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Is There an Open Enrollment Period for Medicare & Medicare Supplements?

Don’t get fooled again! The truth about the Medicare Supplement Open Enrollment Period. Plus, Medicare Advantage, Medicare Supplements, and the big differences between the two.

If you’ve turned on a the TV in recent weeks, you surely have been bombarded with commercials promoting the upcoming Medicare Open Enrollment Period. Like most folks, you dread having to research plans each year.

Finding the answers to your biggest questions about open enrollment for Medicare can be tough….but luckily, you can find them all here! Find out more about the enrollment deadlines, the difference between Medicare Supplements and Medicare Advantage plans, and much more.

Is there an Open Enrollment Period I have to follow?

The short answer is… it depends on the type of Medicare you’d like to get.

Recently, I was contacted by a woman, Marge, who was worried that her Medicare Advantage plan’s network of allowed doctors has changed yet again. She’d received a letter indicating that the co-pays will rise, again, just like they do every year. (It turns out that she was right to be worried about her plan’s changes).

Before calling me, Marge shared her concern with her friend Carol, who is a client of mine (we like to call our clients “Members”). Carol told Marge that under her MediGap plan, she doesn’t have to worry about changes in her out of pocket costs each year. Carol also doesn’t have to worry about her provider network because her MediGap plan allows her to see any Medicare Doctor in the USA.

The more Carol told Marge about her MediGap plan, the more Marge wanted to sign up for the same kind of coverage! Marge asked Carol, “Is there an open enrollment period for Medicare plans like MediGap and Supplements? When is the MediGap open enrollment period and how do I sign up for a MediGap plan? If there a difference between Medicare Supplements and MediGap plans?”  Since Carol wasn’t quite sure, she provided Marge my phone number.

That’s when Marge called me and I began to explain to her the big secret about the Medicare Supplement open enrollment period and the different types of Medicare plans….

But before we discuss MediGap plans, let’s review some important Medicare facts.

Original Medicare vs. Medicare Supplements vs. Medicare Advantage

First you may be wondering why you would want to consider improving your Medicare coverage; after all, Medicare is the best thing since sliced bread, you’ve been told ever since you began working and paying taxes.

Medicare eligibility, as well as Medicare enrollment, are the first pieces of the puzzle to understand. The type of Medicare you “get” when you “age in” (Ex. turn 65 years old, or otherwise become eligible) to Medicare is just two of the many parts of Medicare. The parts of Medicare most folks think of in the traditional sense of the government-provided health care for seniors is called Original Medicare.

Original Medicare only – which consists of Medicare Part A and Part B only – leaves you exposed to financial risks due to the large gaps in Medicare’s coverage. Choosing Medicare A and B only can be a very risky decision!

Part A of Medicare covers your hospitalizations’ “room and board” and emergency room visits. Your Part B covers your doctors, some limited medications (such as chemo), and preventive care. Each of these parts of Original Medicare – Part A and Part B – have high deductibles, coinsurance you must pay, and limitations on coverage provided.

For Part B services such as doctor visits, you could pay as much as 20% of the full bill!Unfortunately, there’s no “stop-loss” or maximum limit on the amount you could be charged. Let’s say, for example, you have to pay 20% of a doctor’s bill that is $1,000. That’s $200 out of your pocket, which isn’t outrageous. But what if your doctor’s bill comes out to $100,000? Do you have $20,000 laying around to pay your Part B portion? Medicare Part B still leaves you exposed to potentially high medical bills!

Not to mention: Original Medicare does not cover prescription medications! (All Medicare recipients are required to have drug coverage) You can quickly see why having Original Medicare as your only coverage is risky.

pro-medicare-tipPRO TIP: You can be charged a penalty for not having creditable drug coverage. To find out if your current drug coverage is sufficient, or to enroll in a Part D plan, contact My Medicare Partners at 1-844-305-6169.

This is why many Medicare recipients chose to enroll in additional Medicare coverage through one of two avenues: either through a Medicare Supplement (also known as MediGap) plan or through a Medicare Advantage (MA) plan.

