- Understanding Medicare Advantage IntroLesson 11:13
- Medicare Advantage BasicsLesson 21:32
- Types of Medicare Advantage PlansLesson 36:23
- Medicare Advantage CostsLesson 43:24
- Enrollment PeriodsLesson 56:57
- Medicare Advantage vs. Medicare SupplementLesson 64:05
- Requirements to Sell Medicare Advantage PlansLesson 72:19
- Next StepsLesson 80:45
Enrollment Periods
One of the requirements to enroll in a Medicare Advantage plan is that your client needs to be in one of their eligible enrollment periods. Some of these enrollment periods happen on an annual basis, while others are tied to specific events or circumstances.
It probably makes the most sense to start with your client’s first enrollment opportunity, their Initial Coverage Election Period. The Initial Coverage Election Period (ICEP) is your client’s first opportunity to get into a Medicare Advantage plan, around when they’re first eligible for Medicare.
For most people, their ICEP will coincide with their opportunity to enroll in Part A and Part B, the Initial Enrollment Period, when they’re turning 65, or they’re receiving their 25th month of Social Security Disability benefits. We’ll look at individuals who are enrolling in their Part A and Part B when they’re first eligible for Medicare at age 65.
The ICEP is a seven-month window that surrounds an individual’s 65th birthday month. So it would include their 65th birthday month, it would start three months before their 65th birthday month, and would extend out three months after their 65th birthday month.
To illustrate, let’s say John has his 65th birthday in June, and he sets up his Part A and Part B coverage to begin June first. For John, his ICEP would start on March 1 and extend out to September 30.
But what about clients that don’t enroll in Part B when they’re first eligible? Instead, their ICEP would span for three months leading up to their Part B enrollment.
Let’s look at an example of Susan. Let’s say she turned 65 three years ago. She picked up her Part A, but because she’s still working, she delayed her Part B enrollment. Upon retiring, she sets up her Part B to be effective May first. So Susan’s ICEP would span from February 1 to April 30.
Now that we’ve covered the Initial Coverage Election Period, we can introduce our next enrollment period, the Medicare Advantage Open Enrollment Period.
This enrollment period, also known as the MA OEP, has two parts. The first part is an individual MA OEP. This occurs when a client enrolls into a Medicare Advantage plan during their ICEP. That client would have a three-month window starting with the month that they’re entitled for Medicare, and it would extend out three months from that. During this time, that client would be able to enroll into a different Medicare Advantage plan or switch back to original Medicare.
Let’s walk through two quick examples of this. We’ll start with John. John turns 65 in June, and he signs up for Medicare Part A and Part B and a Medicare Advantage plan effective June 1. John’s Medicare Advantage Open Enrollment Period would run from June first through August 31.
What about our example of Sue who delayed her Part B enrollment? Sue, whenever she did retire, picked up her Part B and enrolled into a Medicare Advantage plan effective May 1. Sue’s three-month Medicare Advantage Open Enrollment Period would run from May 1 through July 31.
The second part of the Medicare Advantage Open Enrollment Period is an annual enrollment opportunity that happens every year from January 1 to March 31.
This opportunity is just for individuals that are currently enrolled into a Medicare Advantage plan. It allows them to make a one time switch to a different Medicare Advantage plan, or they can disenroll and return to original Medicare. The MA OEP does not give your clients the opportunity to switch from original Medicare to a Medicare Advantage plan.
Any changes made during the MA OEP will go into effect the first of the month following the month your client requests that change.
The next enrollment opportunity we’d like to cover is the Annual Enrollment Period (AEP). And as you may have guessed by the name, this is an annual opportunity that runs from October 15 to December 7 every year.
During this time, your clients will review their Medicare Advantage plan coverage for the upcoming year. Because of this, any enrollment submitted for Medicare Advantage for your client will become effective January 1 of that following year.
Carriers update their plans on an annual basis, so this is a great time to meet with your clients, review their current plan, see if any of their health needs have changed, and make sure you’re addressing those needs with a change for their plan in the upcoming year.
In addition to these enrollment periods, there are several Special Enrollment Periods that give your clients an opportunity to make a change to their plan outside of some of the time frames and circumstances that we’ve covered so far. These work differently because they’re instead triggered by specific events or circumstances, and they have a set time frame of when the change needs to be made. Let’s look at a couple examples.
If your client moves out of their Medicare Advantage plan service area, that would qualify them for a Special Enrollment Period (SEP). They’d have an opportunity to switch into a new Medicare Advantage plan, or they could drop that Medicare Advantage plan and return to original Medicare.
Another Special Enrollment Period that comes to mind is the trial right SEP. Let’s say your client disenrolled from their Medicare Supplement plan to enroll in a Medicare Advantage plan for the first time during the Annual Enrollment Period. That client is gonna have a 12-month SEP extending from the date they enrolled in that Medicare Advantage plan that allows them to disenroll from the plan, switch back to Original Medicare, and rejoin the Medicare Supplement plan that they were previously on. This can be an especially helpful enrollment opportunity for clients that have had health changes in those 12 months or for clients that simply weren’t happy with the Medicare Advantage plan that they enrolled in.
There are many other SEPs that we did not have a chance to cover here today, but we highly recommend going over to Medicare.gov to review their list of SEPs. We include a link to that in the module notes.
Special Enrollment Periods are very important to be aware of, not only so that you can make the sales when the opportunity arises, but so that you can make sure your clients are in the correct plan for them, and they can make changes when they need to.
