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.

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