Medicare Advantage Plans
You must be enrolled in Original Medicare before enrolling into Medicare Advantage.
Initial Enrollment Period (IEP)
The IEP is a 7-month period that begins 3 months before the month you turn 65 and ends 3 months after you turn 65. For someone under age 65 who becomes entitled to Medicare based on disability, entitlement begins with the 25th month of disability benefit entitlement. For these individuals, the IEP begins 3 months before the 25th month of disability benefit entitlement, includes the 25th month, and ends three months after. The IEP for people with ESRD and ALS varies based on their situation.
Coverage begins based on when you enroll during the IEP. If you enroll in the first 3 months of the IEP, coverage begins the first month you are eligible for Medicare. If you enroll in any other month of the IEP, coverage will be delayed. Disabled individuals are automatically enrolled in Medicare Part A and Part B after they have received disability benefits from Social Security for 24 months.
NOTE: In most cases, if someone does not enroll in Part B when first eligible, they will have to pay a late enrollment penalty. The Part B penalty is assessed for as long as the person has Part B.
General Enrollment Period (GEP)
The GEP takes place from January 1 through March 31 of each year. Part B and Part A coverage begins July 1 of that same year.
Special Enrollment Period (SEP) for the Working Aged and Working Disabled.
Individuals who do not enroll in Part B when first eligible because they were covered under a group health plan based on their own or a spouse's current employment (or the current employment of a family member, if disabled) may enroll during the SEP. The individual can enroll at any time while covered under the group health plan based on current employment, or during the 8-month period that begins the month the employment ends or the group health plan coverage ends, whichever comes first.
So, what is Medicare Advantage?
Medicare Advantage plans are offered by private insurance companies. Medicare Advantage, also known as Part C, combines HOSPITAL (PART A) and MEDICAL (PART B) into ONE plan.
Most Medicare Advantage plans include prescription drug coverage Part D and may offer additional benefits not provided by Original Medicare.
- Health Maintenance Organization (HMO) - specific provider network
- HMO Point-of-Service (HMO-POS) - HMO network plus additional providers who agree to accept the terms specified by in insurance company.
- Preferred Provider Organization (PPO) - specifies in-network plus out-of-network providers. Costs to insured various based upon the provider's contract.
- Private Fee-for-Service (PFFS) - can offer full or partial networks of providers, or, in certain cases, they may not use a network of providers at all.
- Special Needs Plan (SNP) - coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals.
- Dual Special Needs Plan (D-SNP) Medicare/Medicaid - (Dual-eligible) offered to Medicare Beneficiaries who are also qualified and enrolled in Medicaid.
- Medicare Medical Savings Account (MSA) - combines a high-deductible health plan with a medical savings account.
Can you switch, drop or change a Medicare Advantage plan once you enroll?
Most of the plan types listed above...Yes, you can switch, drop or change the plan provided you are entitled to make the change based upon the rules established by Medicare. Medicare Medical Savings Account (MSA) is an exception.
Annual Enrollment Period (AEP) Oct 15 – Dec 7
You can join, switch, or drop a plan and go back to Original Medicare. Your coverage will begin on January 1, if the plan gets your request by December 7.
Medicare Advantage Open Enrollment Period (OEP) Jan 1 – Mar 31
If you’re already a Medicare Advantage plan member, you can switch to a different Medicare Advantage plan one time only or go back to Original Medicare.
Special Enrollment Period (SEP)
Depending on certain circumstances, you may be able to enroll in a Medicare plan outside of the initial enrollment or annual enrollment time frames. Some ways you may qualify for a Special Enrollment Period are if you:
- RETIRE and Lose your employer coverage.
- MOVE out of the plan's service area.
- QUALIFY for Extra Help, LIS, SPAP, Medicaid, etc.
- Have been DIAGNOSED with certain qualifying Chronic Health conditions