Your Medicare Advisor

De-Mystifying Medicare Enrollment Periods

Are you aware of your options?

Many Medicare Beneficiaries are not aware that they may have circumstances in which they can change their Medicare Advantage Plan and/or their Medicare Prescription Drug Plan outside of the Annual Election Period. These Medicare enrollment periods may allow a person to switch to a new plan that may better suit their current needs. The many different Enrollment Periods can be very confusing. Below you will find an easy to read chart of Enrollment Periods. If you feel you may qualify for one the Enrollment Periods listed below, please call one of AMAC’s trusted Licensed Insurance Agents for assistance at 800-334-9330.

Special Enrollment Periods for Medicare Advantage Plans and Medicare Prescription Drug Plans

*** All of the enrollment periods below pertain to both Medicare Advantage Plans and Medicare Prescription Drug plans, unless otherwise noted.

If this applies to you: You may qualify for this Special Enrollment Period: You dropped
You dropped a Medigap (Supplement) policy and joined a Medicare Advantage Plan for the first time in your life
or
You joined a Medicare Advantage Plan for the first time in your life when you turned 65
or
You are under the age of 65 due to a disability, are entitled to Medicare and joined a Medicare Advantage Plan for the first time in your life
You are able to drop your Medicare Advantage Plan within the first 12 months of having your Medicare Advantage Plan, revert to Original Medicare, and have special rights to enroll into a Medigap policy. At this time you are also able to enroll into a stand-alone Medicare Prescription Drug Plan.
You move out of your plan’s service area or you move within your plan’s service area but have new plan options available to you If you notify your plan before you move, you can change to a Medicare Advantage or a Medicare Prescription Drug Plan the month before the month you move and for two full months after you move. If you notify your plan after you move, you can make the change the month you tell your plan and the two full months after.
You lived outside of the US and have nowmoved back You can join a Medicare Advantage Plan or a Medicare Prescription Drug Plan plan for two full months after the month you move back to the US.
You are moving into, currently living in or just left an institution like a skilled nursing facility or a long term care facility You can change, join or leave a Medicare Advantage or a Medicare Prescription Drug Plan the entire time you are in the institution and for two full months after you move out of the institution. If you choose to drop your Medicare Advantage Plan you can revert back to Original Medicare.
You leave employer, union or COBRA coverage You have two full months after the month your coverage ends to join a Medicare Advantage or Medicare Prescription Drug Plan.
You have the ability to enroll in other coverage offered by your employer or union You are able to drop your current Medicare Advantage or Medicare Prescription Drug Plan to enroll into an employer or union plan. You can do this whenever your employer or union allows you to make changes to your plan.
You live in the service area of one or more Medicare Advantage or Medicare Prescription Drug Plans with an overall 5 star rating You can join an overall 5 star rated Medicare Advantage or Medicare Prescription Drug Plan one time during the calendar year, using this Special Enrollment Period.
You are eligible for both Medicare and Medicaid You can switch, join or drop a Medicare Advantage or Medicare Prescription DrugPlan at any time during the year.
You qualify for extra help (Low Income Subsidy) for Medicare Prescription Drug coverage You can switch, join or drop a Medicare Prescription Drug Plan at any time during the year.
You are no longer eligible for Medicaid You can make a change for two full months after the month you are notified you are no longer eligible for Medicaid. During this time you can:

  • Join a Medicare Advantage or Medicare Prescription Drug Plan
  • Switch from your current plan to another Medicare Advantage or Prescription Drug Plan
  • Drop your Medicare Advantage Plan and revert to Original Medicare
  • Drop your Medicare Prescription Drug Plan
You have a disabling or severe chronic condition and there is a Medicare Chronic Care Special Needs Plan in your area specific to your condition You can join the Medicare Chronic Care Special Needs Plan at any time; however, once you join the new plan, your opportunity to make changes using this Special Enrollment Period Ends.
You are currently enrolled into a Medicare Chronic Care Special Needs Plan and no longer have the condition that qualifies you for this plan You can change your Special Needs Plan to a Medicare Advantage Plan or a Medicare Prescription Drug Plan starting from the time you no longer qualify for your Special Needs Plan, up to three months after your Special Needs Plan’s grace period ends.
You lose other drug coverage involuntarily that is as good as Medicare’s drug coverage (creditable coverage), or your coverage changes and is no longer considered creditable coverage You can join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan for two full months after the month you lose your creditable coverage, or are notified of the loss of creditable coverage, whichever comes later.
You have your drug coverage through a Medicare Cost Plan and you leave the plan You can join a Medicare Prescription Drug Plan for two full months after the month you disenroll from the Medicare Cost Plan.
You enroll into a PACE Plan (Program of All-Inclusive Care for the Elderly) You can drop your current Medicare Advantage or Prescription Drug Plan at anytime.
You drop coverage in a PACE Plan (Program of All-Inclusive Care for the Elderly) You can join a Medicare Advantage or Prescription Drug Plan for two full months after you drop your PACE plan.
You are enrolling into or already have creditable drug coverage as good as Medicare’s (such as VA or Tricare) You can drop your current Medicare Advantage Plan with drugs, or drop yourMedicare Prescription Drug Plan at any time.
Medicare takes an official action called a sanction, due to a problem with the plan that affects you You can switch your current Medicare Advantage or Prescription Drug Plan during a time period determined by Medicare on a case by case basis.
Your plan contract discontinues during the contract year You can switch your current plan to another Medicare Advantage or Prescription Drug Plan starting the two months before, up to a full month after the contract ends.
Your Medicare plan’s contract is not renewed with Medicare for the following year You can join another Medicare Advantage or Prescription Drug Plan between October 15th and the last day in February.
You either join or choose not to join a Medicare Plan due to an error by a Federal Employee At this time you can:

