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How to Navigate Medicare Advantage in an Enrollment Period

Do you know when and how to enroll in Medicare Advantage (Part C)?

Key Takeaways

  • You are eligible to join a Medicare Advantage Plan (Part C) if you have Original Medicare (Part A and Part B).

  • There are three periods when you can enroll: initial,The initial enrollment period is a seven-month enrollment period when individuals, who are not automatically enrolled in Medicare, can sign up for Parts A and B. The period begins three months before your 65th birthday month, includes your birthday month, and continues for three months following your 65th birthday month. general and annual enrollment. There are special enrollment periodsThe Special Enrollment Period is a 60-day period outside the Open Enrollment Period when you can enroll or change your coverage. Special Enrollment Periods are only granted if you experience a Qualifying Life Event. These are special circumstances that may change your health insurance needs. for individuals that qualify.

  • Medicare Advantage can save you money on annual costs and increase your available benefits.

  • You can enroll through Marketplaces like GoHealth, private health insurance companies, or directly with Medicare.gov. You can also enroll by mailing a paper application to the plan you want to join.

     

What’s the Difference Between Medicare Advantage and Original Medicare?

Private insurance companies provide Medicare Advantage (Part C) and follow Medicare guidelines for services. Medicare Advantage is a part of Medicare, even though it is not public health insurance. Medicare Advantage Plans are alternatives to Original Medicare (Parts A and B)Original Medicare (Parts A and B) is fee-for-service health insurance available to all Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and offer comprehensive benefits that include health and wellness. The policies include Part A, Part B and usually, Part D (prescription drug coverage).Medicare Prescription Drug Plan (Part D) is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies.

It’s important to remember that not all Medicare Advantage Plans are the same. Take time to compare your options and make sure it’s what you need before enrolling.

Who’s Eligible?

Once you join Original Medicare (Part A and Part B), you are eligible for a Medicare Advantage Plan (Part C). To join a Part C plan, you must live in a designated coverage area. In most cases, Part C is unavailable to patients with end-stage renal disease (ESRD), though exceptions are possible with a Special Needs Plan. 

The number of total Medicare beneficiaries enrolled in Medicare Advantage is projected to increase to 51% by 2030. [1]

When is Medicare Advantage Enrollment Open?

You should mark your calendar with a few critical enrollment periods for Medicare Advantage: 

  • Initial Enrollment is seven months around your 65 birthday.  You are eligible to enroll three months before you turn 65, during the month of your birthdate and three months after you turn 65. For example: If you turn 65 in July, you can enroll between April and October.
  • General Enrollment is for those who didn’t enroll in Part B when they were initially eligible. You can enroll in Part B during general enrollment from January 1-March 31, and coverage starts July 1 of the same year.  You can enroll in a Medicare Advantage Plan from April 1-June 30 after you have signed up for Part B. 
  • Open Enrollment is from January 1 to March 31. For plans enrolled during the Annual Enrollment Period, you can change Part C plans or switch from Medicare Advantage to Original Medicare and add Part D if needed.
  • Annual Enrollment Period is from October 15 to December 7. You can change Part C plans or switch from Original Medicare to Medicare Advantage and vice versa.

Important note: Qualifying Life EventsQualifying Life Events (QLE) are life changes that allow you to enroll in a new health insurance plan during a Special Enrollment Period. These include having or adopting a child, losing other coverage, marriage, a change of income and moving. affect Medicare Advantage plans in the same way as other health insurance plans. You will have a new enrollment period if you qualify for special circumstances. Examples include leaving an Employer group plan from work, gaining or losing Medicaid, moving to another state and others.

How Do I Enroll?

You must be enrolled in Original Medicare before you can join Medicare Advantage (Part C). You’ll need the following information from your Medicare card to enroll in Medicare Advantage: 

  • Your Medicare number 
  • The date your Part A and Part B coverage begins

You can find online tools to compare plans or sign up directly with a private health insurance carrier in your area. At GoHealth, we’re available to provide a personal approach with licensed insurance agents ready to discuss all your options. We take time to match you with the right services because we represent you, and not the carrier.

How Does Medicare Advantage Enrollment Work?

Enrolling in Medicare Advantage can be confusing because there are several steps. First, you must enroll in Part A and Part B through Social Security. After you’ve done that, you’ll receive a “welcome packet” from Medicare in the mail with your Medicare card. You must have that card before enrolling in Medicare Advantage. 

You should contact a private insurance company to enroll in Medicare Advantage, or you can enroll by mail after completing paper enrollment forms. You can also contact a licensed insurance agent with GoHealth, who will walk you through the enrollment process and answer any questions about finding the right plan for you.

After you’ve enrolled, keep both of your Medicare and Medicare Advantage plan cards. In most cases, you’ll be asked to use the card from your Medicare Advantage Plan to get services covered by Medicare. However, you may be asked to show your Medicare card for some services as well. [2]

FAQs

Can I make changes to my coverage after December 7?

You can still make some changes to your coverage after the annual enrollment period ends on December 7. However, there are restrictions on what you can do.

During the Medicare Advantage Open Enrollment period (January 1 – March 31), you can

  • Switch to another Medicare Advantage Plan if you already have a Medicare Advantage Plan
  • Leave your Medicare Advantage Plan and go back to Original Medicare

During this period you can’t:

  • Go from an Original Medicare to a Medicare Advantage Plan 
  • Enroll in a Medicare Prescription Drug Plan (Part D) if you’re in Original Medicare
  • Switch from one Part D plan to another if you have Original Medicare

Who can enroll when it is not Open Enrollment?

You may qualify for an exception to the limited open enrollment window.

Some exceptions are:

  • You are newly eligible for Medicare, such as turning 65. You do not need to wait for Open Enrollment.
  • You are eligible for both Medicare and Medicaid and, therefore, can enroll at any time during the year.
  • You are eligible and have lost your prior prescription drug coverage which met the criteria of being “creditable coverage.”
  • A Special Enrollment Period (SEP) for a change in residence.

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