The two could not be more different: Medicare Advantage plans typically have lower premiums, yet tend to have much higher out of pocket costs when “using” the plan. Medicare Supplements, on the other hand, tend to have higher, stable monthly premiums, but take care of all or most medical bills – giving MediGap policyholders unmatched peace of mind.

In simple terms, Medicare Supplement plans keep healthcare costs steady, while Medicare Advantage out of pocket spending can be unpredictable.

medicare-supplement-vs-mapd-medicare-advantage

A vast majority of Medicare Advantage, also known as MA or MAPD plans, plans are HMOs which

  • Require you only visit in-network providers (Doctors and hospitals on their approved list),
  • Require you obtain a referral from your Primary Care Provider (also known as your General Practitioner) before you’re allowed to visit a Specialist doctor,
  • Do not provide coverage outside of your immediate area (often only covered in the county you live in), and
  • Limit you in other ways

For Medicare enrollees who want the ultimate convenience and financial security in their health insurance, Medicare Supplements are recommended over Medicare Advantage plans.

Remember the high costs I mentioned that you may be subject to under Original Medicare? Well, Medicare Supplement plans fill in the gaps in Original Medicare – hence why they are often called MediGap plans.

Medicare Supplement plans cover either partially or in full (depending on the Plan letter selected) deductibles, co-pays, and coinsurance that people with Original Medicare coverage only have to pay out of their own pockets. Many Medicare Supplement plans also offer coverage for emergencies outside of the US, giving you peace of mind while enjoying your retirement to the fullest.

The best way to find out which option is a better fit for you is to speak to an experienced, licensed Medicare Agent. Agents like me can quickly review MA and MediGap plans in your area and review the plan details with you. Agents – whose help is of no cost to you – can also make sure you enroll during the Medicare Open Enrollment Periods.

The Medicare Supplement Open Enrollment Period

Let’s go back to Marge’s original question: When is the open enrollment period for Medicare Supplements? Here’s a little hint…

There is no annual Medicare Supplement open enrollment period! Surprise! The enrollment period for Medicare Supplements is year-round.

Unlike almost every other type of health insurance out there, Medicare Supplement plans do not have a special time of the year during which you have to apply. Folks can apply for a MediGap plan any day of the year. No short deadlines to abide by, no hoops to jump through. (Medicare Advantage enrollees may have some restrictions. See below)

You can already begin to see how simple and easy Medicare Supplement plans are!

A lot of the TV advertisements and mail you receive may be somewhat confusing. But make no mistake about it: Medicare-eligible people can apply for a Medicare Supplement plan at any time, unless their current coverage prevents them from doing so.

To read more about each potential enrollment situation, click the plus signs (+) below:

I currently have a MediGap and want to switch Plan letters

If you are currently on a MediGap plan and would simply like to switch from one Plan to another, you may do so any time of the year. Each Medicare Plan letter has different out of pocket costs. Switching Plans may result in big savings!

Please note that you may be required to go through medical underwriting.*

Ex. you currently have a Plan F but would like to switch to a Plan G.

medicare-savings

Member John A from Texas recently saved over $222 each month by switching from a Plan F to a Plan G!
pro-medicare-tip
PRO TIP
: Don’t assume that your current insurance carrier will have the best price! It’s important to get quotes from several different insurance carriers to compare costs.
All Plans of the same letter have the same benefits, but premium prices can change depending on the insurance company providing the coverage.

I currently have a MediGap and want to switch insurance companies

If you are currently on a MediGap plan and would simply like to switch from one insurance company to another, you may do so any time of the year. Switching insurance carriers may result in big savings!  

Please note that you may be required to go through medical underwriting.*

Ex. you currently have a Plan G with Manhattan Life but would like to switch to a Plan G offered by Humana.