  • switch or join a Medicare Advantage Plan with drugs
  • switch or join a Medicare Prescription Drug Plan
  • drop your Medicare Advantage Plan with drugs and revert back to Original Medicare
  • drop your Medicare Prescription Drug Plan

You can make these changes for two full months after the month you receive notice from Medicare regarding the error.

You were not properly informed that your prescription drug coverage is not creditable coverage, which is coverage at least as good as Medicare’s
or
You were not properly informed that you were losing private drug coverage that is creditable coverage, which is coverage at least as good as Medicare’s
You can join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan. You can join for up to two full months after the month you receive the notice of error from Medicare.
You are enrolled in a State Pharmaceutical Assistance Program and/or lose eligibility to be in this plan You are able to join a Medicare Advantage Plan with drugs, or a Medicare Prescription Drug Plan one time during the calendar year.
You are released from jail You can join a Medicare Advantage or Prescription Drug Plan. You can join for up to two months after the month you are released from jail.

Medicare Enrollment Periods

Initial Enrollment Periods for Medicare Advantage Plans and Medicare Prescription Drug Plans

*** All of the enrollment periods below pertain to both Medicare Advantage Plans and Medicare Prescription Drug plans, unless otherwise
noted.

If this applies to you: You may qualify for this Special Enrollment Period: You dropped
Turning 65 and are newly eligible for Medicare You have a seven month period in which you can enroll into a Medicare Advantage and/or a Prescription Drug Plan. You have the three months before you turn 65, the month you turn 65, and the three months after you turn 65 to enroll.
You have Part A and are signing up for Part B (delayed Part B enrollment) because you have had employer, union or COBRA coverage You have the three months before your Part B effective date to enroll.
Under 65 and newly eligible for Medicare because you are disabled (does not apply to End Stage Renal Disease – ESRD) You have the same seven month enrollment period as when you are turning 65, except it starts three months before your 25th month of disability, and ends three months after your 25th month of disability.
You are already on Medicare because of disability and you turn 65 Initial Enrollment Period 2 – You have the same seven month period to enroll as when you turn 65 without already being on Medicare due to disability. At this time you can:

  • Switch your current Medicare Advantage and/or Medicare Prescription Drug Plan to a different plan
  • Drop your current Medicare Advantage and/or Prescription Drug Plan altogether and revert back to Original Medicare.
You do not have Medicare Part A and you enroll into Medicare Part B during the Part B General Enrollment Period, which is January 1st through March 31st You are able to sign up for a Medicare Prescription Drug Plan the three months after the Part B General Enrollment Period ends, which is April 1st through June 30th. Your coverage will begin on July 1st.
You have Medicare Part A coverage and enroll into Medicare Part B during the Part B General Enrollment Period, which is January 1st through March 31st You are able to sign up for a Medicare Advantage Plan the three months after the Part B General Enrollment Period ends, which is April 1st through June 30th. Your coverage will begin on July 1st. You can sign up for a Medicare Advantage Plan with or without prescription drugs.

Annual Enrollment Periods for Medicare Advantage Plans and Medicare Prescription Drug Plans

*** All of the enrollment periods below pertain to both Medicare Advantage Plans and Medicare Prescription Drug plans, unless otherwise noted.

