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  • Tom Cianflone

All About AEP

Updated: Sep 22



October 1, 2022. This post is about the who, what and when of the Medicare Annual Enrollment Period, or AEP as we say in the business. Who is it for? What can you do? When can you do it? Read on! As always, I'm here to help you with all of this and more. Contact me any time.


Who is AEP for?

If you're reading about Medicare it's because of one of two reasons:

  • Reason 1: You are approaching Medicare eligibility. That could mean, a) you are approaching 65 years old or, b) you are already past 65, still working, still covered by employer group health and now you're planning on leaving the job and transitioning your health care to Medicare.

  • Reason 2: You are already in Medicare.

If reason 1 describes you, AEP is NOT for you. Your entry into Medicare follows different rules and AEP has nothing to do with your situation. If reason 2 describes you, then AEP is for you.


What can you do during AEP?

There are five things you can do during AEP. Some of what you can do during AEP depends on how you are getting your Medicare benefits. When you started with Medicare you made one of two choices: 1) to stay on original Medicare and add a Supplement (aka, MediGap) and a standalone prescription drug plan (PDP) or, 2) to join a Medicare Advantage plan (aka, Part C or MAPD). Here are the five things you can do during AEP:


1) If you're on a Medicare Advantage plan, you can switch to a different Medicare Advantage plan.

Why would you want to do this? Maybe you saw something in your annual notice of change (ANOC) that will adversely affect your medical care. Maybe a doctor or an entire network of medical providers have dropped out of the plan. Maybe a drug that you take is no longer covered in the formulary or it has been moved to a higher cost tier. Here in Broward County, UnitedHealthcare lost their contract with Broward Health almost a year ago and as of this writing still has no contract with them. Sometimes carriers leave a market and their plans are no longer available like MMM who is pulling out of South Florida for 2023. During AEP you can join a different plan for 2023 with no underwriting (no health questions). The new coverage will begin on the first of the new year.


2) If you're on original Medicare with a Supplement, you can switch to a Medicare Advantage plan.

Why would you want to do this? Perhaps the monthly premium for the Supplement is causing a financial hardship. Maybe you need some of the extra benefits that are offered by these plans, for example, transportation, vision, dental and so on. This is a serious change and you need to understand that your Medicare will work differently on a Medicare Advantage plan versus original Medicare. On Medicare Advantage plans you will be limited to the plan's provider network, you may have to get referrals to see specialists and your care may be impeded by preauthorizations that the carrier can deny: a totally different medical experience compared to original Medicare. During AEP you can join a Medicare Advantage plan for 2023 with no underwriting (no health questions). The new coverage will begin on the first of the new year. Joining a Medicare Advantage plan will automatically cancel any PDP you may have been enrolled in when on original Medicare. You will have to contact the Supplement carrier to cancel the Supplement coverage.


3) If you're enrolled in a Medicare Advantage plan, you can switch to original Medicare with a Supplement assuming you can pass the health underwriting questions for the Supplement.

Why would you want to do this? If you've ever had to file an appeal about a preauthorization denial or otherwise had to fight with your Medicare Advantage plan carrier, you might just want out of managed care. During AEP you can switch from a Medicare Advantage plan to original Medicare, but you will likely have to pass medical underwriting. If you are still between 65 and 65-1/2 or if you are still in a Medicare Advantage plan trial period, you could still get a Supplement guaranteed issue (no health questions). Otherwise, you will have to be able to pass the underwriting questions (simple yes/no medical questions, around 10 of them) to get a Supplement. The application for the Supplement should be submitted early in AEP so we find out for certain that the carrier will issue the Supplement to you. Once we have verification that your Supplement is a go, then we enroll you in a PDP with an effective date of the first of the new year. Your enrollment in a PDP will automatically disenroll you from your current Medicare Advantage plan.


4) If you're enrolled in original Medicare with a Supplement, you can shop for a different Supplement.

Actually, you can do this any time of the year because Supplements are not governed by the same enrollment rules as Medicare Advantage plans and PDPs. But you could certainly do it during AEP if you choose to do so. Why would you want to do this? To reduce premiums, you may want to move to a different Supplement plan. For example, if you're covered by a Supplement Plan F, you are buying the most insurance you can buy and also paying the highest premiums. Plan G, Plan N or one of the high-deductible plans could reduce your premium. Again, as in #3 above, you will likely have to pass medical underwriting to move to a different Supplement carrier. If you stay with the same carrier, they may allow you to move to a Supplement Plan that offers less insurance (for example, from a Plan F to a Plan N) without underwriting and at the same time keep your issue age rate.


5) If you're enrolled in a standalone PDP, you can switch to a different PDP.

Why would you want to do this? Drug plans change every year. Maybe you saw something in your annual notice of change (ANOC) that will adversely affect your drug costs. Maybe a drug that you take is no longer covered in the formulary or it has been moved to a higher cost tier. During AEP you can shop for a different PDP for 2023 that will treat your drug costs more favorably. If you find a PDP that is a better fit for your prescription drugs, you can enroll in it during AEP. The new coverage will begin on the first of the new year. Your enrollment in a new PDP will automatically cancel your current PDP.


When?

The Medicare Annual Enrollment Period runs from October 15th thru December 7th. Any changes you make with Medicare Advantage plans or PDPs are effective the first of the new year.


Final Thoughts

You can avoid the information overload of AEP by working with a licensed, local, independent agent, like me! Seriously, if you already have a trusted local agent that is responsive to your needs, continue to work with them. Otherwise, I'm available to help. Please, do not work with call center agents. Local agents understand the markets we live in. We will be your best source of assistance. Finally, do not get lured into calling a toll-free number by Joe Namath, Jimmy JJ Walker or William Shatner. Trust me, they are NOT covered by the Medicare Advantage plans they are hawking on TV. Contact me anytime for straight, smart Medicare advice, always at no cost to you!


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