My Medicare Partners’ Agent, Brett, saved one of his Members $886.06 annually simply by taking her off a Blue Cross plan and switching him to a plan with Mutual of Omaha! Brett also helped save her husband nearly $61 per month by simply switching companies! The coverage remains the same; the only change is the company providing the benefits.

medicare-savings-2

pro-medicare-tipPRO TIP: While each Plan of the same letter has the same benefits, insurance companies may charge different premium amounts. For example, all Plans F in the state of Georgia offer the same benefits, the same coverage, and the same out of pocket costs to the consumer. But Blue Cross’ premium in Atlanta for a Plan F may have a different cost than Cigna for the same exact Plan F in the same area.  That is why it’s so important to compare all of the top-rated insurance carriers in your area!

 

I currently have Original Medicare only and want to be covered by a MediGap plan

Smart move! You will experience much lower out of pocket costs once you’re covered by a Medicare Supplement plan. If you are adding a Medicare Supplement plan to your Original Medicare coverage (you only have Part A and Part B), you may do so any time of the year.

Please note that you may be required to go through medical underwriting.*

Ex. You are enrolled only in the very basic parts of Medicare – Part A for hospitalizations and Part B for medical visits – and are paying out of your own pocket for medical care. You would like to lower your costs, protect your finances, and gain more peace of mind.

I currently have a MediGap and want to be covered by Original Medicare only

While we strongly urge against cancelling supplemental coverage to return to Original Medicare only, you are able to cancel your Medicare Supplement at any time. Please remember that Original Medicare only may leave you exposed to high financial risks!

If, at a later date, you decide to reenroll in the same (or a new) Supplement Plan, please be aware that you may have to go through medical underwriting.* Also premiums may be higher and the availability of plans may change.

pro-medicare-tipPRO TIP: We highly recommend consulting with a licensed, experience Agent before returning to Original Medicare only. It’s vital to assess your health care needs before taking a big risk!

I currently have a Medicare Advantage plans and want to switch to a MediGap plan

Unfortunately due to Medicare Advantage’s restrictions, you may only cancel your MA plan and switch to a Medicare Supplement plan during a certain time of the year, known as the Annual Election Period. Please read more below about the Medicare Advantage Annual Election Period and the Medicare Advantage Annual Disenrollment Period for more information.

Please note that you may be required to go through medical underwriting.*

16_1116_guaranteedacceptanceperiod_webinfographic2x*A special note about Medical Underwriting….

All Medicare beneficiaries may enroll in a Medicare Supplement plan when they first become eligible for Medicare without having to go through medical underwriting. Also known as the Guaranteed Issue Period, folks who are newly eligible cannot be denied acceptance into a MediGap plan during this period, even if they are ill or have preexisting conditions.

The Guaranteed Acceptance Period, during which a Medicare Supplement company cannot refuse you coverage lasts for 13 months:

  • It begins six months before your Medicare Part A and Part B begin (which is usually the month of your 65th birthday), continues
  • The month your Part A and Part B become effective (which is usually the first day of the month that you turn 65), and lasts until
  • The six months after the month you become Medicare-eligible

For example, if Janice’s turns 65 and becomes eligible for Medicare in January 2018, she can apply for her Medicare Supplement plan as early as January 2017. Janice still has all the way until January 2019 to be automatically accepted into a Plan – but I’d never recommend she procrastinate for that long!

If a person applies for a Medicare Supplement plan outside of the Guarantees Acceptance Period (and doesn’t qualify for a special circumstance), they have to go through “medical underwriting.” Medical underwriting means that the insurance company (and/or the agent completing the application) may ask personal health questions of the applicant, such as diagnosed medical conditions, prescribed medications, and height and weight.

Outside of the Guaranteed Acceptance Period, an insurance carrier may choose to outright deny coverage to an applicant. Sometimes, an applicant may be “rated”, or charge a higher premium, due to preexisting conditions.

pro-medicare-tipPRO TIP: Each insurance carrier’s and each Plan’s medical underwriting questions and criteria may vary. Don’t assume that you’re too ill or not healthy enough to pass medical underwriting. You may be surprised!

To read more about exceptions that allow applicants to avoid medical underwriting, read here.