The following enrollment periods apply to all Medicare beneficiaries:
October 15th – December 7th This is the Annual Enrollment Period, also known as Open Enrollment. At this time you can:

  • Change from Original Medicare to a Medicare Advantage Plan
  • Change from a Medicare Advantage Plan and go back to Original Medicare
  • Switch your Medicare Advantage Plan to another with or without drugs
  • Switch Medicare Prescription Drug Plans
  • Join a Medicare Prescription Drug Plan
  • Drop a Medicare Prescription Drug Plan

Changes made during this enrollment period will take effect on January 1st.

January 1st – February 14th This is the Medicare Advantage Disenrollment Period. At this time you can:

  • Leave your current Medicare Advantage Plan and revert back to Original Medicare. Original Medicare will begin the first day of the following month.
  • If you switch to Original Medicare, you can join a stand-alone Medicare Prescription Drug plan. The drug coverage will begin the first day of the month after the new plan gets your enrollment form.

Please be aware that during this Disenrollment Period you cannot:

  • Go from Original Medicare into a Medicare Advantage plan
  • Change Medicare Advantage or Medicare Prescription Drug Plans
  • Join, switch or drop a Medicare Medical Savings account.

If You Enjoy Articles Like This - Subscribe to the AMAC Daily Newsletter!

Sign Up Today
Read more articles by Your Medicare Advisor

12
Leave a Reply

11 Comment threads
1 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
10 Comment authors
  Subscribe  
newest oldest most voted
Notify of
SueAnn Perry

My husband is 67 on his next birthday December 31st, he has a job with full medical/dental benefits and has not signed up for Medicare Part A or B. He has no retirement date in mind at this time. Should he sign up for Medicare now before end of this enrollment period or in January 2015? Thanks for your help. SueAnn

Jack Mullins

I celebrate my 65th birthday in July. I am still working and am planning on continuing to work. I have medical insurance through my employer and I want to keep it as long as they offer it to me. My wife is also covered under my Health Insurance. Do I still have to sign up for Medicare? If so, what do I sign up for? Do I have to give up my employer provided health insurance plan?

steve

I turned 65 in May and have not signed up for Medicare or any supplements. I have health insurance thru my employee and am able to continue to add to my HSA. If I signed up for Medicare, I would not be able to add to my HSA.
I plan on retiring in June of 2014 and my insurance thru my company will expire at the end of june. What time frame do I have to can I sign up for Medicare and supplements before or after I retire. I will be 66 in May of 2014.

Humbert & Ellen Bergami

Ellen-dob10-22-43 Has medicare A

Humbert- dob 11-30-29 Has medicare A&B

Both have employer insurance till 12-31-13 {employment and insurance terminates}

Ellen needs part B , Advantage, Prescriptions.

Humbert needs Advantage, prescriptions.

All needs as of 01-01-2014

We are currently seeking supplemental through Amac.

RODGER PEARSON

I signed up for part A when I turned 65, however declined the part B because my wifes insurance covered her and I. Now that she is retired, I tried to apply for part B and was declined. She had to be still working for me to get part B. Now that I am declined and her cobra insurance expires on 8/10/2013, what can I do?

Shirley

What is the cost of your insurance program? How can I get this information?

Thanks

Diana Wisniewski

Hi Mrs. Rosser,

The first step would be to call your employer health plan administrator and see when you can disenroll. Once you know when you can disenroll, you will be eligible for an SEP (based on your disenrollment date of your current plan) to enroll into an Advantage Plan. You will also have the option to apply for Medigap and a stand alone Medicare Drug Plan. The best way to find out which plan will suit your needs will be to call our Medicare Department at 800-334-9330 and speak to one of our agents who can do some research on the plans in your area.

Linda Rosser

We are new members. We still have primary health coverage thru my husbands work. We have secondary coverage. With our Medicare part A and B. our prescription coverage thru our primary carrier has a $5000 deductable, thus we have no prescription coverage. Our medicine is very expensive. Cam we drop the primary coverage and go to Medicare plan with part D included? How do we no which plan is best for us and is there a enrollment period for this type of change. Very worried and confused. Don’t want to mess up. Thanks

Linda Rosser

Diana Wisniewski

F. Ward and Paul E –

Thank you so much for the positive responses. This article was tough to put together in a language that was easy (or easier) to understand than Medicare’s, that also includes all options together rather than piecemealed in seperate documents. There will be more informative articles to come in future issues that I hope you will find equally as helpful. Have a great day.

F. Ward

Good job of untangling the choices of current users. What about an article about choices and considerations for those approaching 65 in the coming year. I find this pretty bewildering and Medicare is not clear on all the possible options.

PaulE

Nice one-stop view of the various options. Good job!