There are various times when a beneficiary can enroll in a Medicare Advantage plan. If you sell health insurance, it’s important you know all the Medicare Advantage enrollment periods and how to help your clients navigate them.
Read on to learn about the different types of Medicare Advantage enrollment periods and how and when your clients will qualify for them!
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Initial Enrollment Period (IEP)
The Initial Enrollment Period (IEP) isn’t truly a Medicare Advantage enrollment period, but you need to have a good handle on it to understand the Initial Coverage Election Period (which we’ll discuss next). A person enters their IEP the first time they become eligible to enroll in the federal Medicare program, commonly referred to as Original Medicare or Medicare Parts A and B. This period lasts for seven months.
For clients who are aging in to Medicare, the IEP begins three months before the month they turn 65 and ends three months after their birth month. If they miss their IEP, your clients can still get coverage, but they may have to wait. As a result, they may experience coverage gaps for a limited time and/or even have to pay late enrollment penalties.
Example: If your client is aging in to Medicare and their 65th birthday is on April 26, their IEP would begin on January 1 and end on July 31.
If a client is under 65 and has been receiving Social Security or Railroad Retirement Board disability benefits for 24 months, the stipulations differ slightly. Clients who fall into this category will still have an IEP that lasts for a full seven months. It will span three months before the month of their 25th disability check, and three months after the check is received. Your client’s Medicare coverage would start the first day of the month they receive their 25th check.
Example: If your client qualifies for Medicare based on disability and receives their 25th disability check on May 18, their IEP would begin February 1 and end on August 30.
Keep in mind that, while many people are automatically enrolled in Medicare Parts A and B before they turn 65, the IEP is the first time a client can “manually” enroll in it. Clients can also potentially enroll in a stand-alone prescription drug plan and Medicare Supplement plan during this period.
Initial Coverage Election Period (ICEP)
The Initial Coverage Election Period (ICEP) is the first time your client can enroll in a Medicare Advantage (Part C) plan. It’s important to note that, in order for your client to initiate their ICEP, they must have Original Medicare (Medicare Parts A and B). For a client who enrolls in Original Medicare during their IEP, their ICEP can run alongside it. Like an IEP, an ICEP also lasts for seven months.
Your client’s ICEP start date will be delayed if they wait to enroll in Medicare Part B. Since joining an MA plan requires enrollment in Original Medicare, your client’s ICEP will not begin until they are enrolled in Part B. If your client enrolls in Part B at later date, their ICEP will start three months before the month of their Medicare Part B effective date and end three months after the month their Part B coverage starts.
Example: If your client’s Part B effective date is November 1, their ICEP would begin August 1 and end on February 28 (or February 29 in a leap year).
Annual Enrollment Period (AEP)
Unlike some Medicare enrollment periods that can have different dates depending on your client’s age and needs, the Annual Enrollment Period takes place during the same time every year — from October 15 to December 7. This enrollment period is also known as the Annual Election Period, or just simply AEP.
During the AEP, beneficiaries can enroll in, switch, or disenroll from a Medicare Advantage plan or prescription drug plan. Coverage selected at this time will become effective beginning the following year.
Example: Someone who chooses an MA plan on November 8, 2019, during the AEP would have coverage through this new plan starting on January 1, 2020.
AEP is the most common and popular time of year for clients to enroll in a plan. As a Medicare agent, it’s likely that most of your enrollments will happen during this time, but that doesn’t mean you can’t sell Medicare Advantage plans all year long!
Medicare Advantage Open Enrollment Period (OEP)
In 2019, the Centers for Medicare and Medicaid Services eliminated the Medicare Advantage Disenrollment Period and introduced a brand-new Medicare Advantage OEP. The new Medicare Advantage OEP takes place from January 1 through March 31 annually.
During this period, beneficiaries with a Medicare Advantage plan (including those newly eligible for Medicare Advantage) can switch to a different Medicare Advantage plan or disenroll from their Medicare Advantage plan and return to Original Medicare. They can also pick up a stand-alone Part D plan (if needed) and a Medicare Supplement plan. Please note your clients cannot use the Medicare Advantage Open Enrollment Period to disenroll from a Medical Savings Account plan.
During this period, beneficiaries with a Medicare Advantage plan can switch to a different Medicare Advantage plan or disenroll from their current plan and return to Original Medicare.
Those enrolled in Medicare Advantage plans as of January 1 can participate in Medicare Advantage OEP from January 1 to March 31. New-to-Medicare clients who enrolled in a Medicare Advantage plan during their ICEP can participate in this OEP from the month of their entitlement to Part A and Part B through the last day of the third month of their entitlement.
MSA Plan Enrollment Period
OK, technically, there isn’t an established enrollment period in which clients can enroll in a Medicare Medical Savings Account (MSA) plan. But, we thought it’s still worth discussing your clients’ options for your benefit!
Beneficiaries can join a Medicare MSA plan during their ICEP or the AEP. They cannot enroll in an MSA during any Special Enrollment Period, except if they’d like to join an employer- or union-sponsored MSA during the Employer Group Health Plan Special Enrollment Period. The MSA plan’s effective date of coverage is determined by the period in which an enrollment request is made.
MSA plans provide the same coverage that all Medicare Advantage plans must offer and can provide insurance for some other health needs, such as dental, vision, or long-term care, for an additional cost. You most likely have clients who would find these plans appealing, so it’s a good idea to include them in your portfolio.
Note: Beneficiaries can only disenroll from Medicare MSA plans between November 15 and December 31 or during a Special Enrollment Period if they move, become eligible for Medicaid, or experience a special circumstance.
Special Enrollment Periods (SEPs)
Various qualifying life events can make your clients eligible for a Special Enrollment Period (SEP) during which they can enroll or disenroll in Medicare Advantage plans. Possible qualifying events could include losing their current health coverage, moving, losing income, or becoming institutionalized.
If your client qualifies for an SEP, they must make changes to their coverage within that SEP’s specified time period. Rules about when your client can make changes to their coverage, and the types of changes they can make, are different for each SEP, as SEPs depend on clients’ specific circumstances.
When you’re selling, it’s important to tell your clients about the Medicare Advantage “Trial Period” SEP. Individuals who enroll in a Medicare Advantage plan when they’re first eligible for Medicare Part A at age 65 are entitled to a “trial period” that lasts for 12 months. During this year, beneficiaries have the option to disenroll from their first Medicare Advantage plan and switch to Original Medicare if they so choose. They also have a guaranteed issue right to enroll in a Medicare Supplement plan that lasts 63 days after they disenroll from Medicare Advantage. Beneficiaries who return to Original Medicare during this trial period also get a Part D SEP to enroll in a stand-alone Part D plan if they had a Medicare Advantage Prescription Drug plan.
As a Medicare Advantage sales agent, you’ll likely find clients who also qualify for an SEP in the dual-eligible market, which is comprised of individuals who qualify for both Medicaid and Medicare.
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With so many different enrollment periods, it’s important for you to be knowledgeable about them so you can share that information with your clients. It’s best to educate your clients about Medicare enrollment periods, since it’s essential for them to have the right coverage and to know when to sign up for a plan. And, remember that multiple enrollment periods mean that there are plenty of times throughout the year, outside of AEP, that you can be increasing your sales and helping your clients find a Medicare plan that they can trust!