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Medicare Open Enrollment Season: The Big Picture



This post is part of a series sponsored by AgentSync.

It’s almost that time of year again. No, we’re not talking about the scary season, the holiday season, or even the ski season. Believe it or not, we’re talking about something much more exciting: Medicare’s Open Enrollment Season!

Before you start rolling your eyes at our big geek estimate of Medicare open enrollment, remember: In 2021, there were nearly 63 million people enrolled in the Medicare program.

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

Why does a federal program require registration?

With all insurance policies, specific policies provide coverage for specific risks. Medicare is no different. There are a couple of types of coverage available to those who are eligible for Medicare.

  • Original Medicare – Americans who receive Social Security benefits are automatically enrolled in Medicare Part A and Medicare Part B plans when they turn 65.
    • Medicare Part A – This covers inpatient hospital care, skilled nursing facilities, hospice benefits, and home health care.
    • Medicare Part B – This covers doctor visits, preventive care, durable medical equipment, certain prescription drugs, mental health services, and ambulance services.
  • Medicare Advantage (Medicare Part C) – These are sold by private insurers and offered as an alternative to original Medicare plans. They generally include the same coverage as original Medicare plans with the added coverage of hearing, dental, and vision care. They often have lower premiums and limit how much a person will pay out of pocket. Sometimes Medicare Advantage plans automatically include Medicare Part D coverage. Those interested in Medicare Part C coverage must enroll in an optional plan.
  • Medicare Part D – Medicare Part D is offered through private insurance companies. It covers the costs of both generic drugs and prescription drugs. Those interested in Medicare Part D coverage must enroll in an optional plan.
  • Medicare Supplement Insurance (Medigap) – Medigap is sold through private insurance companies and helps fill the gaps in original Medicare plans. To enroll in a Medigap policy, one must first be enrolled in Medicare Part A and Medicare Part B.

Medicare Part A and Medicare Part B work through automatic enrollment for those receiving Social Security benefits. However, those who do not receive Social Security benefits and those who want to enroll in Medigap, Medicare Advantage, or Medicare Part D must do so in either the initial enrollment, special enrollment, general enrollment, or open Medigap enrollment.

What’s with all these registration options?

Those eligible for Medicare have three primary options to first enroll in the plan that is right for them.

  • Initial Enrollment – ​​This seven-month period begins three months before the month of birth when someone turns 65 and ends three months after that month of birth. During this time, they will have the opportunity to sign up for a Medicare plan of their choice. Failure to enroll in Medicare Parts A, B, or D during the initial enrollment period at age 65 can result in expensive penalties if you change your mind and enroll in them later. The exceptions here are if that person chose Medicare Advantage over either 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 qualifies for a special enrollment period. This is a two-month period that begins the month after a person’s employment ends or the month after they lose their qualified employer insurance, whichever comes first.
  • General Registration – Those who miss the initial registration and are not eligible for special registration must wait until the general registration period from January 1 to March 31. Enrollment at this time will result in high penalties and coverage will not begin until July 1. All health expenses incurred before coverage begins must be paid directly by the individual.
  • Medicare Supplement Insurance (Medigap) open enrollment – ​​This is a six-month period that begins on the first day of the month a person turns 65 and enrolls in original Medicare. Currently, Medigap can be purchased regardless of health status. This means that insurers must charge people the same price regardless of whether they are healthy or have pre-existing conditions. After this open enrollment period, insurers have the right to charge more or deny coverage based on pre-existing conditions.

Once you’ve already signed up for Medicare coverage, there are two primary opportunities to change that coverage and switch plans.

  • Annual Open Enrollment – Currently, those receiving Medicare coverage can assess their health coverage and make changes based on evolving needs. Open registration is from 15 October to 7 December each year.
  • Special Circumstances and Special Enrollment Period – Someone already enrolled in Medicare Advantage and Medicare Part D coverage may be eligible to make changes outside of specific enrollment periods if certain life changes occur. Changes in coverage, a physical address change, and a change in employment status are all reasons why someone may be eligible for a change.

Tell us more about open enrollment

Medicare open enrollment exists for a very specific purpose. As such, there are clear guidelines about what a person already enrolled in Medicare coverage can and cannot do right now.

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

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

Why are producers so important to the Medicare enrollment process?

Those looking for Medicare coverage are entering a period in their lives where they will need more healthcare than ever before. As a result, it is absolutely critical that they have the right plan to meet their needs.

But understanding Medicare plan details and navigating the ins and outs of Medicare enrollment is enough to put even a seasoned producer in a bind. That’s why we’ve built this practical series of Medicare enrollment best practices for both producers and agencies, carriers, and MGAs/MGUs.

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