The Medicare Advantage Enrollment Period

Unlike Medicare Supplement plans, Medicare Advantage plans do have strict Open Enrollment periods that enrollees must abide by. An applicant may only sign up for Medicare Advantage during the Annual Election Period (AEP), also known as the Open Enrollment Period or the Annual Enrollment Period.

Medicare Advantage (also known as MA or MAPD, which stands for Medicare Advantage with Prescription Drug coverage) beneficiaries may only disenroll from their Medicare Advantage plan during the AEP or during the Annual Disenrollment Period (ADP).

The MA AEP also applies to Part D prescription drug plans. Please note that although it is not required that you enroll in a Medicare Supplement or Medicare Advantage plan, it is required that all Medicare beneficiaries have creditable prescription drug coverage. People who do not have creditable drug coverage for a period of 63 days in a row or more may be charged a penalty.

What is the Medicare Advantage Open Enrollment Period / Annual Election Period?

annual-election-periodAlso known as the Annual Election Period (AEP), the Medicare Advantage Open Enrollment Period takes place every year from October 15 through December 7. Plan changes will become effective January 1 of the following year.

During the AEP, you may

  • Enroll in a MA plan
  • Switch from one MA plan to another
  • Leave an MA plan to enroll in Original Medicare only
  • Enroll in a Part D prescription drug plan
  • Switch from one Part D plan to another
  • Drop your prescription drug coverage altogether (remember, it is required you have drug coverage or you may face a penalty)
What is the Medicare Advantage Disenrollment Period?

The Annual Disenrollment Period (ADP) applies both to Medicare Advantage (MA) plans as well as Part D prescription drug plans. The ADP runs from January 1 through February 14 of each year. Just as the name implies, during this time, you may leave the MA or Part D coverage you elected to enroll in during the prior AEP. Even if you originally enrolled in your MA or Part D plan in years past, you can still chose to cancel your MA or Part D coverage during this time.

During the ADP, you may also choose to leave your MA plan to pursue more robust coverage by signing up for a Medicare Supplement plan! Of course, you can also leave your Medicare Advantage plan and revert back to Original Medicare only. As discussed earlier, being covered by Original Medicare only could leave you exposed to high financial risks.

Once your MA plan is no longer effective, you may elect to enroll in a stand-alone Part D plan. Stand-alone Part D plans are an important, additional piece to receive full, qualified coverage. If you request disenrollment from your Medicare Advantage (MA) plan in January, for example, your MA will terminate on January 31.

During the ADP, you cannot

  • Enroll in a MA plan or switch from one MA plan to another
  • Switch from one Part D drug plan to another

It is highly recommended to consult with a licensed agent before changing your coverage options. You could be locked out of enrolling in a new plan for several months, so be sure you have assessed your options!

Special Enrollment Periods

As mentioned earlier, it’s very important to pay attention to any Enrollment Periods you may have to follow in order to make changes to your Medicare coverage and benefits.

In some circumstances, a person may be able to make changes to their plan which are otherwise not allowed outside the Enrollment Periods. A person may experience specific situations which allow for Special Enrollment Periods (SEPs) such as moving or becoming Medicaid eligible. If a person’s Medicare Advantage plan is no longer being offered by the insurance carrier for the following plan year, that person may also qualify for an SEP.

pro-medicare-tipPRO TIP: Don’t assume you may or may not qualify for an SEP! Check with a licensed insurance agent before making any permanent changes!

Situations which may allow a person to qualify for an SEP include (this is not a full list)

  • Moving to a new address that is not covered within your current plan’s coverage area, or moving to an address that is within your plan’s area but additional, new options are also available
  • Moving back into the United States after living abroad
  • Moving into, living in, or moving out of an institution such as a long-term-care hospital or a skilled nursing facility
  • Losing Medicaid eligibility
  • Losing Part D Extra Help
  • Losing coverage from your employer or union
  • Being released from jail or prison

Depending on the SEP you qualify for, you may be able to enroll in various types of plans. SEP deadlines and timeframes also vary. Please check with a licensed agent to confirm you qualify for an SEP; don’t assume!

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