This video will help you keep track of the many different dates and time-frames that you need to be aware of if you're a Medicare recipient or going to be a Medicare recipient soon.

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Hi There. Steve Thurmond here with Medigap Tennessee. Your source for Medicare Supplemental, Medicare Advantage, Prescription Drug and Dental plans in Tennessee.

Today I’m going to go over Medicare Enrollment Periods. These terms and abbreviations can be confusing, but this video should clear things up a bit, I hope.
There are certain times that you can enroll or disenroll from different Medicare products.

Knowing when those times are can save you a lot of frustration and disappointment and can also have a big impact on your healthcare coverage and out of pocket expenses over your lifetime. There are quite a few different enrollment and disenrollment periods for various products, but today I’m only going to focus on the main ones.

1.)IEP (Initial Enrollment Period):

This is the enrollment period that pertains to when you’re first eligible for Original Medicare. Your Initial Enrollment Period is when you’re age 64 and nearing your 65th birthday. If you are eligible for Original Medicare, IEP (Initial Enrollment Period) is the 7-month window you have to sign up for Part A and/or Part B of Original Medicare. It begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

If you’re not automatically prompted to enroll into Original Medicare, just give Social Security a call and confirm that you’re eligible for Original Medicare and then start the enrollment process. You can also do so by calling 1-800-MEDICARE.

Once you’ve received your Red, White & Blue Original Medicare card with Parts A & B coverage showing on the card, you’ll then need to make the big decisions of whether to go with a Medicare Supplemental Plan and add your Part D Drug coverage or go with one of the many Medicare Advantage plans available to you.

I’ve covered the differences and pros/cons of all of your options extensively in other videos. If you don’t feel like searching for them…just give us a call and we’ll walk you through all of your options.

2.) AEP (Annual Election Period):

This is the time of year when you can add, change,or drop your Medicare Part D, Prescription Drug coverage or Medicare Part C, Medicare Advantage plan coverage.
This specific window is every year from October 15th – December 7th and specifically pertains to Prescription Drug and Medicare Advantage plans only this DOES NOT pertain to Medicare Supplemental Plans or Medigap plans which are entirely different products that I’ll cover shortly.

Since 2005, a number of different terms have been used to describe this time of year, so depending on what you’re reading or hearing you may hear it referred to as AEP, Annual Enrollment Period, Annual Election Period, Annual Coordinated Election Period or some may even call it OEP,

Annual Open Enrollment Period, Fall Open Enrollment Season, or Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage. Regardless of what it may be referred to, the important thing to remember is that those specific dates, Oct. 15th – Dec. 7th, pertain specifically to Medicare Advantage Plans and Prescription Drug plans ONLY.

It is the time of year when you can add, change or drop either of those specific plans. So, for example; If you’re currently past your initial election period, have Original Medicare Parts A & B, and have decided that a Medicare Advantage plan is right for you.

AEP (Oct 15th – Dec. 7th) is the time when you can replace Original Medicare with a Medicare Advantage plan.

The plan will go into effect on January 1st of the following year and you will then have a Medicare Advantage plan as your primary coverage instead of Original Medicare. If you currently have a Medicare Advantage plan from one of the major carriers like, Humana, Aetna, United HealthCare, Amerigroup, HealthSpring, Wellcare, or BlueCross BlueShield,

AEP (Oct. 15th – Dec. 7th) is the time of year when you can switch to another plan or drop your plan altogether.

If you switch to a different Medicare Advantage plan during AEP, the changes will go into effect on January 1st of the following year and you will start that year with your new plan whether you’ve chosen a different plan from the same provider or a different plan from a different provider altogether. If you drop your current Medicare Advantage plan during AEP, you will simply go BACK to having Original Medicare Parts A & B as your primary coverage on January 1st of the following year.

Keep in mind that you will typically need to pick up a stand alone prescription drug plan (Part D) if you drop your Medicare Advantage plan during AEP. Whatever drug plan you choose will also go into effect on January 1st of the following year. Just a side note here, you CANNOT have a Stand Alone Prescription Drug plan AND a Medicare Advantage plan at the same time… only one or the other. So, if you have a Medicare Advantage plan and want to go back to having Original Medicare, all you have to do is enroll into a Stand Alone Prescription drug plan during AEP and you will automatically be disenrolled from your Medicare Advantage plan starting January 1st of the following year and will once again have Original Medicare as your primary coverage.

