Whether you recently reached age 65 or will soon, want to change your Medicare Advantage Plan or have a life event that has impacted your health coverage, there are multiple opportunities to sign up for a Medicare plan that suits your needs throughout the year. First, let’s review who is eligible for Original Medicare or Medicare Advantage.
Generally, people who are 65 years old, under age 65 and on disability or have been diagnosed with End Stage Renal Disease are eligible for Medicare. There are some cases in which not working enough years in the U.S. may make someone ineligible for Medicare at 65.
New Hanover Health Advantage offers two comprehensive, high-quality Medicare Advantage plan options that include medical and prescription drug services as well as many supplemental benefits. A Medicare Advantage Plan, also known as Part C, provides coverage through private insurance companies approved by Medicare. To be eligible for New Hanover Health Advantage you must be entitled to Medicare Part A and enrolled in Medicare Part B and live in New Hanover, Brunswick or Pender counties.
Understanding the different enrollment periods will help you know when to sign up.
There are four distinct enrollment periods during which you can enroll in Original Medicare or a Medicare Advantage plan.
Initial Enrollment Period (IEP)
If you’re eligible for Medicare when you turn 65, you have a 7-month period around your birthday month to first sign up for a Medicare and a Medicare Advantage Plan.
This 7-month period:
• Begins 3 months before the month you turn 65
• Includes the month you turn 65
• Ends 3 months after the month you turn 65
Signing up for Medicare and a Medicare Advantage plan three months before the month you turn 65 is beneficial because this ensures your Medicare Advantage plan will become effective on the first of your birthday month in which you turn 65.
Annual Enrollment Period (AEP)
The Annual Enrollment Period runs from October 15 through December 7 each year. During this time, you can move from one plan to another plan. Whether you have a Medicare Advantage plan and want to switch to NHHA or if you currently have Original Medicare and want to switch to a Medicare Advantage plan, or if you want to change your Medicare Supplement plan, the AEP is the time where you can make changes to your coverage and switch to a plan you believe will better meet your needs.
If you choose to make a change during the AEP your new coverage will be effective January 1 of the following year.
Open Enrollment Period (OEP)
The Open Enrollment Period takes place from January 1 through March 31 each year and is only for individuals currently enrolled in a Medicare Advantage plan.
During OEP if you are enrolled in a Medicare Advantage plan (with or without drug coverage) you can either switch to another Medicare Advantage plan (with or without drug coverage) or choose to return to Original Medicare.
If you are in a Medicare Advantage Plan during this time, and wish to return to Original Medicare, you can also join a Medicare Prescription Drug Plan.
Your new coverage will begin on the first day of the month following the month you make a change.
Special Enrollment Period (SEP)
After your IEP has ended, there are still certain circumstances and life events that will allow you to join, switch or drop a Medicare Advantage Plan and prescription drug coverage during a Special Enrollment Period. A SEP may begin at anytime when you experience qualifying life events. For example, many lose employer coverage due to retirement, or many people also move to the southeastern NC area and will need to change their plan because of their change of address.
You may be able to join or change a Medicare Advantage Plan during a SEP if you’re experiencing any of the following life events:
• You move outside your current plan’s service area
• You move back to the United States after living outside the country
• You move into or out of an institution such as a skilled nursing facility or long-term care facility
• You are released from incarceration
• You recently obtained lawful presence status in the U.S.
• You lose your current employer/union plan
• You involuntarily lose credible drug coverage
• You recently had a change in Medicaid status (newly receiving Medicaid, had a change in Medicaid level of assistance, or lost Medicaid)
• You receive federal or state assistance (SEP only valid once quarterly per individual and not during AEP quarter of October through December)
• You qualify for Extra Help paying for Medicare prescription drug coverage (SEP only valid once quarterly per individual and not during AEP quarter of October through December)
• You enrolled into a special needs plan (SNP) and no longer qualify as a special need that the plan covers
• You enrolled in another MA plan or Private Fee for Service (PFFS) plan based on misleading or incorrect information provided by plan employees, agents, or brokers
A lot of information was covered, and for many, Medicare can be a very confusing topic. If you feel like you need assistance understanding anything you read or have questions regarding a New Hanover Health Advantage plan, connect with Kathryn “Katie” Sarkorh at 910.667.6442.