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Medicare 102: Understanding Medicare Enrollment Periods

by Diana Wisniewski

Medicare Enrollments Periods continue to be a mystery to most Medicare Beneficiaries. As the Annual Enrollment Period (AEP) is approaching rapidly, AMAC is committed to helping our members handle this enrollment period with ease, as it can be a trying time. Enrollments will begin on October 15th. The sooner you have determined the 2013 plan that suits your needs, the sooner you can enroll, thus avoiding the congestion of calls in the last two weeks of this enrollment period. AMAC has worked diligently all year to build up our in-house Medicare department to handle the volume of calls expected this coming AEP.

***Please note that Supplements (aka Medigap Policies) ARE NOT subject to these enrollment periods, and have all year round enrollment periods. Please see below for further details.

For Medicare Advantage Plans and Prescription Drug Plans:

Annual Enrollment
Period (AEP): October
15th – December 7th
***The AEP “Annual Enrollment Period” (aka Open Enrollment) is approaching fast.*** This is the near 8 week span in which Medicare beneficiaries can enroll into new or different Advantage Plans (MA/MAPD) and their Prescription Drug Plans (PDP) for the upcoming year. You can enroll into an Advantage plan for the first time, or decide not to elect and Advantage Plan for 2013 and revert back to Original Medicare (A & B). In this year’s case you will be making changes that become effective 1/1/2013.
Medicare Advantage
Disenrollment Period:
January 1st – February
14th
This is the period in which beneficiaries who are enrolled into an Advantage Plan can disenroll from the plan and revert back to Original Medicare (A & B). You may apply for a standalone Prescription Drug Plan (PDP) by February14th. You may also apply for a Supplement Policy (Medigap). Please keep in mind that beneficiaries applying for a Supplement may be subject to medical underwriting during this period and can be declined for coverage.
Initial Coverage
Election Period/ Initial
Enrollment Period
(ICEP/IEP)
This enrollment period is for newly eligible Medicare Beneficiaries. When you first turn 65, or are first eligible for Part B if receiving Medicare due to Disability, you have a 7 month window to enroll into an Advantage Plan and/or a Medicare Prescription Drug Plan. You have the three months BEFORE turning 65, the month you turn 65, and the three months AFTER turning 65 (or your Part B effective date if on Disability) to enroll into an Advantage Plan and/or a Prescription Drug Plan. If you do not enroll during this 7 month window, you will have to wait until the AEP to enroll into a plan. Please be aware that if you delay your Part B because you are continuing to work and have medical coverage through your job, when you do decide to start your Part B coverage, your ICEP/IEP is now shortened to the 3 months BEFORE your Part B effective date.
Special Enrollment
Periods (SEP)
The Key word here is “SPECIAL.” If you have a special circumstance, such as moving out of a plan’s service area, or an involuntary loss of employer coverage because you are retiring at the age of 65 or older, than you may qualify for an SEP. There are many other circumstances which may make you eligible for an SEP. The length of the SEP can vary based on the circumstance. If you have enrolled into an Advantage Plan for the first time in your life during ICEP, or have dropped a Medigap policy to go into an Advantage
Plan for the first time in your life, you have an SEP which lasts for the first 12 months of your enrollment in the Advantage Plan. This allows you to revert back to Original Medicare, enroll into a Medigap policy without being underwritten (though you may be subject to a higher premium due to age), and purchase a prescription drug plan.
Open Enrollment Period
Institutionalized (OEPI):
This is a continuous enrollment period for people going in to or leaving an institution like a nursing home or skilled nursing facility. The OEPI ends two months after the beneficiary moves out of the institution.

