Medicare Advantage Enrollment

Medicare Advantage Enrollment

Replaces Original Medicare

CHOICE MATTERS when it comes to your Medicare coverage. Keep in mind Medicare Advantage plans replace Original Medicare; Medicare Advantage plans are fantastic on your budget.

There are multiple private insurance companies who offer Medicare Advantage (MA, MAPD) plans. Ebpcolorado.com represents top-rated insurance companies, including Aetna, Anthem, and UnitedHealthCare (Sponsored by AARP).

There are many types of Medicare Advantage Plans. Some are HMOs, PPOs, PFFS (Private Fee for Service), Special Needs Plans, Medical Savings Accounts, and Low Income Subsidiary Plans. Contact Social Security at 1-800-772-1213 to determine if you qualify for a low-income subsidiary.

Consider the following information before enrolling in a Medicare Advantage plan MA, (MAPD).  This is a partial list of the some of the features of a Medicare Advantage plan. Please refer to the appropriate insurer’s enrollment literature for a complete list of benefits and features.  For service, click here to see clearly how MA plans really work.

  • There are NO PRE-EXISTING condition exclusions for Medicare Advantage plans. All plans are GUARANTEE ISSUE.
  • Members must live in the plan’s service area.
  • Medicare Advantage plans require REFERRALS from their Primary Care Physician (PCP).
  • Medicare Advantage members must use NETWORK providers (non-network care is not covered).
  • Medicare Advantage members MUST SELECT a PCP prior to enrolling, or one will be assigned.
  • Medicare Advantage plans MAY OR MAY NOT include prescriptions drug coverage.
  • Medicare Advantage plans replace Original Medicare.
  • Medicare Advantage plans have all the benefits of Original Medicare plus EXTRA BENEFITS; some of which are offered at no additional costs, for example, gym memberships.
  • Medicare Advantage plans cover preventive benefits at 100%.C
  • Some Medicare Advantage plans have NO OR LOW MONTHLY PREMIUMS. Copays and coinsurance apply at the time of service, if applicable.
  • Medicare Advantage plans must give members at least the same coverage as Original Medicare.
  • Benefits, premiums, copays, and plans vary by insurer and county of residence.
  • If you join a Medicare Advantage plan, you cannot use or be sold a Medicare Supplemental policy.
  • If you are enrolled in a Medicare Advantage plan with or without Rx coverage, and you enroll in a stand-alone prescription drug plan (PDP), you will be automatically disenrolled from your Medicare Advantage plan, leaving you with no coverage.

Again, the above is a partial list of Medicare Advantage features.  Reference the individual insurance company’s enrollment literature for a complete list of benefits and features. To easily get literature & information – free and fast, click here_____.

WHEN CAN I ENROLL?

  1. During your Initial Enrollment Period (IEP)

Eligible individuals can enroll three months before their birthday month, during their birthday month, or three months after their birthday month.  This is a seven-month enrollment period.  This enrollment period is for Medicare Part A and Part B, as well as for Medicare Advantage (MA, MAPD), and prescription drug (PDP) coverage.

enroll-period-1075x118-new-note

EWorking individuals age 65 or older, have different enrollment periods for Parts B and Part D if they are covered under a union or employer’s group plan. The enrollment period begins when the individual retires or terminates coverage, whichever occurs first. Reference section, WHAT IF I’M COVERED BY A UNION, OR EMPLOYER’S GROUP PLAN?

If you delay applying for Social Security or Railroad benefits beyond age 65, you have the option of enrolling in Medicare at 65, and applying for social security retirement benefits later.

  1. During your Annual Election Period (AEP)

There is an Annual Election Period, October 15 thru December 7.  Coverage is effective January 1. Members can add, drop, or change plans and carriers as follows:

  • Change from Original Medicare to a Medicare Advantage plan
    • Individuals canceling a Medicare Supplemental plan must actively notify the insurance company of the cancellation in a timely manner
  • Switch from a Medicare Advantage plan to another Medicare Advantage plan
  • Change from a Medicare Advantage plan with prescription drugs to a Medicare Advantage plan without prescription drug coverage, or vice versa
  • Return to Original Medicare
  • Enroll in a MA or MAPD plan for the first time, even if the individual did not enroll during their Initial Enrollment Period (IEP)
  • Enroll in stand-alone Part D, prescription drug coverage. A penalty may apply if you did not enroll during your Initial Enrollment Period (IEP)
  • Switch from one prescription drug plan to another prescription drug plan (PDP)
  • Drop prescription drug coverage (PDP)

During Annual ELECTION PERIOD
Note:  Individuals switching from a Medicare Advantage plan to a Medicare Supplemental plan are medically screened by the insurance company offering the Medicare Supplemental plan if the application is submitted six-months after their Initial Medicare Enrollment Period.  Their enrollment application may be approved, rated-up B or denied.

  1. During a Special Enrollment Period (SEP). Listed below are some of the qualifying events.
  • Loss of group coverage: union or employer D
  • Moving in or out of a service area, i.e., permanent change in residence
  • 5-Star Rating reached for a Medicare Advantage plan, if available in your area You can switch once from December 8 – November 30
  • Release from jail
  • Gaining or losing Medicaid eligibility
  • Gaining or losing Part D low income subsidy
  • Involuntary loss of creditable drug coverage

Don’t lose your opportunity to enroll during a SEP if you qualify.  Make certain you understand the enrollment period(s) associated each Special Enrollment Period.  Check with your insurance company for details.

In summary, there are three times individuals can enroll in a Medicare Advantage plan:  During the Initial Enrollment Period, during the Annual Enrollment Period, or during a Special Enrollment Period, if applicable.

Is there an annual DISENROLLMENT period for MEDICARE ADVANTAGE plans?

Yes.  January 1 thru February 14 Medicare Advantage members can disenroll from their Medicare Advantage plan, and return to Original Medicare and enroll in PDP plan (optional). Generally, your PDP plan will be effective the first of the month after the insurance company receives your signed enrollment application.  An optional Medicare Supplemental enrollment application may be submitted too, which may or may not be approved contingent upon your health status. F  The application may be approved, rated-upD, or denied. In general, if approved, your effective date will be the first of the month after your application has been signed and received by the insurance company.  Check with your insurance company for details.


A Individuals who have worked less than 40 quarters can enroll in Medicare Part A.  The premium depends on how many quarters the individual has worked.  The average monthly premium for Part A coverage is $413.

B Premiums may increase.

C Reference insurance company’s literature for a complete list of preventive care benefits paid at 100%.

D Your or your spouse’s union or employer group plan.

E Different enrollment periods (Part B and D) apply for working individuals age 65 or older.

FIf your Medicare Supplemental enrollment application is submitted six months after your Initial Enrollment Period.