Enrollment & Disenrollment Rules in Medicare Advantage Plans

Enrollment

If you want to join a Medicare Advantage (MA) plan, you must have Medicare Parts A and B. Your Part B premium will continue to be taken out of your Social Security or Railroad Retirement benefits check, unless you are enrolled in a Medicare Savings Program (MSP). 

 

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You cannot be denied enrollment in an MA plan due to a pre-existing condition, which now includes if you have end-stage renal disease (ESRD) — permanent kidney failure. Also, the plan’s premium must be the same for all beneficiaries regardless of your health condition or age. 

Note: if you have ESRD, a Medicare Advantage plan may impose a 20% co-insurance for dialysis until you reach the maximum out-of-pocket for the year. (Contact your local Health Insurance Counseling and Advocacy Program (HICAP) for more information).

If you want to join an MA plan, you must reside in the plan’s service area and the plan you choose must be accepting new members.

 

You can only join MA plans during certain periods:

• Initial Coverage Election Period (ICEP): The 7-month period when you are first eligible for Medicare. Your coverage start date depends on which month you enroll.
• Annual Election Period (AEP): October 15 – December 7 each year. Coverage effective January 1.
• General Enrollment Period (GEP): If you have Medicare Part A and are enrolling in Part B for the first time during the GEP, which is from January 1 – March 31 each year, you can also enroll in a Medicare Advantage plan (with our without prescription drug coverage) or a Part D prescription drug plan between April 1 – June 30. Your coverage is effective July 1.

To enroll, submit your application directly to the plan via the plan’s website or a plan sales representative. You can also call 1-800-MEDICARE or enroll on the Medicare website at Medicare.gov. The date your coverage starts depends on the period in which you enroll.

Remember not to drop your existing coverage, if any, until your coverage with your MA plan has started.

In addition, if you are already in a Medicare Advantage plan (with or without drug coverage), you also have the Medicare Advantage Open Enrollment Period, from January 1 – March 31 each year. During these 3 months, you can:

• Switch to another Medicare Advantage plan (with or without drug coverage), or
• Disenroll and return to Original Medicare. If you do so, you can also join a Part D prescription drug plan.

There are Special Election Periods (SEPs) during which you may be able to enroll in or disenroll from your MA plan, depending on your situation. For example, if you move out of your plan’s service area, you have a Special Election Period (of up to 3 months) to disenroll from your plan and join a plan available in your new location. See Special Election Periods (SEPs).

For enrollment information on other parts of Medicare, see:

• Enrolling in Medicare Parts A & B
• Enrolling in Medicare Part D
• Special Election Periods (SEPs) for Parts C & D

 

Disenrollment

As enrollment in an MA plan is limited to certain periods, disenrollment is also limited to certain periods:

• Annual Election Period (same as mentioned above)
• Medicare Advantage Open Enrollment Period – January 1- March 31 each year
• Special Election Periods (depending on the situation, as mentioned above)

During the Annual Election Period (AEP), the Medicare Advantage Open Enrollment Period or in a Special Election Period (SEP), if you want to leave your MA plan and don’t want to join another MA plan, you must send a written request to the plan or call 1-800-MEDICARE during the enrollment period.

If you want to switch from one MA plan to another, simply submit an enrollment application to the new plan and once you are accepted, you will be automatically disenrolled from your current plan. Again, in general, you can only make changes such as this during the AEP, MA-OEP or an SEP.

Note: This method of disenrollment also applies to Part D prescription drug coverage. For example, if you are in an MA plan with Part D coverage (MA-PD) and wish to switch to a stand-alone prescription drug plan (PDP), enrolling in a PDP automatically disenrolls you from your previous MA-PD plan, and vice versa.

Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31)

If you’re in a Medicare Advantage plan with or without Part D coverage, you can:

• Switch to another Medicare Advantage plan with or without Part D coverage, OR
• Disenroll from your plan and return to Original Medicare anytime between January 1 – March 31. If you disenroll and return to Original Medicare, you are also given a Special Election Period (SEP) to enroll in a Part D plan during this time.

Your MA plan switch or disenrollment becomes effective the first day of the following month. For example, if you switch or disenroll from your MA plan in January, your change becomes effective February 1. If you switch or diseroll in February, your change becomes effective March 1.

If you’re returning to Original Medicare, we encourage you to enroll in a Part D plan as close to the time of your MA plan disenrollment as possible in order to avoid any gap in drug coverage. For example, if you disenroll from your MA plan on January 28 and enroll in a Part D plan on February 1, you would return to Original Medicare on February 1, but wouldn’t have drug coverage until March 1.g month.

Remember, if you are switching or disenrolling from your MA plan, you must continue to use providers and services in your current plan’s network until the date your switch or disenrollment becomes effective. Otherwise, the plan will not pay and Medicare will not pay, because your MA plan requires you to use providers in your plan’s network.