How Does Medicare Advantage Enrollment Work?

Right now, the Medicare Open Enrollment Period is underway. This is the annual time, from October 15th through December 7th, when eligible seniors can sign-up for Medicare for the first time, and current participants who want to make changes to their existing coverage can do so.

There are different types of Medicare. Medicare Part A (hospital coverage) and Medicare Part B (medical services coverage) are together known as Original Medicare. This is because it’s what was originally offered when the government health insurance program was created in 1965.

Fast forward to 1997, and the government newly allowed Medicare enrollees to go beyond Original Medicare by enrolling in Medicare Advantage. Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. Consequently, its enrollment features are different from Original Medicare.

Medicare Advantage allows for program enrollees to receive their Medicare benefits through a private health insurance plan, and for private health insurance carriers to receive payments from the Medicare program to cover their beneficiaries’ medical costs. The main benefit is that Medicare Advantage plans offer more coverage options than traditional Part A and B coverage.

That said, a Part C participant still has to carry Part A and B to qualify, and they have to live in an area where their desired plan is offered. This can be not only a more expensive approach, as every Medicare Advantage plan comes with premium costs and potentially high out-of-pocket deductibles, but in many cases no such plans are even available, particularly in rural areas.

Enrollment dates and conditions can also be something to contend with. As mentioned above, enrollment in Part A and B are mandatory. This can be done during a senior’s initial seven-month enrollment period beginning three months prior to their 65th birthday month, or during Medicare’s annual Open Enrollment Period. Keep in mind that in 2019, Medicare Advantage may introduce a new Open Enrollment Period which you can learn more about by clicking this link.

Medicare allows for program participants to switch from Original Medicare to Medicare Advantage, and vice versa, during open enrollment, but there’s an important one-year deadline that applies when switching back to Original Medicare from a Medicare Advantage plan. Again, the main draw of Part C plans are that they offer additional coverage. Original Medicare participants, however, can always enroll in Part D prescription drug coverage and they have the option of purchasing supplemental coverage, known as Medigap, to pay for costs that Part A and B don’t cover.

Medigap is not available for Medicare Advantage enrollees, and after one year there’s no requirement that it will be available for Medicare Advantage participants who want to switch over to Original Medicare. If Medigap is offered at all, it could be extremely expensive, particularly for seniors with health conditions.

We know that you and your loved ones may have more Medicare questions. Don’t wait to ask us! You can also learn more on the Medicare website, including using the Medicare tool to research plan benefits, let us share four upcoming program changes to be aware of.