PART 3:  MEDICARE ADVANTAGE TERMS & ENROLLMENT PERIODS

KEY MEDICARE ADVANTAGE TERMS

So let’s take a look at the terms you need to understand in order to figure out whether a Medicare Advantage plan is right for you.   Keep in mind that all the time frames in this section apply ONLY to Medicare Advantage plans.   NONE OF THESE RULES APPLY TO MEDICARE SUPPLEMENT PLANS.

This item confuses so many people so often that it bears repetition:  

THE MEDICARE ENROLLMENT PERIODS DO NOT APPLY TO MEDICARE SUPPLEMENT PLANS.

Service Areas

Regardless what type of Medicare Advantage plan you like, you MUST live in an area the plan service area in order to sign up.  If you move out of the area, or if the plan closes service in your area, you will have a new enrollment period to change your Advantage plan.   You must also use only doctors and hospitals that are in your Medicare Advantage plan network.  

MEDICARE ADVANTAGE ENROLLMENT PERIODS

As of right now (2011 – 2012) the times you can change either your Medicare Advantage or Part D plans are:

INITIAL ENROLLMENT PERIOD (varies)

There are actually 5 different triggers for the Initial Enrollment Period, but the most common is the easy one:  under normal ‘turning age 65 circumstances’ it’s the 7-month period beginning 3  months before your 65^th birthday includes the month of your 65^th birthday, and extends through the 3 months FOLLOWING your 65^th birthday.  

During your Initial Enrollment Period, the Medicare world is your oyster.   You can enroll in any kind of Medicare and / or Part D plan you desire regardless of your health as long as you don’t have end stage renal disease. (There’s a special government program for that condition.) 

ANNUAL OPEN ENROLLMENT PERIOD:  October 15 to December 7

During this time you can

×      join a Medicare Advantage plan even if you’d passed on it before

×      Join a Medicare Part D plan

o        WATCH!   Late penalties apply if you didn’t enroll when you were first eligible

×      DROP either an Advantage or Part D drug plan and go back to Original Medicare

×      CHANGE from one Advantage plan to another

ANNUAL DISENROLLMENT PERIOD:   January 1 to February 14

Yep, you guessed right.   During this period you can

×      DISenroll from a Medicare Advantage plan & return to Original Medicare

×      If you disenroll from an Advantage plan, you CAN still sign up for a Part D drug plan

o        but you canNOT switch from Original Medicare to an Advantage plan

SPECIAL ENROLLMENT PERIODS

Special Enrollment Periods are triggered by events rather than predetermined dates.  While there are a goodly number of triggers, the two most common are:

×      You move out of your Medicare Advantage Service Area

×      Your Medicare Advantage plan closes down in your area

These situations trigger a 2-month period (3 months, if you move & notify the insurance company in advance) during which you can either join a Medicare Advantage plan or switch to a new one offered in your new area. 

Keep in mind that this is only an overview of the most common situations affecting Medicare Advantage plans.   For detailed information, go to Medicare’s own site:

http://www.medicare.gov/navigation/medicare-basics/medicare-basics-overview.aspx