When to Enroll in a Medicare Advantage Plan?

Medicare Advantage plans offer an alternative way to receive Medicare benefits, provided by private companies approved by Medicare. These plans, sometimes called “Part C” or “MA Plans,” must cover all services included in Original Medicare Parts A and B, which are hospital and medical insurance respectively. Many Medicare Advantage plans also include prescription drug coverage (Part D) and may offer additional benefits like dental, vision, and hearing services that Original Medicare does not typically cover. Understanding the specific enrollment periods for these plans is important for selecting the most suitable coverage.

Eligibility and Initial Enrollment

To enroll in a Medicare Advantage plan, an individual must first be enrolled in both Medicare Part A and Part B. They must also reside within the service area of the Medicare Advantage plan they wish to join. This ensures that the plan’s network of providers and services is accessible to the enrollee.

The first opportunity to enroll in Medicare, and subsequently a Medicare Advantage plan, is during the Initial Enrollment Period (IEP). This period spans seven months, beginning three months before the month an individual turns 65, including their birth month, and extending three months after. For example, if a person’s 65th birthday is in June, their IEP runs from March 1st to September 30th. Coverage typically begins the month after enrollment for those joining during their IEP, though signing up in the three months before turning 65 can result in coverage starting on the first day of the birthday month.

Individuals who qualify for Medicare due to a disability also have an Initial Enrollment Period. This begins three months before their 25th month of receiving Social Security Disability or Railroad Retirement Board benefits, includes that 25th month, and ends three months later.

Regular Enrollment Periods

Beyond the initial eligibility window, there are specific times each year designated for enrolling in or changing Medicare Advantage plans. The Annual Enrollment Period (AEP) occurs from October 15th to December 7th each year. During this time, individuals can switch from Original Medicare to a Medicare Advantage plan, change from one Medicare Advantage plan to another, or drop a Medicare Advantage plan to return to Original Medicare. Any changes made during the AEP become effective on January 1st of the following year.

Another important period is the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1st to March 31st annually. This period allows individuals already enrolled in a Medicare Advantage plan to make a single change. They can switch to a different Medicare Advantage plan or disenroll from their Medicare Advantage plan to return to Original Medicare. If returning to Original Medicare, individuals can also enroll in a standalone Medicare Part D prescription drug plan during this time.

The General Enrollment Period (GEP) for Original Medicare Part B runs from January 1st to March 31st each year. This period is primarily for those who missed their initial opportunity to enroll in Part B. If an individual enrolls in Part B during the GEP, their coverage begins the month after enrollment.

Special Enrollment Periods

Special Enrollment Periods (SEPs) provide opportunities to change Medicare Advantage plans outside of the regular enrollment times due to specific life events. The duration and specific actions permitted during an SEP depend on the qualifying event.

Common qualifying events for an SEP include moving to a new service area where the current plan is not available, losing other creditable health coverage, or becoming eligible for programs like Medicaid or Extra Help. For instance, if an individual moves out of their plan’s service area, they may qualify for an SEP to choose a new plan in their new location, typically lasting for two months. Similarly, if a plan stops serving an area or significantly reduces its provider network, an SEP may be granted. Individuals who qualify for a Special Needs Plan (SNP) may also have an SEP to enroll.

Information Needed for Enrollment Application

Preparing the necessary information before beginning a Medicare Advantage plan application can streamline the process. Individuals should have their Medicare identification number readily available, which is found on their red, white, and blue Medicare card. This number confirms their enrollment in Medicare Parts A and B, a prerequisite for Medicare Advantage.

Personal identification details are also required, including a full legal name, current address, date of birth, and contact information such as a phone number and email address. If the individual has current health insurance, details about that coverage, including policy numbers and effective dates, may be needed. A comprehensive list of current prescription medications, including dosages, and the names of preferred doctors, specialists, and hospitals, will be beneficial. This information helps in selecting a plan that meets specific healthcare needs and network preferences.

Submitting Your Medicare Advantage Application

Once all necessary information has been gathered and a Medicare Advantage plan has been chosen, the next step involves submitting the application. Individuals can typically apply for a Medicare Advantage plan directly through the plan’s online portal, by phone, or by mail. Licensed insurance agents are also available to assist with the application process, providing guidance and submitting the application on the individual’s behalf.

After the application is submitted, a confirmation of receipt is usually provided. The processing time for applications can vary, but coverage typically begins on the first day of the month following the plan’s receipt of the enrollment request, or on the specific effective date tied to the enrollment period used. For example, plans selected during the Annual Enrollment Period begin on January 1st.