Can I Enroll In A Medicare Advantage Plan Anytime?Learn about when you can apply for a Medicare Advantage Plan with our guide.
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If you’re thinking about joining Medicare Advantage, one question you might have is when you can apply.
Medicare has guidelines on when beneficiaries can switch to Medicare Advantage once they’re enrolled in Medicare. If you decide to change plans outside of these periods, you won’t be able to.
This article will cover everything you need to know about when you can enroll in a Medicare Advantage Plan.
What Is Medicare Advantage?
While most people know that Medicare is a health program for older individuals, they don’t usually know the different types of plans out there.
When you join Medicare, you’ll have a couple of options on the coverage that you can get. Medicare is divided into different parts which cover different medical costs.
Medicare Part A is hospital insurance.
Medicare Part B is outpatient insurance for general medical costs.
Original Medicare vs. Medicare Advantage
Original Medicare is the federal program for hospital and outpatient medical expenses (Part A and Part B).
This is different from Medicare Advantage, which are Medicare health plans that are run by private health insurance companies.
Medicare Advantage Plans must offer at least the same benefits as Medicare Part A and Part B, but many Medicare Advantage Plans also offer additional benefits, such as prescription drug coverage.
In order to join a Medicare Advantage Plan, you’ll need to have both Medicare Part A and Part B coverage. There are three private health care plans you can look into:
Medicare Supplement Insurance.
Prescription Drug Plan.
Can I Get Medicare Advantage If I Have Another Private Health Plan?
Keep in mind that you can only register for one of these at a time.
No, you won’t be able to get Medicare Advantage if you have:
Medicare Supplement Insurance Plan ❌
A Standalone Part D Plan (Prescription Drug Plan) ❌
If you have either one of these plans already, you’ll need to end your contract before you can legally join a Medicare Advantage Plan.
But don’t worry, your insurance agent should be able to help you with this so that you don’t have to spend hours phoning around or filling in forms.
There are four basic types of Medicare Advantage Plans you can get. Let’s cover them in more detail:
MA plans, also known as Medicare Advantage Plans, are health insurance plans offered by private companies that contract with Medicare. MA plans include all the benefits of Original Medicare Part A and Part B but don't have Part D (prescription drug coverage).
MA-PD plans, or Medicare Advantage Prescription Drug Plans, are MA plans that also offer Part D coverage. These plans combine all the benefits of Original Medicare with prescription drug coverage and some extra benefits like routine vision and dental care.
SNP, or Special Needs Plans, are MA plans specifically for people with certain chronic conditions or health needs. SNP plans offer all the benefits of MA and MA-PD plans, plus extra benefits and services to meet the needs of people with chronic conditions, such as specialist care, condition-specific nursing homes, and home health care.
Some MA plans are offered through pilot programs in certain areas. These pilots test new MA plan models and benefits. Some MA plans in these areas may have higher quality ratings than MA plans offered in other areas.
If you need help with finding any of the types of plans mentioned here, reach out to our team of Medicare agents at 1-888-912-2132 or firstname.lastname@example.org to get started.
Can I Change Medicare Advantage Plans at Any Time?
The short answer is no, you can’t join a Medicare Advantage Plan at any time. There are specific enrollment periods for Medicare beneficiaries to join, swap, or drop a Medicare Advantage Plan. Let’s go over them:
Initial Enrollment Period
Every new Medicare beneficiary is entitled to an initial enrollment period which is a seven-month period before and after they become eligible for Medicare.
You can enroll in Medicare three months before and three months after your birth month when you turn 65. Once you’re enrolled in Medicare Part A and B, you’ll be able to join a Medicare Advantage Plan immediately.
Medicare Advantage Open Enrollment Period
You can enroll in a Medicare Advantage Plan during the annual Medicare Open Enrollment Period, which runs from October 15 to December 7 each year.
General Enrollment Period
If you're already enrolled in a Medicare Advantage Plan and you want to make changes to your coverage, you can do so during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31.
You can also switch back to Original Medicare during this time period if you're unhappy with your Medicare Advantage Plan.
Special Enrollment Period
In special circumstances, you’ll be able to join a plan if you’ve missed the enrollment periods we've covered above.
Medicare also has a special enrollment period that allows you to join or switch Medicare Advantage Plans at any time of the year.
Some examples of qualifying life events include:
Losing other health coverage: If your private health care insurance is ended by your provider, you’ll be allowed to find a new plan at any point in the year. There will be no penalties and Medicare Advantage must accept your application.
Moving out of your plan's service area: Let’s say you decide to move to a different state to retire. If your Medicare Advantage Plan doesn’t cover your new location, you’ll be given x months to find a new plan that does.
Your health care provider stops offering Medicare Advantage: If your current health care provider decides to stop offering Medicare Advantage in your area, you’ll be given a chance to find a new plan.
The chance to get a 5-star Medicare Advantage Plan: Medicare allows beneficiaries to switch to a Medicare Advantage Plan with a five-star rating if one becomes available in their area.
Trial periods for Medicare Advantage Plans
If you join a Medicare Advantage Plan and decide that it isn’t for you, you’ll have one year to switch to a Medicare Supplement (Medigap) policy.
Keep in mind that this period will start as soon as you’ve joined a Medicare Advantage Plan. For example, if you signed up on December 10th, 2021, your coverage begins on January 1st, 2022.
