Can I Change My Medicare Advantage Plan? Understanding the 5 Election Periods
As of this writing, the 2021 AEP Season (annual election period) has been over for 8 days. Many are celebrating the end of phone calls and junk mail. However, as I spoke with many during this time, I realized there is plenty of confusion as to when a beneficiary (that’s you) can change his or her plan. Some people thought they MUST change their plan during AEP or lose their coverage. Not true. If you’re happy with your plan, you don’t need to do anything, it will just rollover. So, let’s take a look at when you can change your Medicare Advantage plan and how SEP (special election period) codes provide flexibility in unusual circumstances.
You may hear the words election and enrollment be used interchangeably. For instance, the Annual Election Period is also known as the Annual Enrollment Period. So, regardless of which on you see or hear, it’s the same thing, whether it’s the annual, open or special election/enrollment period.
Therefore, to answer the question, an election period is a set time when you can either enroll for the first time in the plan of your choice or change your existing plan. There are five (5) election periods, with two being very similar and used interchangeably, but there is a difference. They are:
Let’s parse these individually.
You only get one IEP. This is the time when you are first eligible for Medicare. It lasts seven months, beginning three months before your 65th birthday month, your birthday month, and ends three months after your birthday month. If your birthday were April 15th, your IEP would begin on January 1st and end on July 31st.
The ICEP can run concurrently with your IEP. However, the difference is when you decide to take your Medicare. If you decided to continue working past 65 and were covered by group insurance, you can elect to take your Part-A (hospital portion of Medicare insurance), since it’s $0 premium to qualified individuals. However, since Part-B requires paying a monthly premium, many choose to wait to take it until they retire.
Now, you decided it’s time to retire. You will lose your creditable coverage (group insurance) on July 31st. You now have eight (8) months to get your Part-B from Medicare and enroll in either a MediGap supplement with a standalone Part-D (prescription) plan or Medicare Advantage plan with Part D. This is your ICEP, and it ends the last day of the month prior to your Part-B being effective or eight months have elapsed. Confusing. I know. (You have 63 days to ger your Part-D plan: but that’s for another article).
Example. You applied for your Part-B in August and hypothetically, it’s effective date will be October 1st. Your ICEP will end on September 30th. However, let’s say you procrastinated and took your time, and now had to apply for your Part B during OEP (January 1st through March 31st). Your Part B will now be effective July 1st, but that’s 11 months after you lost your group coverage. Since April 30th was the end of the eight-month period, your ICEP ended three months prior. This is important because you may incur some lifetime penalties (for more on penalties, click here).
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This one is known to everyone, since it’s so advertised on TV, mail, Internet and over the phone. It’s the one-time of the year everyone can choose to change their plans for the following year. It lasts from October 7th to December 31st, and any changes take effect on January 1st. Sometimes referred to as Open Enrollment (not to be confused with OEP, see next). During this time, if you chose a plan early in AEP, and then found one you liked better, you can still change it, as the last application filed wins. That’s good and bad. You need to be careful, because it’s also easy for an unscrupulous person to change your plan without your knowledge if you’re not careful, overriding the plan you initially chose.
During OEP, January 1st through March 31st (for Medicare Advantage beneficiaries only), you can change your plan or change to Original Medicare with a standalone PDP (prescription drug plan). Unlike AEP, where you can submit as many applications as you want and the last one in wins, you only get one opportunity during OEP.
All the previous enrollment periods are set in stone. However, life happens. When it does, it can trigger special enrollment/election period codes so you can address your circumstances. There are quite a few and the following are just some you may qualify for; but when in doubt, speak with your agent. He or she can see if an SEP code is available to address any problem you may be experiencing.
If you qualify for the prescription drug program known as Extra Help (LIS), you are given a quarterly SEP code. In other words, you can change your plan once a quarter (if needed), with the exception of the final quarter. The final quarter is AEP, so you can change your plan with that election period.
If you suffer financial hardship and qualify for either the Extra Help program or a Medicare Savings Program, you receive a special election. Being eligible for a Medicare Savings Program requires changing your plan to a Dual Eligible Special Needs Plan (D-SNP). These plans are designed to coordinate Medicare with Medicaid.
Medicare Advantage plans are county specific. With few exceptions, where a plan may cover several counties, if you move out of the coverage area an SEP code is triggered to allow you to find new coverage.
Chronic conditions trigger SEP codes to allow one to change their plan. These are known as SNPs (special needs plans). Some examples include, but are not limited to:
If you have a change in your health, speak with your agent to see if changing to a plan designed to address the specific care necessary for your condition would be best for you.
Understanding the rules and how they apply to you will empower you to take control of your healthcare needs. Remember, you are not married to your Medicare Advantage plan. If life’s circumstances warrant a change, make sure to speak with your agent for some help and guidance.
If you don’t have your own agent or moved away from your agent’s area of service, give us a try. We would love to help you with caring, personalized, one-on-one assistance. At YourCareRep.com, our only goal (and legal and moral obligation being a fiduciary agent) is to provide only what is in your best interest, and no one else’s.