If you are a Medicare beneficiary you will probably agree that nothing is more regulated and often confusing than Medicare. You would think that after 40 years things would be easy to understand and actually make sense.
Understanding the Medicare Advantage enrollment guidelines is the first step to ensure that you get the best Medicare Advantage plan.
In order to enroll in a Medicare Advantage plan, you must meet some basic criteria.
- You must be enrolled in Medicare Parts A and B.
- You must live in the plan’s service area.
- You cannot have End-stage-Renal Disease (some exceptions apply).
These are fairly straight forward guidelines, where things get a little tricky for Medicare Advantage enrollment is the enrollment periods themselves.
Guidelines start with when to enroll
You can submit an application to enroll in a plan between October 15th and December 7th. You can also switch or drop a plan during this time.
But what if you enroll in a plan and later find out there is a better alternative? If you are still within the enrollment period, don’t worry, merely submit an application for the better plan.
The last application submitted before the end of the enrollment period will be the plan you will be enrolled in for the following year. Last plan submitted sticks!
It is imperative that you compare Medicare Advantage plans during this enrollment period and make your best choice be the last you make before the time frame ends.
Changing your coverage after December 7th
Between January 1 and February 14, if you are enrolled in a Medicare Advantage plan, you can leave your plan and return to original Medicare. You cannot switch to another Advantage plan unless you have a circumstance that affords you a Special Enrollment Period. After you leave your plan, you will have until February 14 to enroll in a Part D plan that will begin the first day of the following month that you enroll.
A large number of people in the past were able to switch Medicare Advantage plans between January 1 and March 31. If they are not aware of this new Medicare Advantage guideline and are unhappy with their plan, they will more than likely be locked-in to the plan unless they choose to return to original Medicare.
Understanding Marketing guidelines
Insurance agents are under more regulation when Medicare Advantage plans and Part D are involved than any other product they represent. Additional annual training is required, as well as testing if they are to present these products.
Agents are prohibited from certain activities. Below are some of the activities that they are not allowed to engage in. This information is provided so you will be able to determine if you are being engaged by an honest and ethical agent. If an agent engages in any of these activities, you should find another agent.
- Cold call you on the phone.
- Come to your home uninvited.
- Call any referrals you may have for them.
- Approach you in common areas, like parking lots or public buildings.
- Give you a gift valued at more than $15.
- Offer you a gift to enroll in a plan.
- Cannot present other products during your Medicare appointment.
Agents must also have your written permission to speak to you about a Medicare plan or Part D. This form is called a Scope Of Appointment Form. You will be asked to initial the types of plans to be discussed and sign giving the agent permission to present the plans. This does not obligate you to enroll, nor will it change your current enrollment. It is required by CMS.
Once you have an agent who abides by these guidelines, you can get down to the business of comparing Medicare Advantage plans. Medicare Advantage plan enrollment guidelines are not that confusing and you should be able to locate a plan that will meet your needs. it is often helpful to compare plans online prior to meeting with an agent.