By Susan Stewart
The Medicare Advantage/Prescription Drug Plan year cycles through three seasons: the Annual Enrolment Period (AEP), Open Enrollment Period (OEP), and Rest of Year (ROY).
So, what do these seasons mean and when do they occur?
Annual Enrollment Period
The AEP begins the cycle and runs from October 15th to December 7th. This is the free-for-all when beneficiaries can make as many changes to their plans as they want. Whatever plan is in place on December 7th is the plan you take into the next year, whether it’s a Medicare Advantage plan or a Prescription Drug Plan. Your agent has access to next year’s plans on October 1st, but they can’t change to next year’s plan until the 15th.
AEP is when carriers compete for the upcoming year. Your current plan may change, and other plans may offer benefits they didn’t offer last year. It’s the perfect time for a full review of your doctors, medications, and needs. If a hospital or any other medical service provider is important to you, mention them to your agent, too. Be prepared. A good agent needs to review all this information to best advise you.
Open Enrollment Period
Following AEP is the OEP, which runs from January 1st to March 31st. In this period, Medicare allows one change to a Medicare Advantage plan. The rules around the changes are moderately complicated, and certain circumstances could allow a second change. It’s up to your agent to know them.
Rest of Year
Last comes the ROY period, which we’re in right now. To understand how it works, you need to know about Special Election Periods (SEPs), which are required every time an agent writes a Medicare Advantage or Prescription Drug Plan. These are simple during the other two periods: From October 15th to December 7th, the Special Election Period is the AEP. Easy. From January 1st to March 31st, the Special Election Period is OEP. Still relatively easy but more restrictions. During ROY, though, your agent needs to find an alternate SEP for Medicare to approve the change.
Some of the more common SEPs are for individuals who are just turning 65; lose employer health coverage, usually due to retirement; move to a new county or state; and Medicare Drug Event (MDE) or receive assistance from the Extra Help program to help pay for prescriptions.
Some less common SEPs are LCC (involuntary loss of prescription drug cover), 5ST (a 5-Star plan), DST (FEMA declared disaster that could have prevented a plan change during AEP or OEP), and CHR (plans for beneficiaries with eligible chronic health needs). Other, even rarer SEPs include LTC (recent discharge from a skilled nursing facility) and LAW (recently became lawful citizen entitled to Medicare).
This is not a comprehensive list, and every Special Election Period has rules and timeframes that you must follow for Medicare to approve the change. If you don’t, Medicare will deny your plan change. During ROY, be patient with your agent if they need to search for an SEP by asking questions that may seem strange or double check your eligibility for the SEP they are considering. It’s always in your best interest for an SEP to be valid.
