If you decide to go with Medicare Part C, you may have heard of a special election period or open enrollment. Continue reading to find out what these terms mean and how they may be beneficial to you.
Special Election Period (SEP)
With unexpected changes in life, many may be comforted by knowing you can make alterations in Medicare coverage. Individuals with the Medicare Advantage Plan or Medicare Part D may partake in the Special Enrollment Period. Also known as the “Trial Period” this type of enrollment would allow them to disenroll from Original Medicare to enroll in Medicare Advantage temporarily. It allows consumers to try out a plan for up to 12 months before they make a decision. Special circumstances for this enrollment and approval from CMS (Centers for Medicare & Medicaid Services) are needed before consumers can make the switch.
Special Enrollment Periods
Listed below are the periods you can add, drop, or switch your Medicare Advantage Plan or Medicare Part D coverage.
When you’re eligible for both Medicare and Medicaid or have qualified for assistance with Medicare prescription drug coverage payments.
- January – March
- April – June
- July – September
When you’ve been enrolled in a State Pharmaceutical Assistance Program (SPAP) or have lost eligibility.
- Only available once during a calendar year.
Any changes made will begin to take effect on the first day of the next month. You would have to wait until the next enrollment period to make further changes. Special Enrollment Period cannot be used from October to December.
Open Enrollment Periods
If you want to make changes to or join a Medicare Advantage Plan you’ll have two chances during the year to do so. These changes would take effect during the following year. During the open enrollment period, you’ll be able to do the following:
- Switch from one Medicare Advantage to another
- Drop Medicare Advantage to return to Original Medicare (must be within first three months)
To ensure you can make the switch to Medicare Advantage from Original Medicare, you must meet the criteria listed below.
- Currently be enrolled in Medicare Part A and B
- Live in an area that’s serviced by Medicare Advantage
- Cannot have End-Stage Renal Disease
The period for this enrollment is from January 1 to March 31.
What’s the difference between the two?
The main difference in SEP and open enrollment for Medicare Advantage is eligibility. Most consumers will not be eligible for SEP because it is meant for special circumstances that is approved by the CMS. On the other hand, open enrollment is available to a larger population of individuals who are just looking for a simple change in health insurance plans. SEP is also a trial period for Medicare patients, and will not be long term like the choices made during open enrollment. It is to be noted that there are a few changes that cannot be made during open enrollment, such as switching from Original Medicare to a Medicare Advantage Plan and many more.
Making changes to your Medicare plan can be troublesome when you’re not sure what the pros and cons are to switch. Be sure to research plans to get a better understanding of what your Medicare health insurance plan entails.