Latest / Smart Coverage. Real Advice.: Medicare / Medicare Enrollment Windows Explained: AEP, Medicare Advantage OEP, and Special Enrollment Periods
Transcript
- Tanya: What’s the difference between Medicare’s Annual Enrollment Period, the Medicare Advantage Open Enrollment, and a Special Enrollment Period—and how do I know which one applies to me? If you’re feeling confused by all these windows, stick around. Tanya: Welcome to Smart Coverage. Real Advice., the insurance podcast from The Jordan Insurance Agency. I'm Tanya, your host, and I'm here with Billy Jordan, a licensed insurance agent and the president of The Jordan Insurance Agency. Billy: Glad to be here, Tanya. A quick disclaimer: we're not affiliated with or endorsed by Medicare or any government agency, and this is general education, not advice for your situation. Now, let’s get into these Medicare enrollment periods—because knowing which window fits your situation can make a world of difference. Tanya: Let’s start with the basics. What is the Annual Enrollment Period, and who does it apply to? Billy: The Annual Enrollment Period, or AEP, runs from October fifteenth through December seventh every year. During this window, anyone with Medicare can switch, drop, or join Medicare Advantage or prescription drug plans. Any changes you make take effect on January first. Tanya: So if you want to change your Medicare Advantage plan or your drug coverage, this is the main time to do it? Billy: Exactly. For example, if you review your Annual Notice of Change in September and see your plan is dropping your doctor or changing prescription coverage, you can use AEP to switch to something that fits better for the next year. Tanya: What’s a common mistake people make during AEP? Billy: A lot of folks skim or ignore their Annual Notice of Change. That’s risky—because your plan’s provider network or prescription tiers might shift, and you could be stuck with higher costs or lose access to your doctor if you don’t act before December seventh. Tanya: Okay, so that’s the main window in the fall. But then there’s this Medicare Advantage Open Enrollment Period in the new year. What’s that for? Billy: The Medicare Advantage Open Enrollment Period, or MA OEP, runs from January first through March thirty-first. It’s only for people already in a Medicare Advantage plan. You can make a one-time switch to another Advantage plan, or drop it and go back to Original Medicare—and add a standalone Part D drug plan if you want. Tanya: So, if you’re on Original Medicare with just a drug plan, you can’t use MA OEP to change your drug coverage? Billy: That’s right. MA OEP is just for Medicare Advantage members. If you’re on Original Medicare with a standalone Part D plan, you have to wait until the next AEP unless you qualify for a Special Enrollment Period. Tanya: Can you give me an example of how someone might use MA OEP? Billy: Sure. Say you switch to a new Medicare Advantage plan during AEP, but in January realize your specialist isn’t in the network. MA OEP lets you make one more switch or go back to Original Medicare—but only once during that period. Tanya: What’s a mistake people make with MA OEP? Billy: Trying to switch more than once. You only get one change in that window, so make it count. And remember, you can’t use it to switch standalone drug plans if you’re not in Medicare Advantage. Tanya: Now, what about Special Enrollment Periods—when do those come into play? Billy: Special Enrollment Periods, or SEPs, happen after certain life events. For example, if you move out of your plan’s service area, lose employer coverage after sixty-five, or your Medicare Advantage plan leaves your region, you get a SEP. These periods let you make changes outside the standard AEP and MA OEP windows. Tanya: How long do you have to act during a SEP? Billy: It depends on the event. If you lose employer coverage, you have eight months to enroll in Part B, and a two-month window to pick a Medicare Advantage or standalone drug plan. If you move, you get two full months after the month you move to choose a new local plan. Tanya: Can you share a real-world example? Billy: Absolutely. Let’s say someone retires and loses their employer health plan. They need to submit two forms—CMS-L564 from their employer and CMS-40B to Social Security—to activate Medicare Part B without a penalty. Then they have two months to enroll in a Medicare Advantage or drug plan. Tanya: What’s a common SEP mistake? Billy: Missing the paperwork deadlines. If you don’t file the right forms on time, you could face late enrollment penalties or gaps in coverage. It’s easy to overlook, especially when you’re busy with a big life change. Tanya: I hear a lot of questions about Medigap, too. Can people buy a Medigap policy during AEP or MA OEP without any health questions? Billy: That’s a big misconception. Standard enrollment periods like AEP and MA OEP don’t guarantee you can get a Medigap policy without underwriting. The only time you have guaranteed-issue rights is during your six-month Medigap Open Enrollment Period, which starts when you’re sixty-five or older and have Medicare Part B. Tanya: So if you’re outside that initial six months, you might have to answer health questions? Billy: Exactly. Private insurers can look at your health history, charge more, or even deny coverage. There are a few special situations—like if you tried a Medicare Advantage plan for the first time and switch back within twelve months, or if your Advantage plan leaves your area—but most people outside their initial window will face underwriting. Tanya: Can you give a quick example of how that works? Billy: Sure. If someone turns sixty-five and enrolls in Medicare Part B, they have six months to buy any Medigap plan without health questions. If they wait until they’re sixty-eight, they’ll have to go through underwriting unless they qualify for a special situation. Tanya: What’s a mistake people make with Medigap timing? Billy: Waiting too long. Some folks assume they can buy a Medigap plan anytime without hassle, but if you miss your six-month window, you may face higher premiums or even get declined. Tanya: Let’s recap. Three things to remember. Tanya: One, the Annual Enrollment Period runs October fifteenth to December seventh, and it’s your main chance each year to switch Medicare Advantage or drug plans. Tanya: Two, the Medicare Advantage Open Enrollment Period is just for current Advantage members from January first to March thirty-first, and you only get one change. Tanya: Three, Special Enrollment Periods are triggered by life events like moving or losing employer coverage, but you have to act fast and file the right forms to avoid penalties or gaps. Tanya: For a personalized look at your situation, book a free thirty-minute chat with Billy and his team at thejordaninsuranceagency.com/podcast. Billy: I'm Billy Jordan with The Jordan Insurance Agency. Until next time, take care. Tanya: Thanks for listening to Smart Coverage. Real Advice. from The Jordan Insurance Agency.