Supplements (Medigap Policies)

Open Enrollment: This is the 6 month period after your part B effective date when you can enroll into a Supplement without being underwritten. Keep in mind you have a pre-enrollment period of 6 months before your part B effective date in which you can apply for a supplement without being underwritten.
Guarantee Issue Period: This is similar to an SEP in which special circumstances will allow you to enroll into a Supplement without being subject to underwriting. Keep in mind that your premiums can be higher due to your age at the time of enrollment.
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Comments (9)

  1. Diana Wisniewski says:

    Ms. Davis,

    Medicare Part A is inpatient medical coverage awarded to seniors for paying Medicare taxes while working for at least forty quarters (10 years) in their lifetime. Of course there are exceptions to this such as a housewife whose husband worked forty quarters, or people on disability for twenty-four months. It is impossible to know the answer to your question because there is no way to tell what changes will go through or be repealed, depending on who will be the next president. I do not know what will happen in the future, but I would like to mention some options currently available to you in the event that you do require medical treatment. For people with limited income and resources, your state may help to pay for Part B. You may also be eligible for a Low Income Subsidy that will help with Part D coverage (Prescription Drug Plan) on one of four levels. This means that you may be able to get help with premiums and/or the cost of drugs, and not be subject to the donut hole (Part D coverage gap), dependant on the level you qualify for. Please call Social Security at 1-800-772-1213 for more information. TTY users can use
    1-800-325-0778.

    Best Regards,
    Diana Wisniewski

  2. Diana Wisniewski says:

    Mr. Sora,

    Thank you for contacting AMAC with your Medicare questions. If there are any changes to your benefits that coordinate with Medicare, they will request forms from the employer to gather necessary information regarding claims etc. An example would be to see if there is any difference in who will be the first payor of claims, Medicare or your plan. Other reasons would be if a person goes on disability or worker’s compensation. The best way to find out exactly why Medicare is requesting these forms is to call Medicare at 1-800-MEDICARE 24 hours a day/ 7days a week, or to call Social Security at 1-800-772-1213 as each person has different circumstances.

    Sincerely,
    Diana Wisniewski

  3. Diana Wisniewski says:

    Mr. Doherty,
    Thank you for supporting AMAC, we appreciate all of our member’s questions and comments. I would like to address you question about needing coverage. If the VA is meeting all of your medical needs, you may want to consider disenrolling from the Caremark Plan. The problem with this is that if you have ancillary benefits that are not obtainable through the VA, you will lose them. The good news is that there are affordable standalone dental plans that you can get in lieu of your Caremark plan, though the benefits may differ. I would suggest researching your current coverage with Caremark, seeing exactly what you will be missing if you disenroll. Before disenrolling do some research on standalone dental plans available in your area. Please feel free to call 866-262-2006 to be connected with a trusted AMAC sales representative in your area from 9:00am to 7:00pm EST to discuss our dental options. You can also view our dental plan on this web site by clicking on Benefits, and scrolling down to Dental Plans.
    Warmest Regards,
    Diana Wisniewski

  4. Mary K says:

    It would be nice if AMAC would provide answers to the above questions in the “Comments” section as I am sure, many folks have the same concerns and would appreciate the information.

  5. nancy genachaw says:

    I am 77 have ONLY medicare coverage. After having a knee replacement I am very happy with medicare coverage and feel I am still ahead money wise ,not having paid insur premium for the yrs since turning 65. Hosp did want up front money but their bill,after money paid, $24

  6. Amy Davis says:

    I have Medicare Part A (the free part) only. Under Obamacare if it is not repealed will I have to purchase additional insurance or will Part A cover the requirement for insurance so I don’t get fined, which I can’t afford (anymore than I can afford additional insurance which I’ll never use because of my total aversion to doctors except emergency room sutures and casts).

  7. seb sora says:

    i am taking a leave of absence, and now medicare wants froms filled out from my place of business….i don’t understand why?…does anyone?

  8. Joe Doherty says:

    This is a question:
    I am 71 years old and retired from industry. I have prescription drug benefits provided by my union in NYC and overlapping coverage from the Veterans Affairs. I use the VA for all prescriptions as it is easier and less expensive. I also have Medicare Part A and B and union coverage for doctor visits [CareMark]. The VA also provides free medical coverage and since they are local and easy to access I use them for just about every medical issue I may have. The only lacking coverage I have is dental and I would certainly like to find an affordable plan for those needs. I find the barrage of solicitations overwhelming and hard to decipher; my question is – DO I NEED TO DO ANYTHING AT ALL?
    Thanks for all that you do, I deeply appreciate AMAC.
    Joe Doherty

    • harry okuda says:

      Want to read other comments. I am a vet although I do not get any of the benefits of VA.

      harryo

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