As much information as there is about Medicare, I’m surprised people still do not remember important Medicare dates. The surplus of commercials, mailers, emails, and advertisements probably do more to obscure and confuse people about Medicare enrollment dates. The first Medicare enrollment date to remember is the most important one.
Medicare Initial Enrollment Period
You are first eligible for Medicare at age 65. You can enroll in Medicare three months before your 65th birthday, the month of your birthday, and three months after your birthday. If you do not enroll, a penalty is permanently added to your Medicare Part B premium if you do not enroll.
The penalty is 10% of your current Part B premium added to your Part B premium for the rest of your life. Yes, it never stops. The 10% penalty is for not being enrolled in Medicare each full year when you were eligible. I have client who cannot verify he had employer health coverage for 4 year. Yes, he has a permanent 40% penalty tacked on to his Medicare Part B premium.
There is also a separate permanent penalty for not having a Medicare Part D plan as well.
The exception is if you have an employer health plan that is as good as Medicare. If you do, then you may defer going on Medicare indefinitely without penalty as long as you remain on a qualifying employer health plan. This is the part that many salespeople leave off in the rush to sell you a supplement or Medicare plan.
The Big Medicare Enrollment Date Is Annual Election Period (AEP)
Once you are on Medicare, you have an opportunity to change your Medicare Part D or Medicare Part C/Medicare Advantage plan during Annual Election Period (AEP). AEP that is from October 15th–December 7th each year.
You need this period because Medicare plans change, and your health needs change. You can switch to a plan that better serves your needs during this time. AEP is particularly important for a person on expensive medications.
Part D and Part C plans can drop prescription drugs, move them to higher tiers, or increase their copays significantly. The Annual Election Period allows people to switch to a plan that covers their medications at a lower cost.
Those on Part C/Medicare Advantage plans may be interested in other Medicare Advantage plans that have lower copays and better benefits. The Annual Election Period (AEP) is an opportunity to shift to a better plan.
For those who want to move to a Medicare Supplement from an Advantage plan or go from an Advantage plan to a Medicare Supplement, this is the time for that switch.
Medicare Advantage Open Enrollment Period (OEP)
A couple of years ago, CMS (Center for Medicare & Medicaid Services) decided to create Medicare Advantage Open Enrollment Period (OEP). OEP is from January 1 — March 31 each year; if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a Medicare Part D prescription drug plan) once during this time.
CMS observed that Medicare beneficiaries change Medicare Advantage plans during Annual Election Period AEP (Oct 15th–Dec 7th), but mistakes happen. The biggest mistake is the plan they switched to did not have their doctors in the network.
Other mistakes happened as well. OEP was an opportunity to rectify the situation. It was a free get-out-of-jail pass. You can make one change to another Part C/Medicare Advantage plan.
Or you could ultimately get out of your Medicare Advantage plan and go back to Original Medicare (Part A & Part B) and purchase a Part D plan.
The Lesser-Known Medicare Enrollment Date Is General Election Period
Another Medicare enrollment date to remember is January 1-March 31 each year for those who missed their initial enrollment period. This is called the General Enrollment Period. Your coverage, however, does not start until the following July 1. You might pay a monthly late enrollment penalty if you don’t qualify for a Special Enrollment Period.
At this time, you may have an open enrollment period for a Medicare Supplement starting in July. You may also enroll in a Part D plan, but you will need to wait until Annual Election Period in October to enroll in a Medicare Advantage plan.
Special Enrollment Periods
There is a myriad of Special Enrollment Periods. One of the most common is when someone is past 65 and 4 months and losses their employer’s health plan. At this time, CMS will allow you to enroll in Medicare Part A and Part B without delay or penalty if you can verify employer health coverage.
Some additional forms need to be completed and submitted to the Social Security Administration. Still, you will be enrolled on the date of your choosing and not need to wait for General Election Period.
Rules & Penalties
Medicare has lots of rules, regulations, norms, and penalties. Some of them are pretty obscure, but there is little to no forgiveness for mistakes or ignorance of the law. If you have questions about Medicare, please call us at 402-614-3389 or check out our blogs and videos on OmahaInsuranceSolutions.com. You can also call Medicare at 800-633-4227 or look on Medicare.gov for information about Medicare enrollment dates to remember.
Medicare Open Enrollment Is Also Known As Medicare Annual Election Period
Medicare Open Enrollment is when people may make changes to their Medicare plan. Medicare Open Enrollment is also called Annual Election Period or AEP. That is the new official name Medicare Open Enrollment. Annual Election Period (AEP) is when you can change your Medicare Part D prescription drug plan or your Medicare Part C Medicare Advantage plan. AEP is from October 15th–December 7th. A lot of people blow this opportunity. They don’t check to see if they have the best plan for their needs and situation for the coming year. BIG MISTAKE. For some people with serious health issues and medication needs, HUGE MISTAKE!
There are a thousand complaints the day after Medicare Open Enrollment (Annual Election Period), December 8th. People offer a myriad of excuses–It’s the agent’s fault,’ ‘I was too busy to deal with it,’ ‘The dog ate my Medicare card.’ The number of phone calls I get on December 8th is amazing–mostly non-clients. They are hoping to find a Medicare-fairy-godmother to save them from their negligence. Sorry, there is no Medicare-fairy-godmother!
