Medicare Annual Election Period Cheat Sheet
This article was updated on: 02/25/2016
This cheat sheet can help clarify some of Medicare’s basic information to help you understand the options available to you.
Enrollment periods for Original Medicare
These enrollment periods may be used to enroll in Original Medicare, Part A and Part B.
- The Initial Enrollment Period is the time when you can first enroll into Medicare. This period lasts for a total of seven months, beginning three months before the month of your 65th birthday and ending three months after it. People with disabilities may also qualify for the Initial Enrollment Period outside of this seven-month range if they have collected disability benefits from Social Security for 24 months. If you get Medicare due to a disability, you can join during the seven-month period that begins three months before your 25th month of disability and ends three months after your 25th month of disability.
- The General Enrollment Period runs from January 1 to March 31 each year. You can use this time to enroll into Medicare Part A and/or Part B if you did not enroll during your Initial Enrollment Period. Your coverage will begin July 1.
- You may enroll into Medicare Part A and/or Part B through a Special Enrollment Period if you delayed enrollment because you had employer-sponsored health coverage.
Election periods for Medicare Advantage and Medicare Prescription Drug Plans
- The Initial Enrollment Period for Part D is when you’re first eligible to enroll in Medicare prescription drug coverage because you have Medicare Part A and/or Part B and live in the service area of the Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. It usually takes place at the same time as your IEP for Medicare Part A and/or Part B.
- The Initial Coverage Election Period is when you’re first eligible to enroll into a Medicare Advantage plan. For most people, this takes place at the same time as your Initial Enrollment Period for Medicare Part A and/or Part B and lasts seven months. If you delay Medicare Part B, your ICEP takes place three months before you have Medicare Part B and ends the day before your Part B effective date begins.
- The Annual Election Period runs from October 15 to December 7 each year. It allows Medicare beneficiaries to add, change, or drop their current coverage. You can use this period to enroll into a Medicare Advantage or Medicare Prescription Drug Plans or switch plans. If you’re already enrolled into a Medicare plan, you can use this period to disenroll from your plan. For example, if a Medicare beneficiary is enrolled into a Medicare Advantage plan, he or she may use the Annual Election Period to disenroll and return to Original Medicare.
- If you’re enrolled into a Medicare Advantage plan and change your mind, the Medicare Advantage Disenrollment Period is another chance for you to disenroll from your Medicare Advantage plan and return to Original Medicare. This period runs from January 1 to February 14 every year. If you’re disenrolling from your Medicare Advantage plan, you can also use this period to enroll in a stand-alone Medicare Prescription Drug Plan.
- The Special Election Period can be used throughout the year and is intended for people going through certain circumstances, like a move to a new service area or admission to a nursing facility.
Basic parts of Medicare
Medicare options are divided into four overall categories from which beneficiaries can choose.
- Part A is insurance that covers inpatient hospital costs, including hospice care and skilled nursing facility services.
- Part B is insurance that covers outpatient services, including doctors’ visits, ambulance rides, lab testing, and durable medical equipment.
- Part C is Medicare Advantage, which provides you with all Part A and Part B benefits through a private insurance company and may also include additional coverage, such as routine vision, hearing, and routine dental. Some plans also include Medicare Part D prescription drug coverage, called Medicare Advantage Prescription Drug (MA-PD) plans.
- Part D provides prescription drug coverage via private insurance companies. If you’re enrolled in Original Medicare, you can get this coverage through a stand-alone Medicare Prescription Drug Plan. If you have Medicare Part C, you can get Medicare Part D coverage through a Medicare Advantage plan with prescription drug coverage.
Types of Medicare Advantage plans
There are many different kinds of Medicare Advantage options available. Not every plan provider will have each kind, and you should shop around to see all the options available in your service area.
- HMO stands for Health Maintenance Organization, and these plans provide coverage through a network of physicians, hospitals, and providers.
- PPO, or Preferred Provider Organization, plans may have broader networks than HMOs and may let you go outside of the network for care, though you may be responsible for higher copayments.
- HMOPOS means Health Maintenance Organization Point of Service. It is a form of HMO that, like PPOs, lets you use providers outside of the network, although at a potentially higher out-of-pocket cost, and some restrictions apply.
- PFFS stands for Private Fee-for-Service. These plans let you visit any physician or hospital approved by Medicare that accepts the plan’s terms and agrees to treat you.
- MSAs, or Medical Savings Accounts, give you insurance coverage with a high deductible and a savings account that you use to pay for your health-care costs.
- SNPs are Special Needs Plans intended for people with certain chronic illnesses or those living in an institution (such as a nursing home) or people who qualify for both Medicare and Medicaid. These plans combine specialized health coverage and prescription drug benefits.
Medicare Supplement insurance
Medicare Supplement insurance, also known as Medigap, covers a variety of out-of-pocket expenses (such as deductibles and copayments) that are not covered by Original Medicare, Part A and Part B. Medigap does not, however, help with the cost of medical services not covered by Original Medicare (e.g., long-term care, eye glasses, hearing aids). The type of Medicare Supplement plan determines which deductibles and copayments are covered and the amount of such coverage.
There are 10 standardized Medicare Supplement plans available in 47 states of the United States (Massachusetts, Minnesota, and Wisconsin have their own versions of Medigap plans). Each of these plan types are designated with a letter (such as Plan F), and all plans of that letter offer the same benefits. For example, a Medicare Supplement Plan F enrollee in Florida has the same benefits as a Medicare Supplement Plan F enrollee in California. But prices for the same plan may vary from one insurance company to another.
During the Annual Election Period, you can switch Medicare plans or enroll in a new one. If you’re confused, I can help you get more comfortable with your options. Find out about my background below; you can access my profile by clicking on the “View profile” link below my photo. If you prefer, use the links below to schedule a phone appointment or have me email you information about plans that could work for you. To take a look at the plans available in your area, click on the Compare Plans button. Or just pick up the phone and give us a call to get help from a licensed insurance agent.
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