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- Lesson 80:45
One of the requirements to enroll in a Medicare Advantage plan is that your client must be in an eligible enrollment period. Some of these enrollment periods happen annually while others are tied to specific events or circumstances.
It’s probably best if we start with the first enrollment opportunity your clients experience, the Initial Coverage Election Period.
The Initial Coverage Election Period or ICEP is an individual’s first opportunity to enroll in a Medicare Advantage plan surrounding when they have Medicare Part A and B. For most people, their ICEP will coincide with their Initial Enrollment Period for Part A and B when turning 65 or receiving their 25th month of Social Security Disability Benefits.
We’ll look at individuals enrolling in Parts A and B when first eligible at 65. Their ICEP would be a seven-month enrollment period that includes three months before they turn 65, the month they turn 65, and three months after they turn 65.
To illustrate, say John turns 65 in June and signs up for Medicare parts A and B effective June 1st. His ICEP for a Medicare Advantage plan would last from March 1st to September 30th.
But what about clients who do not enroll in Medicare Part B when first eligible? Their ICEP would span the three months leading up to their enrollment in Part B. For example, Sue turned 65 three years ago and signed up for Medicare Part A, but since she was still working, she delayed her enrollment in Part B. Upon retiring, she signs up for Part B to be effective May 1st. Her ICEP would start on February 1st and end on April 30th.
Now that we’ve covered the Initial Coverage Election Period, this would be a great time to introduce our next enrollment period, the Medicare Advantage Open Enrollment Period.
This enrollment period, also referred to as the MA OEP, has two parts. The first part is an individual MA OEP. This occurs when a client joins a Medicare Advantage Plan during their ICEP. That client would have a three-month window starting with the month they were entitled to Medicare to switch to another Medicare Advantage Plan or return to original Medicare.
Let’s walk through two quick examples of this.
John turns 65 in June and signs up for Medicare Parts A and B and joins a Medicare Advantage plan effective June 1st. His Medicare Advantage Open Enrollment Period would be from June 1st to August 31st.
What about our example Sue, who delayed her Part B enrollment? When she retired, she signed up for Part B and a Medicare Advantage Plan, both Effective on May 1st. Sue’s three-month Medicare Advantage Open Enrollment Period would begin on May 1st and end on July 31st.
The second part of the Medicare Advantage Open Enrollment Period is an annual enrollment opportunity that runs from January 1st to March 31st. This opportunity is only available to clients who are currently enrolled in a Medicare Advantage plan and allows them to switch to another Medicare Advantage plan or return to original Medicare. Keep in mind, this switch only works one way. The annual MA OEP does not give your clients the opportunity to switch from original Medicare to a Medicare Advantage plan. Coverage for the Medicare Advantage Open Enrollment Period begins the first day of the month after your client requests the change.
The next enrollment opportunity we’d like to cover is the Annual Enrollment Period or AEP. As you may have guessed from the name, AEP is an annual enrollment opportunity the lasts from October 15th to December 7th.
During this time, your clients will review Medicare Advantage plans for the upcoming year. Because of this, when your client enrolls in a plan during AEP, their coverage will be effective on January 1st of the following year.
Carriers update their plans each year, so the AEP is a great time to reconnect with your clients. As we mentioned, you want to review their current plan, get an update on their health needs, and ensure that they have coverage to fit those needs for the upcoming year.
In addition to these enrollment periods, there are a few Special Enrollment Periods that allow your clients to change their coverage outside of the time frames and circumstances we’ve mentioned so far. These enrollment periods work differently because they’re triggered by certain events and only last for a specified period of time.
Let’s go over a few quick examples.
If your client moves out of their Medicare Advantage plan’s service area, that qualifies them for a Special Enrollment Period. Your client also has the option to switch to another Medicare Advantage plan or drop their Medicare Advantage plan and return to Original Medicare.
Another Special Enrollment Period that comes up often is the Trial Right SEP.
Let’s say during the Annual Enrollment Period, your client dropped their Medicare Supplement policy to join a Medicare Advantage Plan for the first time. Your client would have an ongoing SEP for the next 12 months that would allow them to drop their Medicare Advantage Plan, return to Original Medicare, and return to their old Medicare Supplement policy.
The Trial Right SEP can be helpful, especially if a beneficiary has health changes in that 12-month period, or if they decide that a Medicare Advantage plan isn’t the right fit for them.
There are many other SEPs other than the ones we mentioned here. We encourage you to explore them at Medicare.gov, we’ll have the link in the notes for this module.
Knowing when your clients can make changes to their Medicare Advantage coverage not only helps you make the sale, but also helps your clients ensure they can make needed changes should that time come.