When January 1st arrives and the new plan year begins, people may find out their plan does not cover one or more medications, or the price of one of their drugs went through the roof. Now they have a deductible on their plan they didn’t have before, a medication moved to a higher tier, or their doctor is no longer in-network. Their Medicare situation is a disaster because they didn’t double-check during the Medicare Open Enrollment / Annual Election Period (AEP).
What are the most significant problems created by not reviewing your Medicare plan during Medicare Open Enrollment / Annual Election Period (AEP)?
Formulary Check During Medicare Open Enrollment
During Medicare Open Enrollment /Annual Election Period (AEP), insurance companies determine the medications on their approved list of drugs in the formularies that service their Medicare Part D prescription drug plans and the Part C Medicare Advantage plans.
Some years, they drop certain medications altogether. In other years, they might shift the medications from a lower to a higher tier.
The result is you may end up paying more for your prescription drugs. In some cases, a lot more. Checking the formulary and comparing it to the other plans in the area is a straightforward but essential process.
During Medicare Open Enrollment / Annual Election Period (AEP), reviewing medications is a big part of what we do. I sometimes have to arm-twist clients to send me their current list of medications. Some will tell me that they don’t need to do anything because their medications have not changed, but I try to remind them it doesn’t matter. The insurance companies change their formularies.
Over the years, I have had clients neglect their reviews and end up with substantial prescription drug bills as a consequence. Your agent should thoroughly check your medications with dosages each AEP.
Double Check Physician Directories
The Medicare Advantage plan manages your care. That means that an insurance company under the supervision of Medicare is making determinations about your care. As part of that program, they have doctors contracted with the plan. Some doctors and hospitals are not contracted. Doctors may change their credentialing.
It is important to double-check to ensure your doctor is still in-network during Medicare Annual Election Period (AEP) / Medicare Open Enrollment.
We have three medical networks in the Omaha, Lincoln, and Council Bluffs area. The vast majority of medical professionals are part of one or more of these networks. The networks work with the local Medicare Advantage plans. Doctor access is not an issue.
I have clients, however, throughout the U.S., and the other plans are not as generous in the number of in-network medical professionals. Checking the directory to make sure your physicians are still in-network every year is critical during Annual Election Period (AEP) / Medicare Open Enrolment.
With Medicare Advantage plans, copays may change from year to year. This AEP saw very little change among the plans around here. I suspect that was because the plans determined prices in the Spring of the preceding year.
The inflation we are experiencing right now was not a factor in the 2022 planning. I think 2023 will be a different ball game.
Copays can change each year, so you need to review those changes. For example, the cost of MRIs may jump on your plan to the extent you want to change to another plan. Sometimes plans will drop benefits that Medicare does not require, like dental.
I’ve seen plans in the past drop benefits like dental. Beneficiaries don’t imagine their plan could ever change. The lack of coverage and the price tag associated with that shocks clients.
The dreaded Donut Hole or Gap! The Donut Hole is still there. I’ve seen the burden of drug costs lighten for some of my clients, but it is still expensive when people fall into the Donut Hole.
If you are on expensive medications that drive you into the Gap, checking your medications for the level of Gap coverage is essential. While no plan eliminates the cost, some plans are structured, so you pay less than other plans. Some plans delay going into the Gap longer, or other plans even out the cost because of a zero deductible.
If drug costs are an issue for you, look at the various Part D, and Part C plans side-by-side to determine which payment schedule would benefit your wallet during Medicare Open Enrollment.
Have A Conversation About Your Travel Plans
Many clients on Medicare like to travel. Their grandkids are scattered throughout the country. Friends moved to warmer clients, or getting out of town is just great. Other clients have semi-permanent homes in Arizona, Florida, and Texas. Medicare is a federal program. It exists from sea to shining sea in the U.S. The Medigap policies that company them work anywhere in the U.S. too. (Medicare. however, does not leave the borders of the U.S.)
Medicare Advantage plans, however, are set up for a particular area or region. The HMO (Health Maintenance Organization) plans only include doctors and hospitals in that area. Emergencies are a different matter. Emergency visits are covered anywhere in the country. Some insurance companies with HMO plans also have national networks, so you can still get in-network services and prices outside of your geographic region for ordinary services.
For those who travel a lot and especially those who stay for long periods away from home, I highly recommend the PPO (Preferred Provider Organization) plans. You may go to doctors and hospitals outside the network as long as they take Medicare. Out-of-network copays may be more, but you have the convenience and security of going anywhere that accepts Medicare.
You can change your Medicare Advantage plan during Medicare Open Enrollment even if you are out of the area. There is email, U.S. mail, text, and even voice signatures.
Over the years, I have had client reevaluate their situation during Medicare Open Enrollment or AEP. Those paying enormous amounts in monthly Medigap premium look to switch to a Medicare Advantage plan.
The amount of money they pay in premium very quickly covers any copays. Others anticipate more medical costs as they age, switching to Medigap plans. Medicare Open Enrollment or AEP is the time to review your ever-changing circumstances and adjust accordingly.
While Medicare supplements are not geared toward Medicare Open Enrollment or AEP exclusively, it is still an excellent time to look at your pricing. Running Medigap quotes only takes a few moments. I can tell you in a minute if you have the lowest price for Plan G or Plan N in your area. We can then make adjustments accordingly.
Medicare planning is not a one-and-done deal. As you change, Medicare changes and the Medicare plans change. You need to make the adjustments that best fit your needs and circumstances at that time.
Ignore Medicare Annual Election Period (AEP) October 5th–December 7th at your peril or not.