How Does Open Enrollment Work?

That's a good question, I'm glad you asked. And the the answer is: it depends, there are several open enrollments  so you have to know which applies to you and which applies to what kind of Medicare plan. I have a feeling that I'm about to tell you so you'll know.

The first enrollment period is appropriately called the initial one. For most people this revolves around their 65th birthday and allows them to enroll from 3 months before their birth month and up to three months after. they can enroll during this time in Parts A and B and either a Supplement and Prescription plan or an Advantage plan. In other words during your initial period, you can enroll in any kind of plan offered in you area and acceptance is guaranteed regardless of health. Some subsequent enrollment periods are limited and it is important to understand this before making your choice on your initial enrollment.

 

To get more technical, when it comes to Supplement plans (also known as Medigap) you actually have up until 6 months after your part B effective date to sign up with taking your health status into account. This paragraph only applies to Medicare Supplement plans and not to Advantage plans. But why complicate things unless you need to. Just get everything going before the month you turn 65.

The second kind of enrollment period is the kind you hear about every year. it is Annual Open Enrollment. What most people don't realize is that it only applies to Advantage (usually HMO) plans and to prescription drug coverage plans. it runs from October 15th through December 7th. You are allowed to switch Advantage or Rx plans without underwriting, meaning your health status is not considered, it is guaranteed enrollment. Or you can go from a Supplement plan to an Advantage plan, without health underwriting. What you CAN'T do without health underwriting, is go from an Advantage plan to a Supplement plan.

Next there are special circumstance enrollments such as when a person is dropping or losing their work coverage and needs to get the rest of Medicare they didn't sign up for initially. This is also a guaranteed enrollment with no health status underwriting and allows you to go into any plan.

Medicare Supplement AKA Medigap plans also have an annual enrollment in California but it works very differently  than expected. First of all, it is only for people that already have a supplement plan and want to switch to another supplement plan. In other words you can't use it to switch from an advantage HMO to a supplement. It is a guaranteed enrollment with no health underwriting. This enrollment revolves around your birth month and one month prior. The general rule is that for guaranteed issue you can only switch to an equal or lesser plan. Some carriers by current practice (meaning they could discontinue it at any time), allow you to switch from any supplement plan to any other supplement plan, meaning you could go from one with lesser benefits to one with greater benefits.

You can actually switch  a Medicare supplement plan or enroll in a Medicare supplement plan at any other time of the year but it is subject to your health status and you may or may not get accepted if it's not your birthday annual open enrollment period. So for example, as mentioned above, during the Advantage HMO Annual Open enrollment, you could drop your HMO and enroll in a Medicare Supplement, but to do so, you'd have to pass health underwriting with the Medicare Supplement company. This is actually a tricky process that can leave you in a sticky situation if it doesn't turn out right, so it is best done through a broker (such as myself) who knows how best to do this. If you don't know what you're doing you can end up with only an Rx plan and no HMO or Supplement to go with it. This could happen if you don't pass underwriting, but don't find out until Annual Open Enrollment is over with.

One more option is the Medicare Disenrollment Period. It runs from January 1 through February 14th. If you are on a Medicare Advantage plan and want to change to a  Medicare Supplement plan it can be done during this time. It's not guaranteed issue, so you will need to qualify for the Medicare Supplement based on health. The trick is this: You must first apply for the Supplement and if accepted only then do you apply for the Part D prescription coverage. The reason for this is that when you get accepted on the Part D pan it will automatically cancel out your Advantage plan and you only want to do that if you are sure you are accepted on the Supplement plan. If you don't get accepted on the Supplement plan, then you don't apply for the Part D plan and you simply stay on the advantage plan. This whole processis best handled by a knowledgeable agent such as myself.

If you apply in January and can get a Feb 1st start date on the Medicare Supplement , then cancel your Advantage plan effective for January 31, or if you get a March 1st, then cancel Advantage plan for Feb 28  (29th if leap year).

It's good to include a letter of intent to the Supplement company saying if accepted, you will be cancelling your Advantage plan.

What you can't do during disenrollment is switch from one Advantage plan to another.

There are other special enrollments but I have covered the most common ones.