Administered by the federal government, Medicare provides a low-cost health insurance option to seniors and people with certain disabilities. There are four parts: A (hospital coverage), B (medical coverage), C (Advantage) and D (prescription drugs). Medicare Advantage (Part C) is the private option, but it follows similar enrollment procedures in terms of when you can sign up and restrictions on getting a policy. The federal and private portions of Medicare differ in what they offer and how they approach healthcare coverage, but original Medicare and Advantage share at least one thing in common: the initial enrollment period (IEP).
You might not be sure what the IEP is or when to sign up for Medicare Advantage. This process can be confusing, especially if you’re used to traditional health insurance from work or an Affordable Care Act marketplace. Here are some dates and deadlines for Medicare Advantage enrollment.
When to Apply – Your IEP
The initial enrollment period (IEP) starts three months before you turn 65 and runs for three months after, for a total of seven months, including your birthday month. For example, if your birthday is July 4, your IEP runs from April 1 through October 31. During this time, you can consider your options, weigh the pros and cons of different health plans, and decide whether you’re going to sign up for original Medicare (Parts A and B) or Medicare Advantage (Part C). You can only enroll in Advantage if you’ve already signed up for Parts A and B – it’s a semi-simultaneous process. Some people get enrolled automatically into original Medicare. You may get enrolled automatically if you:
- Already receive retirement benefits from Social Security or the Railroad Retirement Board;
- Are younger than 65 and have a disability;
- Have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease); or
- Live in Puerto Rico and receive benefits from Social Security or the Railroad Retirement Board
People receiving disability benefits get enrolled automatically starting on the 25th month of disability payments. For people with ALS, enrollment starts immediately. If you’re already receiving benefits from Social Security or the Railroad Retirement Board when you become eligible for Medicare – and you have been for at least four months – you’ll get enrolled into Parts A and B starting on the first day of your 65h birthday month.
Important note: Just because you’re enrolled automatically doesn’t mean you have to keep original Medicare. You can opt out of Part B altogether or choose Medicare Advantage instead. You will need to take action, though, to change your plan by contacting Social Security and then enrolling in an Advantage plan on your own.
Everyone else needs to sign up for coverage. That includes people who aren’t getting retirement benefits and people with end-stage renal disease. It’s a good idea to sign up when you’re first eligible, even if you aren’t sure whether you want original Medicare or Medicare Advantage. There are late enrollment penalties if you delay enrollment, with some fees becoming a permanent surcharge on your premiums. If you choose original Medicare and later decide that you need the more comprehensive benefits afforded by Advantage, you can make the switch during a period known as Medicare open enrollment.
Medicare Open Enrollment
Medicare Open Enrollment runs annually from October 15 through December 7. It’s the period each year when you can make changes to your Medicare coverage. During the open enrollment period (which might be abbreviated to OEP), you can:
- Change from original Medicare to Medicare Advantage;
- Switch from Medicare Advantage back to original Medicare;
- Switch from your current Medicare Advantage plan to a new one;
- Change from an Advantage plan with drug coverage to one without (or vice versa);
- Join a Medicare Part D prescription drug plan if you have original Medicare;
- Switch from your current Part D plan to a new one; or
- Drop your Part D coverage altogether
There’s also a six-week period called the Medicare Advantage Disenrollment Period. From January 1 through February 14, you can drop your Medicare Advantage plan and switch to original. This is the only thing you can do during this period. However, if you do switch to original and need drug coverage, you can also sign up for a Part D plan until February 14.
Ways to Enroll
There are several options for enrolling in Medicare, but it essentially comes down to your preference. You can:
- Apply online. Visit the Social Security website online to fill out an electronic application. You may need to provide additional documents, such as income-related information, but the administration will contact you if it needs anything else. There aren’t any forms to sign, and the process should take about 10 minutes to complete.
- Visit a Social Security office. You might prefer to speak with a real person. In that case, visit a local office. You’ll likely need to make an appointment ahead of time. An agent can answer questions in real time and help you fill out the application correctly.
- Make a phone call. Call the Social Security Administration at (800) 772-1213. Railroad retirees should call (877) 772-5772.
As far as enrolling in Medicare Advantage, you’ll need to sign up with the company you plan on buying a plan from, via an independent agency or broker website, or through a site like this one that lets you compare policies and price points. Remember that you need to be enrolled in original Medicare before you can sign up for Advantage, so take care of the initial enrollment process first so that you’re good to go for your private plan.
Changes to Medicare Advantage – What Can You Expect in 2019?
In early April, the Centers for Medicare & Medicaid Services (CMS) released its 2019 Medicare Advantage and Part D Rate Announcement and Call Letter, announcing changes to Medicare Advantage and Part D for 2019. Some of the guidelines, such as policy changes concerning supplemental benefits, tightening of regulations concerning opioids and support for longer duration of physical therapy, will affect consumers directly. Other, more complex changes in the way Medicare reimburses providers and ranks insurers may have significant long-term effects.
Key Insurer Changes
While Original Medicare is a program through which the government pays healthcare providers for services rendered to patients 65 and over, in Medicare Advantage the government pays private insurance companies a fixed amount per person to pay healthcare providers. About a third of Medicare recipients are enrolled in Medicare Advantage plans, with the percentage choosing Medicare Advantage trending upward and premiums decreasing slightly. The relationship between Medicare and its private counterpart affect the changes announced for 2019.
First, although Medicare reimbursement rates are uniform, different private insurers have the freedom to adjust the premiums and co-pays they charge for specific services, with each Advantage plan making slightly different changes for 2019. Second, Medicare will release its star ranking in October and now allow participants to change from insurers ranked with three or fewer stars to five-star plans at any time with no penalty. Finally, insurers now have increased flexibility to add new forms of supplemental coverage to their plans.
Perhaps the most significant change that Medicare is undergoing is philosophical, shifting from reimbursement rates based primarily on cost to using complex metrics to evaluate outcomes. Along with routine annual adjustments of a few percentage points to reimbursement rates for thousands of individual treatments, overall reimbursement rate-setting philosophy has a significant effect on the cost of medical care.
Over the long term, such shifts may change co-payments, which providers are willing to accept Medicare plans, and even the ways in which certain medical conditions are treated. Eventually, these changes should result in a trifold emphasis on preventive care, support services, and initiatives supporting aging in place and hospice care. Some Medicare Advantage insurers may be more proactive than others in anticipating these changes, meaning greater differentiation between companies.
A major change for Medicare participants in all plans was the enactment in the federal budget bill of February 2018 of a permanent solution to the issue of hard caps on physical therapy services. American Physical Therapy Association President Sharon L. Dunn, PT, PhD, describes removal of the physical therapy cap as a victory for patients.
In response to the growing opioid addiction epidemic, Medicare will be tightening restrictions on prescribing opioids, particularly in conjunction with other drugs that have been shown to increase the possibility of opioid dependency. Prescribers will now also restrict long-term, high-dose prescriptions.
New Medical Transport and Other Supplemental Benefits
Perhaps the most exciting change for 2019 is what CMS describes as “reinterpreting the standards for health-related supplemental benefits in the Medicare Advantage program to include additional services … including coverage of non-skilled in-home supports and other assistive devices.” Translation: more services to help enrollees with everyday support. Medicare Advantage plans may now choose to offer reimbursement for non-emergency transportation to medical appointments, including rides provided by sharing services such as Uber and Lyft, along with various assistive devices and services that enable beneficiaries to live safely in their own homes for longer. This represents part of an ongoing philosophical shift towards enhancing quality of life and investing in preventive care.