When to Enroll in a Medicare Advantage Plan

When can you enroll in a Medicare Advantage plan? Learn about the different enrollment periods, how they work, and when you should sign up.

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More than 28 million Medicare beneficiaries are enrolled in a Medicare Advantage plan, also referred to as Medicare Part C. However, there is often a great deal of confusion around when an individual qualifies and can sign up for Medicare Advantage.

Beneficiaries are required to pay premiums for Medicare Parts A and B, which cover inpatient and outpatient visits respectively, to remain eligible to enroll in a Medicare Advantage plan. Millions of Americans turn to Medicare Advantage to provide additional coverage for services, medications, and medical devices that Medicare Parts A and B (referred to collectively as Original Medicare) do not cover. Medicare Advantage also provides the flexibility to enroll, switch, or drop plans during specific enrollment periods each calendar year.

It is important to note that enrollment opportunities for Medicare Advantage plans are not offered year-round. Signing up must take place within one of the designated enrollment periods, unless you have certain circumstances that qualify for a special enrollment period. If you are looking to enroll in a 5-Star Medicare Advantage plan, this qualifies as a special enrollment period. A beneficiary may enroll/switch to a 5-Star plan at any time during the year, provided you meet the plan’s enrollment requirements.

This guide provides you with a basic framework on the different Medicare Advantage enrollment periods, timing for each, and how you can plan ahead.

Medicare Advantage Plans: Enrollment Periods

There are 4 distinct enrollment periods for Medicare Advantage, each having separate conditions: 

  • Initial Enrollment
  • Annual Enrollment
  • Open Enrollment
  • Special Enrollment

If you are looking to enroll or switch to a 5-Star Medicare Advantage plan, you may do so any time of the year.

1. Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) for Medicare Advantage begins three months prior to your 65th birthday and ends three months after. 

Certain conditions allow you to qualify early for Medicare Advantage, specifically if you have Lou Gehrig’s Disease (ALS) or end-stage renal disease. Enrollees with other disabilities and long-term illnesses may also qualify early, but ALS and end-stage renal disease expedite Medicare coverage specifically. Individuals with ALS can enroll in Medicare Advantage in the month they receive their first SSDI payment, while most end-stage renal disease patients can enroll in Medicare Advantage during their fourth month of dialysis treatment.

2. Annual Enrollment Period (AEP)

The Annual Enrollment Period (AEP) runs every calendar year from October 15 to December 7. This period allows beneficiaries with Original Medicare to switch to Medicare Advantage, or make changes to an existing Medicare Advantage plan.

There are parameters around the specific actions/changes you may make during this period, which will depend on your current coverage. New coverage choices made during AEP go into effect on January 1 of the following year.

3. Open Enrollment Period (OEP)

The Open Enrollment Period runs January 1 to March 31. Similar to AEP, the Open Enrollment Period provides opportunity to switch/make changes to an existing Medicare Advantage plan. This is also the timeframe you may change back to Original Medicare, if you find the Medicare Advantage coverage is not a good fit for your healthcare needs. However, you are only able to make a change to your plan once during this period. Any coverage changes made will go into effect the following month.

4. Special Enrollment Period (SEP)

Medicare Advantage plans have specific service areas in which you must live to be eligible for coverage. With this said, what happens when a beneficiary chooses a plan and then decides to relocate? This is one reason the Special Enrollment Period (SEP) was created. The SEP does not have a specific timeframe during the year for enrollment, and it is not tied to your 65th birthday. Unlike other enrollment periods, this is connected to changing personal circumstances (such as moving, or requiring a change in prescription drug needs).

Other special circumstances may include getting married, a change in household income, or changes in the types of services that are covered in your plan. While this list is not exhaustive, they are some of the most common reasons a special enrollment period takes place. As mentioned earlier, if you are looking to enroll in a 5-Star plan, this qualifies as a SEP and may be done at any point during the year.

How to Enroll in a Medicare Advantage Plan

If you are considering a Medicare Advantage plan, make sure you are currently enrolled in Original Medicare Parts A and B (this is necessary in order to qualify). Now that the different enrollment periods have been outlined, you can determine which time is right for you to begin reviewing your coverage options and enroll in a plan.

Speak with a Baylor Scott & White licensed insurance agent for a free consultation. They will help review your coverage options, medical care needs, and work to find a plan that’s best for you.

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Contact us any time and a Baylor Scott & White Health Plan licensed insurance agent can answer any questions you have about Medicare.