If you are thinking of enrolling in a Medicare Advantage plan, you will be in one of three situations:
You’re new to Medicare, but you already know you want to enroll in Medicare Advantage.
You’re enrolled in Original Medicare (Parts A and B), but you’ve decided you’d prefer to be enrolled in Medicare Advantage.
You’re already enrolled in Medicare Advantage, but you’ve decided you want to switch plans.
Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance). It’s important to know that you first have to be signed up for Original Medicare to enroll in Medicare Advantage (also called Part C). Medicare Advantage is an alternative way of receiving your Original Medicare benefits, but private insurance companies provide them instead of the federal government.
With Original Medicare, prescription drug coverage is optional and can be purchased as a Part D plan from a private insurance company. With Medicare Advantage, prescription drug coverage is usually bundled into the plan, so you won’t have to purchase a standalone plan.
You are not entirely separated from Medicare when you enroll in a Medicare Advantage plan. With some exceptions, everyone on a Medicare Advantage plan will still pay the Medicare Part B premium, which is then given (along with other funding) to your Medicare Advantage insurer to pay for your benefits.
Medicare continues to provide guidelines under which the insurers must operate and monitors certain charges, such as maximums for out-of-pocket expenses. Medicare also defines the enrollment periods during which someone can sign up for a Medicare Advantage plan.
Here are the various periods:
Have you just become eligible for Medicare? The Initial Enrollment Period is a 7-month window when you are first eligible for Original Medicare at your 65th birthday. It covers the three months before your birthday month, your birthday month, plus three more months. As soon as you are signed up for Parts A and B, you are free to enroll in a Medicare Advantage plan.
Did you delay enrolling because you already had insurance? The Initial Coverage Election Period is when you can enroll if you delayed signing up for Part B (for example, because you had qualified health care coverage through an employer). Once you are ready to transition to Medicare and you sign up for Part B, a window opens up to enroll in Medicare Advantage. The window’s length depends on when you do sign up for Part B.
Are you renewing your coverage? The Open Enrollment Period runs from October 15 to December 7 each year. You can enroll in a Medicare Advantage plan, switch Medicare Advantage plans or make other coverage changes. All Medicare Advantage plans have to be renewed each year, so this enrollment period is exceptionally active.
Are you unhappy with your plan? The Medicare Advantage Open Enrollment Period gives members with Medicare Advantage plans an opportunity each year (between January 1 and March 31) to switch to a different Medicare Advantage plan – or disenroll from Medicare Advantage and return to Original Medicare.
Has something changed in your life? A Special Enrollment Period is a window triggered by several life circumstances in which you can enroll in a Medicare Advantage plan. Circumstances could include moving out of your plan’s service area, losing insurance coverage, qualifying for dual coverage (Medicaid and Medicare) or qualifying for a low-income subsidy such as Extra Help.
Do you simply want a better plan? The 5-Star Special Enrollment Period is a recent addition to the available enrollment periods. It is based on how a Medicare Advantage plan rates on quality and performance according to member and provider satisfaction surveys. Plans are rated between one and five stars, with five considered excellent. If a 5-star Medicare Advantage plan is available in your area, you can use this period to switch one time to such a plan between December 8 and November 30.
Takeaway action step: Especially if you don’t enroll in Medicare Advantage during your Initial Enrollment Period (during the seven months around your 65th birthday), consult with Medicare as often as needed through the Medicare website’s Live Chat or by calling 1-800-MEDICARE. You don’t want to miss the appropriate enrollment window and possibly incur penalties.
1 Centers for Medicare & Medicaid Services. “Joining a health or drug plan.” medicare.gov (accessed May 26, 2022).
2 Centers for Medicare & Medicaid Services. “Special circumstances (Special Enrollment Periods).” medicare.gov (accessed May 26, 2022).
3 Centers for Medicare & Medicaid Services. “5-star special enrollment period.” medicare.gov (accessed May 26, 2022).