This means you’ll have until January 1st, 2023, to join a Medigap plan.
Look at the Medicare Star Rating before You Sign Up
Medicare Star Ratings is a quality measurement system that is used by the Centers for Medicare and Medicaid Services (CMS). These ratings can help Medicare beneficiaries see how different health care providers compare measures of quality and patient satisfaction.
There are two types of Star Ratings:
Overall star ratings.
Star ratings for specific measures.
Check both of them before you sign up for a Medicare Advantage Plan. If you need help with finding top-rated plans in your area, speak to one of our Medicare agents today.
How and When to Enroll in a Medicare Advantage Plan
The best time to enroll in a Medicare Advantage Plan is during the open enrollment period which happens every year in October.
During Open Enrollment, you'll be able to enroll, switch, or drop a Medicare Advantage Plan. In fact, you’ll be able to change your Medicare coverage in a number of ways:
If you have Medicare Advantage, you can:
Change to a different Medicare Advantage Plan.
Switch from a Medicare Advantage Plan with drug coverage (MA-PD) to a plan without drug coverage (MA-only).
Switch from a Medicare Advantage Plan without drug coverage (MA-only) to a different Medicare Advantage Plan with drug coverage (MA-PD).
Switch to Original Medicare.
If you have Original Medicare, you can:
Sign up for a Medicare Advantage Plan.
Join a Medicare drug plan (Prescription Drugs Plan).
If you have a Medicare Part D Plan (Prescription Drugs Plan), you can:
Switch Medicare Prescription Drugs Plans.
Drop your Medicare drug plan altogether.
Drop your Medicare drug plan and join Medicare Advantage.
Different Plans Mean Different Benefits and Costs
HMOs: Health Maintenance Organizations
If you enroll in an HMO plan, you'll only be covered by doctors and other health care providers who participate in the HMOs network. HMO plans typically don't charge a deductible for covered services, and you usually won't have to file claims with your insurance company.
PPOs: Preferred Provider Organizations
PPO plans offer more flexibility than HMOs. With a PPO plan, you can see out-of-network doctors, but you'll pay more for their services. PPO plans also have higher deductibles than HMOs.
PFFS: Private Fee-for-Service Plans
Private Fee-for-Service plans allow members to go to any doctor or other health care provider who accepts the plan's terms and conditions. PFFS plans typically have higher deductibles than HMOs and PPOs.
When Can You Disenroll from a Medicare Advantage Plan?
There are two enrollment periods when you can disenroll or drop your current Medicare Advantage Plan.
Medicare Advantage Open Enrollment Period: You can disenroll from your Medicare Advantage Plan during this time and return to Original Medicare.
General Enrollment Period: You can disenroll from your Medicare Advantage Plan during this time and return to Original Medicare, or you can switch to Medicare Advantage Plans.
Can You Be Turned Down for a Medicare Advantage Plan?
In general, You cannot be turned down for a Medicare Advantage Plan because of a chronic illness or health condition.
Previously, there were certain exclusions for people who suffered from ESRD and ALS. However, as of 2018, all Medicare Advantage Plans must consider applications regardless of the applicant's health.
One exception is that Medicare Advantage can refuse an application if an area-specific plan is already full.
How to Change Medicare Advantage Plans
Switching your Medicare Advantage is easy. Here are some tips you can use if you’re thinking of changing Medicare Advantage Plans.
1. Use a health insurance agent: Using an experienced broker or agent can save you lots of time if you want to switch Medicare plans.
2. Look at the benefits that the new plan offers: See if the plans you are interested in offer you the same or more coverage.
3. Calculate the costs beforehand: Make sure you understand what your monthly premiums will be and how much you’ll pay in co-pays for services. If you want to get a zero-premium Medicare Advantage Plan, check the fine print to see that you’re getting enough cover.
What Are Zero-premium Medicare Advantage Plans?
Zero-premium Medicare Advantage Plans is a type of health insurance plan that has zero premiums, meaning that members will not have additional money every month for coverage.
However, with zero-premium plans, you will still be responsible for coinsurance, deductibles, and other out-of-pocket costs for Medicare Part A and B.
If you are interested in a zero-premium plan, you will need to shop around and compare different options to find the best coverage for your needs.
4. Look at a range of plans: Get your insurance agent to look into a couple of options and decide for yourself which one is right for you. A good insurance agent will be able to tell you the differences and benefits between each option.
5. Remember the enrollment dates: You’ll only be allowed to switch plans at certain times of the year. Make sure you’re ready for Open Enrollment and General Enrollment when they come around.
Your agent should be able to assist you with the process which means you just need to sign up for the new plan and your new Medicare Advantage provider will handle everything on your behalf.
Where Can I Find Out More about Enrolling in a Medicare Advantage Plan?
Most Medicare Advantage Plans offer more benefits than Original Medicare. However, it’s important that you choose a plan that offers you the coverage you need at a price you can afford.
If you want to learn more about Medicare Advantage, enrollment periods, coverage, and other topics, our Medicare hub is a great place to start.
We also have a team of expert health insurance agents who can help you with your questions and assist you with finding a comprehensive Medicare Advantage Plan in your area. Reach out to us today at 1-888-912-2132 or email@example.com to get started.