That also goes for the opposite scenario. If you have Original Medicare with a Stand Alone Prescription drug plan and want to switch to a Medicare Advantage plan that includes drug coverage, you only have to enroll into a Medicare Advantage plan of your choice during AEP and you will automatically be disenrolled from your drug plan and Original Medicare

starting January 1st of the following year and your new Medicare Advantage plan that includes drug coverage will be your primary coverage. If you like your current Medicare Advantage Plan or Prescription Drug plan, you don’t have to do anything and it will automatically renew each year. andyou don’t have to re-enroll. Just be sure to pay close attention to your plan’s annual notice of changes as these plans do typically change in one way or another almost every year.

A plan that you might have liked in your current year may have made significant changes that you don’t like the following year, so be mindful of any changes that may have come from your provider for your specific plan.

So, to recap AEP…I’ll say it one more time.

AEP (Annual Election Period) is the very specific window of Oct. 15th – Dec. 7th each year and ONLY pertains to Medicare Advantage and Prescription Drug plans.

3.) SEP (Special Election Periods):

Generally speaking, Special Election Periods are just as they sound. They are special periods (outside of the normal AEP window of Oct. 15th – Dec. 7th) when certain individuals can add, change or drop various Medicare Advantage or Prescription Drug plans.

Just like AEP (The Annual Election Period), SEP (Special Election Periods) only pertain to Medicare Advantage and Prescription Drug plans. In order to qualify for a Special Election Period, certain conditions must apply to you, such as involuntarily losing creditable employee coverage due to retirement or moving outside of your current plans coverage or service area.

These circumstances will give you a window of time called a “Special Election Period” in which you can add, change or drop your Medicare Advantage Plan or Prescription Drug plan coverage. That window is typically 63 days after your last day of coverage from you current provider whether it’s losing your employee coverage or needing to change your current Medicare Advantage plan coverage due to moving outside of it’s service area.

You’ll have 63 days to move to a Drug Plan or Medicare Advantage Plan from your employee coverage or change from your current Medicare Advantage plan or Drug plan to another plan that’s available in the location you’re moving to.

Now, some individuals have an ongoing or “Rolling Special Election Period” that lasts all year long. In order to have a Rolling SEP, you must have some sort of Federal or State subsidy in addition to your Original Medicare coverage.

Those subsides are as follows:

LIS which stands for Limited Income Subsidy and is also referred to often as “Extra Help” to pay for some of your prescription costs, SLMB which stands for “Specified Low Income Medicare Beneficiary” and pays for your Medicare Part B Premium each month, QMB which stands for Qualified Medicare Beneficiary and is a pink paper card you may receive in the mail every three months from your state Medicaid Office, and lastly; full Medicaid, which is help from the state, such as TennCare in Tennessee.

Any of the aforementioned will give you a Rolling Special Election Period and allow you to add, change or drop Prescription Drug Coverage or Medicare Advantage plan coverage at any time during the year for any reason. Any changes made to your current plan will go into effect immediately the following month… so you don’t have to wait till the following year if you have an SEP.

Some subsidy scenarios from the state like Full Medicaid or QMB will also make you eligible for what’s called a Special Needs Plan that has a lot of extra benefits at no cost whatsoever to you. The extra benefits can include dental and vision coverage, gym memberships, transportation, and quarterly allowances for over the counter products.

Give us a call to see if you qualify for any of the above mentioned subsidies they can be a huge help to those of you on a fixed, low monthly income and we’re happy to show you how to apply if you’re not currently receiving any kind of help.

4.) MADP (Medicare Advantage Disenrollment Period):

Because there is an Annual Enrollment Period for Medicare Advantage Plans, there is also an annual disenrollment period as well. The annual disenrollment period is January 1st through February 14th of each year. It’s the window that you can disenroll from your Medicare Advantage plan and go back to Original Medicare. A Medicare Advantage plan might not be a good fit for you and you may realize you’ve made a mistake by enrolling into one during AEP (you Annual Election Period), so this gives you a window of opportunity early in the year to get out of your Medicare Advantage plan and go back to Original Medicare as your primary coverage.

You will also have the opportunity to pick up a Stand Alone Prescription Drug plan at this time as well.

If you want to go back to Original Medicare, the easiest thing to do is to simply enroll into a Stand Alone prescription drug plan during the disenrollment period… by doing so it will automatically disenroll you from your current Medicare Advantage plan…WHY? Because, remember you cannot have a Medicare Advantage plan AND a Stand Alone Prescription drug plan at the same time… only one or the other and by enrolling into one, you will be subsequently disenrolled from the other.

