Medicare Advantage plans provide individuals with an alternative option to receive their Medicare Part A (hospital) and Part B (medical) benefits, which are offered by private insurance companies approved by Medicare.
To effectively navigate Medicare Advantage also known as Medicare Part C enrollment, it is crucial to understand the available enrollment periods. These periods can vary depending on individual circumstances, and they provide opportunities to enroll in a new plan, drop current coverage, or change plans throughout the year. Understanding these enrollment periods is essential, especially if you already have a Medicare Advantage plan or are considering enrolling in one. By being informed about the different periods, you can make informed decisions about your coverage and ensure that you have the best possible plan for your needs.
When Can I Enroll In Medicare Advantage?
Medicare Advantage enrollment is subject to specific periods during the year, meaning that you cannot enroll at any time. Four enrollment periods are available to Medicare Advantage enrollees, each with different rules and criteria. These periods range from annual events to one-time opportunities and special circumstances. The four enrollment periods are the Initial Coverage Election Period, Annual Enrollment Period, Medicare Advantage Open Enrollment Period, and Special Enrollment Period. It’s important to be aware of these enrollment periods to ensure that you enroll in a plan that meets your healthcare needs.
It is also important to know that in order to receive Medicare Advantage benefits, individuals must qualify for both Medicare Part A and Part B coverage. While Medicare Advantage plans offer additional benefits, they do not replace the need for Medicare Part A and Part B coverage. Also, to enroll in a Medicare Advantage plan, individuals must also live within the service area of the plan, which is determined by the plan’s state license and Medicare approval. The plan may also have a network of healthcare facilities and professionals who provide covered services to its members. Therefore, individuals should ensure that the Medicare Advantage plan they choose is available in their area.
Furthermore, enrolling in a Medicare Advantage plan does not excuse individuals from paying the Medicare Part B premium (which is 164.90$ in 2023), except for those who qualify for a government subsidy. Additionally, the Medicare Advantage plan itself may require a premium, depending on the type of plan and coverage it offers.
Initial Coverage Election Period
The Initial Coverage Election Period is a window of time for those who are new to Medicare to enroll in Medicare Part A, Part B, and Medicare Part D. Additionally, it is the first opportunity for Medicare Advantage enrollment. This period starts three months before your 65th birthday and ends three months after your 65th birthday. During this time, you have the freedom to enroll in any Medicare Advantage plan of your choice.
Annual Enrollment Period
In case you miss your Initial Coverage Election Period for Medicare Advantage enrollment, you can take advantage of the Annual Enrollment Period. This enrollment window runs from October 15 to December 7 every year and allows you to enroll in a Medicare Advantage plan that becomes effective from January 1.
The Annual Enrollment Period also gives you the opportunity to switch to Original Medicare or another Medicare Advantage plan from your current plan. Once you disenroll from your Medicare Advantage plan, you can enroll in a Medigap plan and a stand-alone Part D drug plan to pair with Original Medicare.
Medicare Advantage Open Enrollment Period
From the 1st of January to the 31st of March each year, Medicare Advantage beneficiaries can utilize the Open Enrollment Period and modify their present policy. This period is not intended for new enrollments in Medicare Advantage, but rather for changing your coverage options or reverting to Original Medicare. So, beneficiaries can use this period to join a stand-alone Medicare Prescription Drug Plan to cover their prescriptions, as Original Medicare drug coverage is limited. Additionally, beneficiaries can use this period to switch from one Medicare Advantage plan to another.
Special Enrollment Period
Medicare Advantage beneficiaries may qualify for a Special Enrollment Period (SEP) to enroll in or modify their plan outside of the standard enrollment period. There are various types of SEPs, such as Trial Right Periods, Low-Income, and Life-Changing Events. During the Initial Enrollment Period, beneficiaries are entitled to a 12-month trial period to enroll in a Medicare Advantage plan, and they can switch back to their Original Medicare at any time during this period. Low-income beneficiaries and those who experience specific life-changing events can also be eligible for SEPs. The eligibility for each SEP type may vary and require proof of circumstances (like losing employer or group coverage, low-income subsidy, extra help Special enrollment, etc.). It’s recommended to contact the local Social Security Administration office to confirm eligibility for these SEPs.
Can I Enroll In Medicare Advantage if I’m Delaying Part B Enrollment?
Yes, you can. If you continue to work after turning 65, you may delay enrollment in Medicare Part B, but you need to ensure you have creditable coverage; otherwise, you may have to pay a late enrollment penalty. Once you retire or lose your creditable health coverage, you receive an eight-month Special Enrollment Period to enroll in Medicare Part B. It is advisable to sign up before retiring to avoid any coverage gaps. However, you can still enroll in Medicare Part B while working, and you will also receive your Initial Coverage Election Period to get a Medicare Advantage plan if it fits your needs.
However, if you miss enrolling in Medicare Part B during your Special Enrollment Period, you will need to wait until the next General Medicare Open Enrollment Period, which takes place from January 1 to March 31 each year. Failure to enroll in Part B when you were eligible may result in a late-enrollment penalty, which means you will have to pay an extra 10% of your premium for every 12-month period you were eligible for but did not enroll. You may be required to pay this penalty for as long as you remain enrolled in Medicare ( because you need to be enrolled in Part A and Part B to be eligible for Medicare Advantage).