Medicare Open Enrollment Season: The Big Picture

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It’s almost that time of year again. No, we’re not talking about bad weather, holiday season, or even ski season. Believe it or not, we’re talking about something even more exciting: Medicare’s open enrollment season!

Before you start looking at our great benefits for Medicare enrollment, keep in mind: In 2021 there were approximately 63 million people enrolled in the Medicare program.

That’s a lot of people. And if you’re an insurer, agency, carrier, or MGA/MGU responsible for enrolling even a portion of Medicare beneficiaries, the open enrollment period is an opportunity to help place older and disabled Americans in the insurance that best meets their needs. needs. So, if you ask us, that’s a season to celebrate.

Why does the federal program require registration?

With general insurance, special policies provide coverage for specific risks. Medicare is no different. There are several types of coverage available to those who are eligible for Medicare.

  • Medicare Part I – Americans who receive Social Security benefits only enroll in Medicare Part A and Medicare Part B plans after age 65.
    • Medicare Part A – This covers inpatient hospital care, skilled nursing care, medical benefits, and home health care.
    • Medicare Part B – This covers doctor’s appointments, preventive care, regular medical equipment, other drugs, psychiatric services, and ambulance services.
  • Medicare Advantage (Medicare Part C) – Sold by private insurers, these are offered as an alternative to original Medicare plans. They often include the same coverage as original Medicare plans and add hearing, dental, and eye care. They usually have lower fees and reduce the amount of money a person pays out of pocket. In some cases, Medicare Advantage plans only include Medicare Part D coverage. Those interested in Medicare Part C coverage must register for an opt-in plan.
  • Medicare Part D – Medicare Part D is provided through private insurance companies. Covers the cost of generic and brand-name drugs. Those interested in Medicare Part D coverage must register for an opt-in plan.
  • Medicare Supplement Insurance (Medigap) – Medigap is sold through private insurance companies and helps fill gaps in original Medicare plans. To enroll in a Medigap plan, one must first enroll in Medicare Part A and Medicare Part B.

Medicare Part A and Medicare Part B use automatic enrollment for those who receive Social Security benefits. However, those who do not receive Social Security benefits and who wish to enroll in Medigap, Medicare Advantage, or Medicare Part D must do so through initial enrollment, special enrollment, regular enrollment, or open enrollment for Medigap.

What are all these options?

Those who are eligible for Medicare have three first chances to enroll in the plan that is right for them.

  • Early enrollment – This seven-month period begins three months before the birth month when someone turns 65 and ends three months after the birth month. During this time, they will have the opportunity to enroll in the Medicare plan of their choice. Failure to enroll in Medicare Parts A, B, or D during the initial enrollment period at 65 can result in costly penalties if you change your mind and enroll later. The exception to this is if the person enrolled in Medicare Advantage instead of Medicare Parts A, B, or Medicare D, or if they are still employed and covered by their employer’s health plan.
  • Special enrollment – Not everyone is eligible for special enrollment. This is a two-month period that begins the month after the end of your employment or the month you lose your employer’s insurance, whichever comes first.
  • Regular registration – Those who miss the first registration and are not eligible for special registration will have to wait until the registration period from Jan. 1 through March 31. Enrollment during this period incurs significant penalties and delivery does not begin until July. 1. All outstanding medical expenses must be paid by the individual.
  • Medicare Supplement Insurance (Medigap) open enrollment – This is a six-month period that begins on the first day of the month in which a person turns 65 and enrolls in original Medicare. Meanwhile, Medigap can be purchased regardless of health status. This means that insurers have to charge people the same price regardless of their health or pre-existing conditions. After this open enrollment period, insurers have the right to charge more or refuse coverage based on pre-existing conditions.

Once you’re already enrolled in Medicare, there are two main opportunities to change your coverage and change plans.

  • Annual open enrollment – During this time, Medicare beneficiaries can evaluate their health care coverage and make adjustments based on evolving needs. Open enrollment begins Oct. 15 to Dec. 7 every year.
  • Special events and special enrollment periods – Someone who is already enrolled in Medicare Advantage and Medicare Part D may be eligible to change outside of the enrollment period if other lifestyle changes occur. Changes in coverage, changes in address, and changes in employment are reasons why someone may qualify for a change.

Tell me more about open enrollment

Medicare open enrollment has a specific purpose. As such, there are clear guidelines about what a person already enrolled in Medicare can and cannot do at this time.

To ensure that their coverage meets their needs, Medicare enrollees can switch from a Medicare Advantage plan to another Medicare Advantage plan, leave a Medicare Advantage plan and return to original Medicare coverage, and join a Medicare drug plan.

However, they cannot switch from Original Medicare to a Medicare Advantage Plan, join a Medicare drug plan if they are enrolled in Original Medicare, or switch between Medicare drug plans if they are enrolled in Original Medicare.

Why are manufacturers so important to Medicare enrollment?

Those seeking Medicare coverage are entering a time in their lives when they will need more care than ever before. Therefore, it is very important that they have the right plan to meet their needs.

But understanding the Medicare process and navigating the ins and outs of Medicare enrollment is enough to put even the most experienced producer’s head in a pretzel. That’s why we made this a useful list of best practices for Medicare enrollment for both producers and agencies, carriers, and MGAs/MGs.

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