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Medicare Advantage Enrollment Guidelines

Figure Pointing to Red PaperMedicare Advantage plan enrollment guidelines- know the rules

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.



Agents cannot:

  • 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.

12 comments

  1. thank you for the mini course. it confirmed what i knew for the most part, but it was great to have another opinion and source of information. keep up the good work

  2. Mark, I’m glad that you found it to be of some benefit. There seems to be a good amount of confusion about Medicare and especially Medicare Advantage plans. The changes in 2011 Medicare Advantage enrollment periods has certainly added to the confusion. Thanks for your feedback.
    David

  3. The cost for Medicare Complete does it include Part A and Part B or do you still have to pay Part A and Part B ?

  4. Bud, Great question. AARP Medicare Complete is a Medicare Advantage plan ans as such you must have both parts A and B and pay for their costs. If you have worked 40 quarters and paid taxes you are automatically enrolled in Medicare Part A without cost. You are responsible to pay your Part B premium which can vary based on your income.

  5. i was at a marketing meeting for 2012 medicare advantage plans and they advised that one of several new rules is that we cannot ask what doctors people see or what prescriptions they are taking. How are we suppose to help someone choose the correct plan if we don’t have that info?

  6. Lisa, Are you sure they were not referring to a educational Medicare meeting? Rules are different for sales meetings and educational meetings.

  7. Heather youngdell

    I have AARP Medicare complete as my plan. I received a silver sneakers card but when I went to the website to sign it said it had no record of my account. Do I have silver sneakers with this plan and where do I get information on where I can go in my area to utilize it. I would appreciate your help and cooperatio i this matter.
    thanks,
    Heather

  8. Heather, Benefits can vary with the same Medicare Advantage plan from area to area. Your best solution would be to call the customer service number on your insurance card.

  9. Is it true that if you are in the AARP Advantage Plus plan for over a year and want to take out a supplement instead that you have to go thru a medical screening and could possibly be turned down for a supplement if you have a pre-existing condition?

  10. Sharon, Yes, if it has been more than a year since you enrolled in the Medicare Advantage program you will be subject to underwriting and could be denied coverage. The exception would be if you enrolled in an Advantage plan due to being Medicare-eligible due to a disability. You would still have your Medigap Open Enrollment Period when you turned 65.

  11. I have been in a Medipak Advantage plan through Blue Cross that is not being renewed. Would I under these circumstances have to go through underwriting if I wished to go back to Medicare supplement?

  12. Hi James, You will qualify for Guaranteed Issue Rights. You should contact your agent or if your agent doesn’t handle Medigap policies call PlanPrescriber at 800 310-0376 and they should be able ti help.

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