What Changes Can Your Clients Make During Medicare Annual Enrollment?

The Medicare Annual Enrollment Period (AEP) happens every fall from October 15 until December 7, and it is a time that can be very confusing for Medicare beneficiaries. They will receive a ton of mail, get endless phone calls, and see many commercials about what they can do during this period. While some beneficiaries have advisors to assist them, many try to navigate the maze themselves. You have the opportunity to be their trusted Medicare advisor and help them explore what’s available during AEP.

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What Can Medicare Beneficiaries Do During AEP?

1. Change their Prescription Drug Plan (PDP).

PDPs have a one-year contract, and the pricing on premiums, co-pays, coinsurance, etc. can change from year to year. In addition to the costs changing, the formulary can also change, and so can the prescriptions your client takes. This can dramatically change costs when comparing one plan to another, so it’s best to at least evaluate the projected costs for the year. Lastly, Preferred Pharmacies can also change from year to year, which may have an impact on costs as well. (Due to legislative changes made through the Inflation Reduction Act, there will be a disruption in PDP plans for the next couple of years. Please encourage all your clients to take a look at their plans and projected costs each year.)

2. Change their current Medicare Advantage (MA) plan.

Like PDPs, Medicare Advantage plans have a one-year contract, and changes can occur with each new year. In addition to costs changing on these plans, they can also have network changes. While network changes can happen at any time of the year, most plans try to keep the contract through the end of the year to avoid extra issues with members. It’s important to consider any changes to an MA plan and how they might impact your client. If necessary, AEP is the time to make a change.

3. Sign up for a Medicare Advantage plan.

You may encounter a client who only has Original Medicare (with or without a supplement). AEP is the time those who have Medicare Part A and Part B can sign up for a Medicare Advantage plan. If your client has a Medicare Supplement (Medigap) and has never tried an MA plan, they can try one for a one-year trial. If they don’t like it, they can return to their Medicare Supplement (same company and plan) within a year without underwriting. Also, some clients may decide to move to an MA plan due to the costs of their Medicare Supplement. Please note that Medicare Advantage plans cannot be paired with a stand-alone drug plan, so clients who need drug coverage must find an MA plan that includes prescription drugs. Also, the client must contact their Medicare Supplement company to cancel their Medicare Supplement plan prior to January 1. Otherwise, they might be responsible for the premiums.

4. Disenroll from a Medicare Advantage plan and sign up for a Medicare Supplement with underwriting.

Most states do not allow members to move to Medicare Supplements without underwriting. (There are a few exceptions. Download our Medicare Agent Guide for more details.) If your client is healthy enough, AEP can be a good time to make a change to their Medicare Supplement and PDP. Please note that it is advised to avoid changing anything with their Medicare Advantage plan or enrolling in a PDP until after the client has been approved for the Medicare Supplement.

Can You Pass? Medicare Quiz for Agents

What Can Your Medicare Clients Not Do?

1. They cannot change their Medicare Supplement from one company to another or move to a different type of plan. While there are different rules in some states about changing plans, AEP is not for Medicare Supplement changes.
2. They cannot have their effective date start before January 1.
3. They cannot make a change after December 7.

If you have questions about the Medicare Annual Enrollment Period or if you would like to add these products to your product portfolio, please schedule a call with La Rae Mills here.