Happy AEP! What You Should Know About Medicare Enrollment Periods

It’s Medicare season once again… Can’t you hear the music and feel it in the air? 

With news that premiums are coming down next year (phew!), and knowing that plan coverages change every year, Medicare is top-of-mind for a lot of our older clients. It’s vital that Medicare plans be reviewed every year, and we figured it would be a good idea to get the pros involved to walk us through the three primary “enrollment periods.” 

Thus, we welcome Bill Rowe of Covenant Medicare in Centerville, Ohio, who has graciously shared the insight you’re about to read.

“Happy AEP” is a common refrain among Medicare agents. 

To make a change to a Medicare Advantage plan or a Prescription Drug plan, a Medicare beneficiary must have an “enrollment period.” There are a variety of enrollment periods. We will discuss 3 in this article. 

Annual Enrollment Period (AEP) begins on October 15 and ends on December 7 every year for a January 1 effective date. Agents can begin discussing Medicare Advantage and Prescription drug plans for the following year on October 1.

Medicare Advantage Open Enrollment Period begins on January 1 and ends on March 31 every year. If you’re in a Medicare Advantage Plan, you can change to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Any changes you make will be effective the first of the month after the plan gets your request.

5-star Special Enrollment Period is an opportunity to “upgrade” your plan, so to speak. Medicare uses ratings from 1–5 stars to help you compare plans based on quality and performance. If a Medicare Advantage Plan, Medicare drug plan, or Medicare Cost Plan with a 5-star quality rating is available in your area, you can use the 5-star Special Enrollment Period to switch from your current Medicare plan to a Medicare plan with a 5-star quality rating. You can use this Special Enrollment Period only once between December 8 and November 30 the following year.

The AEP in the Greater Dayton, OH market will be a busy one for multiple reasons. Here are a few: 

Reason #1

In recent years, Medicare has seen an increase in complaints. For this reason, CMS (Centers for Medicare and Medicaid Services) has mandated that all telephonic conversations with Medicare beneficiaries must be recorded and retained for 10 years. Face-to-face conversations are not required to be recorded. Further, Medicare beneficiaries must be made aware of the following disclaimer: 

“We are not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact or 1-800-MEDICARE to get information on all your options.”

Reason #2

Depending on the county, there will be two or three additional companies competing for business. For instance, in Montgomery County, both Cigna and Devoted Health are new to the market. In 2022, there were 63 Medicare Advantage plans from which to choose. For 2023, that number has increased to 77 plans.

Reason #3

While there is a nationwide decrease in 5-star plans, the Dayton market still has several 5-star plans from which to choose for 2023. In Montgomery County, Devoted Health has 3 plans which have received 5-stars, while all 9 of Medical Mutual of Ohio’s plans have received a 5-star rating. 

When choosing a plan, there are some important considerations. First, while a plan may have a 5-star rating, that doesn’t necessarily mean it is the correct plan for you. It is important to pick a plan that accounts for the specific prescriptions you are taking. Next, you should ensure that your doctors will accept the plan. Finally, everyone should consider other benefits like dental, vision, hearing, fitness memberships, OTC benefits, grocery benefits, etc. 

Keep in mind, if you’re a Medicare beneficiary, you have spent a lifetime paying into the Medicare system. It is important to take the time every year to meet with a knowledgeable advisor who can help you find a plan that meets your specific needs. After all, you’ve earned it. 

Disclaimer: Bill Rowe is responsible for this content. Nothing in this blog is intended to be legal advice, nor is this blog intended to solicit any business for Houck Menninger Law, LLC.  This blog is for informational purposes only.

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