Medicare Advantage Eligibility and Enrollment

​​​Medicare Advantage Plan Eligibility

• Be enrolled in Medicare Part A and Part B, 
• Live in the plan’s service area,
• Be a U.S. Citizen (or a part of specific lawfully present individuals in the U.S.), and
• Not be incarcerated

Medicare Advantage Plan Enrollment Periods

There are specific timeframes in which a beneficiary may join, switch, or drop a Medicare Advantage Plan. These are called the "Enrollment Periods" or "Special Enrollment Periods."

Before a decision is made whether to join, switch, or drop an Advantage Plan, all options and timelines need to be understood so the possible "one-time" election is not used up in each enrollment period.

Initial Election Period (IEP) – When first eligible for Medicare, a decision needs to be made by the beneficiary to remain in Original Medicare or to join a Medicare Advantage Plan. The IEP begins 3 months before starting Medicare, includes the month Medicare begins, and ends 3 months after Medicare begins (7-month time span). Once an IEP election is made and enrollment takes effect, the IEP ends.

Annual Open Enrollment Period (AEP) – The AEP, also known as the Medicare “Open Enrollment Period”, runs from October 15 through December 7 each year. Plan choices become effective January 1 of the following year. During the AEP, any Medicare beneficiary may join, switch, or drop an Advantage Plan. Note: The last election request made during the AEP, determined by the application date, will be the plan that becomes effective in January.

Medicare Advantage Open Enrollment Period (MAOEP) – From January 1 through March 31 of each year is the MAOEP. Beneficiaries must already be in an Advantage Plan on January 1 to use this enrollment period. Enrollees may switch from an Advantage Plan (with or without a Medicare Part D drug plan) or disenroll from an Advantage Plan and return to Original Medicare (with or without a stand-alone Medicare Part D drug plan). Only one election may be made during the MAOEP. The changes will become effective the first of the month after the month the election is made. If a beneficiary returns to Original Medicare, they may want to cover Medicare out-of-pocket costs by purchasing a Medigap Insurance (Supplement) Policy; however, they can be denied coverage due to medical underwriting if not eligible for a Guaranteed Issue period.

Special Election Period (SEP) – There are circumstances that provide a beneficiary the right to add, switch, or drop their Advantage Plan on a one-time, limited, or ongoing basis outside of the IEP, AEP, or MA-OEP. These are called Special Election Periods. Relocation outside of the beneficiary’s current plan’s service area, plan termination, or being eligible for both Medicare and Medicaid are examples of situations that may generate a SEP. What changes a person can make and when depends upon the specific SEP being used.

Federal Trial Periods (SEPs) – These are one-time SEPs. If a beneficiary chooses to enroll in an Advantage Plan when first starting Medicare at age 65 (SEP65) or if switching from Original Medicare and a Medicare Supplement, at any age, to join an Advantage plan for the first time, they will have a Trial Period SEP to disenroll from the Advantage Plan, outside of the AEP or MA-OEP, and return to Original Medicare. A Trial Period SEP may be used only once during their first 12 months of enrolling in their first Advantage Plan. If used, the beneficiary will return to Original Medicare and will have a Guaranteed Issue right of 63 days to purchase a Medicare Supplement Policy. 

Five (5) Star Plan (SEP) – A beneficiary may join an Advantage Plan or Prescription Drug Plan with a performance rating of 5 stars at any time between December 8 and November 30 each year. This SEP may be used only once each year. The beneficiary must meet other basic requirements to join an Advantage Plan with coverage effective the first of the month following the month in which 5-star plans receive an enrollment request. As not all 5-star plans include Medicare Part D Prescription drug coverage, before enrolling, be sure to understand how that enrollment may affect current drug coverage.

Note: Individuals may enroll in Medicare MSA Plans only during the IEP or the AEP. The only SEP available is for enrollment in an employer-sponsored MSA Plan. May disenroll from an MSA Plan only during the AEP or a SEP. MSAs are not included in the MA-OEP.

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