5.) Medicare Supplemental Open Enrollment Periods:

First things first, lets clear something up. Unlike Medicare Advantage Plans and Prescription Drug plans, you CAN enroll into a Medicare Supplemental plan (also called a Medigap plan) at ANY time during the year as long as you have Original Medicare Parts A & B. There is no Annual Election Period like there is with Medicare Advantage and Prescription Drug plans.

However, there are only a few times when you can enroll into a Medicare Supplemental plan WITHOUT having to answer health questions or worry about the possibility of being denied for pre existing conditions. One of those times is during your Medigap “Open Enrollment Period.” This Medigap Open Enrollment period is a 7 month window that starts on the first month your Medicare Part B goes into effect and lasts six months after that Medicare Part B effective month.

For most people, this usually means your 65th birthday month, but some people don’t start their Medicare Part B till after 65. Those individuals usually have creditable “Medical Coverage” from their employee plan or simply choose to opt out of Medicare Part B till a later date.

If you are considering a Medicare Supplemental plan instead of a Medicare Advantage plan (and I highly recommend you do), then you do NOT want to miss this open enrollment window… especially if you have any type of health conditions or complications.

If you miss the 7 month open enrollment window, you can still submit an application for a Medicare Supplemental plan at ANY time, but you will have to answer a slew of health questions and will be beholden to the company’s full underwriting discretion and guidelines and you CAN be denied coverage.

It’s very important that you don’t miss this window…doing so could cost you your health and a lot of extra out of pocket costs over your lifetime.

6.) Medicare Supplemental Guaranteed Issue Periods:

Guaranteed Issue periods are also specific to Medicare Supplemental Plans/Medigap Plans I just spoke about. Remember, Medigap or Medicare Supplemental plans ARE NOT Medicare Advantage plans they are very different products.

Guaranteed Issue Periods (sometimes called “Medigap protections”) are rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy even if you have health problems or pre-existing conditions. In these situations, an insurance company: Must sell you a Medigap policy without asking you health questions. Must cover all your pre-existing conditions and can’t charge you more for a Medigap policy because of past or present health problems… just like during your Medicare Supplemental Open Enrollment Period.

You can think of this as an SEP (Special Election Period) just for Medigap plans. Most people run into this scenario when they’re retiring and losing their employee coverage. The Guranteed Issue Period is the window of time that you can add a Medigap plan to Original Medicare in order to pick up the other 20% that Original Medicare doesn’t cover.

It’s the 63 day window that starts on the last day of coverage by your employer. You are then Guranteed to be able to choose a Medigap plan without having to answer any health questions or be beholden to the Medigap company’s underwriting guidelines. Because you’re leaving you’re employees creditable coverage, you will also be granted an SEP (Special Election Period) to pick up a Prescription drug plan of your choice as well.

Be sure to get a copy of your employee coverage disenrollment letter from you benefits administrator as this will need to be submitted with your Medigap Plan application as well as your Prescription drug plan application.

There are a few other Guaranteed Issue periods as well, but they’re not as common, such as if you currently have a Medicare Advantage plan and your plan is leaving Medicare and is no longer available or if you move outside of your current Medicare Advantage plan’s service area or you lose your Medicare Advantage plan for no fault of your own such as a company bankruptcy.

These situations will grant you a Guaranteed Issue Period in which you can switch back to Original Medicare and then add a Medicare Supplemental plan without having to answer health questions. For someone that doesn’t like their current Medicare Advantage Plan…these scenarios are like having a golden ticket from Willy Wonka and should absolutely be taken advantage of to get better coverage with Original Medicare and a Medigap plan from any company of your choice.

It can be a tricky scenario, however, so just give us a call and we’ll guide you through the entire process. There is also what’s known as a “Trial Right” Guaranteed Issue Period. This pertains specifically to individuals that enroll into a Medicare Advantage plan FOR THE FIRST TIME (usually when they initially turn 65 or when their Medicare Part B initially becomes effective) and they’ve been in the Medicare Advantage Plan for less than a year and want to switch back to Original Medicare. They are granted a Trial Right and can switch back to

Original Medicare as their primary coverage and then also pick up a Medigap plan and a Stand Alone prescription drug plan without answering health questions. This should tell you something about Medicare Advantage plans.

People often get reeled in by their free or low monthly costs and then realize they’re paying more out of pocket for inferior coverage. I know this is a confusing topic and it’s hard to keep track of all the different abbreviations, dates, do’s and dont’s so just give us a call. We’ll spend as much time with you as you need so that you can make educated decisions while navigating in the ins and outs of Medicare and it’s many secondary products.

Remember…Medicare doesn’t cover everything…so just give us a call at 1-800-431-5431 and let us help you zap the gap!

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