Recently we shared a blog that detailed the top 10 reasons to switch to a Medicare Advantage plan. While the benefits of the Medicare Advantage plan are clear, we understand that it can be logistically challenging (and sometimes confusing) to switch plans — especially if it’s not during the general/open enrollment period or if you have special needs.
Many of our patients wonder whether it’s too late to switch to a Medicare Advantage plan, who qualifies for a plan change outside of open enrollment, and which circumstances qualify for Special Needs Plans throughout the year. In this blog, we’ll answer the top frequently asked questions that our patients ask about the Medicare Advantage open enrollment period.
When is open enrollment for Medicare Advantage plans?
Also referred to as “general enrollment”, open enrollment for existing Medicare Advantage plan patients happens from January 1-March 31 each year. This means that anyone who already has a Medicare Advantage plan can make coverage periods during this time frame.
It’s important to note that this is different from the Medicare annual enrollment, which happens from October 15-December 7 each year and is for anyone with any type of Medicare plan.
Also consider that if you have never enrolled in any Medicare plan before, you have a slightly different initial enrollment plan; it begins three months before you turn 65 and ends 3 months after you turn 65.
Can I make changes to my Medicare Advantage plan coverage if the open enrollment period has ended?
Sometimes, yes. There are many qualifying conditions that provide eligibility for enrollment during a Special Enrollment Period (SEP), which we’ll detail more below.
Which life events or circumstances are eligible for a Special Enrollment Period?
There are many unique factors that can trigger a SEP to open outside of the Medicare Advantage open enrollment period; for example, one that we often see with our patients is moving locations or changing addresses.
Additionally, there are three types of patients that require Special Needs Plans (SNPs). If you qualify for a SNP, then you are able to change coverage throughout the entire year.
What are Special Needs Plans, and who qualifies for one?
Medicare Special Needs Plans (SNPs) are Medicare Advantage plans that are assigned based on very specific criteria for certain medical conditions, income thresholds, or institutional needs.
As such, the three types of SNPs are categorized as follows:
- Chronic Condition SNP (C-SNPs): If you are already living with a qualifying chronic condition (such as diabetes, dementia, or chronic heart failure), then you are able to enroll in a Medicare Advantage plan specific to that condition at any time so long as you have the condition. If you’re newly diagnosed with a condition that qualifies for a C-SNP, your doctor must provide documentation to confirm your qualifying condition for your SNP to take effect. If this doesn’t happen by the end of your first month enrolled in the SNP, you will be disenrolled from the SNP and trigger a two-month Special Enrollment Period in which you can change coverage.
- Dual Eligible SNP (D-SNPs): These SNPs are for people who qualify both for Medicare and Medicaid. A Special Enrollment Period is applicable as long as you qualify for both.
- Institutional (I-SNPs): If you are placed in a qualifying long-term care facility for 90 days or more, or if you require caretaking for 90 days or more that is equivalent to nursing home care whether at home or in a facility, then you may qualify for an I-SNP. Once this need presents itself, you can enroll in an I-SNP regardless of the time of year.
Are there any other circumstances that could trigger a Special Enrollment Period?
Yes, there are a handful of other situations that qualify, including but not limited to: loss of coverage, opportunities to get other coverage, contractual changes to your existing plan, and errors committed by Medicare employees. For the full list of circumstances, visit here.
When do changes to my Medicare plan take effect?
If you have an original Medicare plan and switch to a Medicare Open Advantage plan during the fall annual enrollment, then your new coverage will begin on January 1.
If you already have a Medicare Advantage Plan, then the coverage changes you make will take effect on the first of the following month. For example, if you modify your coverage on January 28, then your new coverage changes will kick in on February 1.
If you qualify for a Special Needs Plan, then your coverage changes begin immediately after you are deemed eligible.
Here to Help Any Time of the Year
If you have any other specific scenarios or questions about coverage changes during or after the Medicare Advantage open enrollment period, please reach out to us. We are committed to your care and want you to receive the best healthcare — and the best benefits — that you deserve.