Sunday, January 29

Medicare Open Enrollment Season: The Big Picture


This post is part of a series sponsored by AgentSync.

It’s almost that time of year again. No, we’re not talking about the scary season or the holiday season or even ski season. Believe it or not, we’re talking about something even more exciting: Medicare open enrollment season!

Before you draw your attention to our great nerd for open enrollment in Medicare, remember: In 2021, there were approximately 63 million people enrolled in Medicare.

That’s a lot of people. And if you are an insurance producer, agency, carrier, or MGA/MGU responsible for enrolling even a portion of those Medicare beneficiaries, the open enrollment season is an opportunity to help put elderly and disabled Americans into the insurance plan best suited to meet their needs. So, if you ask us, this is a season to celebrate.

Why does a federal program require registration?

With all types of insurance, specific policies provide coverage for specific risks. Medicare is no different. There are two types of coverage available to those who qualify for Medicare.

  • Original Medicare – Americans receiving Social Security benefits are automatically enrolled in Medicare Part A and Medicare Part B plans when they turn 65.
    • Medicare Part A – Covers hospital inpatient care, skilled nursing facility care, hospice benefits, and home health services.
    • Medicare Part B – Covers doctor’s appointments, preventive care, durable medical equipment, some prescription drugs, mental health services, and ambulance services.
  • Medicare Benefits (Medicare Part C) – Sold by private insurance companies, offered as an alternative to original Medicare plans. They generally include the same coverage as the original Medicare plans with additional coverage for hearing, dental, and vision care. They often have lower premiums and limit the amount a person will pay out of pocket. Sometimes Medicare Advantage plans automatically include Medicare Part D coverage. Those interested in Medicare Part C coverage must enroll in the choice plan.
  • Medicare Part D – Medicare Part D is offered by private insurance companies. It covers the cost of both generics and generics. Those interested in Medicare Part D coverage must enroll in the choice plan.
  • Medicare Supplemental Insurance (Medigap) Medigap is sold through private insurance companies and helps fill gaps in original Medicare plans. To enroll in a Medigap policy, you must first enroll in Medicare Part A and Medicare Part B.

Medicare Part A and Medicare Part B work by automatically enrolling those receiving Social Security benefits. However, those who do not receive Social Security benefits and those who wish to enroll in Medigap, Medicare Advantage, or Medicare Part D must do so at either Initial Enrollment, Private Enrollment, Public Enrollment, or Open Enrollment in Medigap.

What’s with all these recording options?

Those eligible for Medicare have three initial chances of enrolling first in the plan that’s right for them.

  • Initial Registration – This seven-month period begins three months before the month of birth when the person turns 65 and ends three months after that month of birth. At this time, they will have the opportunity to enroll in the Medicare plan of their choice. Failure to enroll in Medicare Parts A, B, or D within the initial enrollment period of 65 may result in heavy fines if you change your mind and enroll in them later. The exceptions here are if that person opts out of Medicare Advantage instead of Medicare Parts A, B, or Medicare D, or if they are still employed and covered by their employer’s health care plan.
  • Private Enrollment Not everyone qualifies for a special enrollment period. This is a two-month period beginning a month after a person’s employment ends or a month after they lose their eligible employer insurance, whichever comes first.
  • Public Registration – Those who have missed the initial registration and are not eligible for private registration will need to wait until the general registration period from January 1 through March 31. Enrolling at this time will result in high penalties and coverage will not start until July 1. All health costs incurred prior to the start of coverage must be paid directly by the person.
  • Open Enrollment for Medicare Supplemental Insurance (Medigap) – This is a six-month period beginning on the first day of the month in which a person turns 65 and enrolls in Original Medicare. At this time, Medigap can be purchased regardless of health status. This means that insurance companies are required to charge people the same price regardless of whether they are healthy or have pre-existing conditions. After this open enrollment period, insurers have the right to charge more or refuse coverage based on pre-existing conditions.

Once you’ve already signed up for Medicare coverage, there are two primary opportunities to change that coverage and switch plans.

  • Annual Open Enrollment – At this time, those receiving Medicare coverage can assess their health coverage and make changes based on evolving needs. Open registration starts from 15 October until 7 December each year.
  • Special Circumstances and Special Enrollment Period – Someone already enrolled in Medicare Advantage and Medicare Part D coverage may be eligible to make changes outside of specified enrollment periods if certain life changes occur. Changes in coverage, a physical change of address, and a change in employment status are all reasons why a person qualifies for a change.

Tell me more about open enrollment

There is an open enrollment in Medicare for a very specific purpose. As such, there are clear guidelines about what a person who is already enrolled in Medicare coverage can and cannot do at this time.

To ensure that their coverage best meets their needs, Medicare enrollees can switch from a Medicare Advantage plan to a different Medicare Advantage plan, drop a Medicare Advantage plan and return to original Medicare coverage, and join a Medicare prescription drug plan.

However, they cannot switch from an original Medicare plan to a Medicare benefits plan, join a Medicare prescription drug plan if enrolled in original Medicare, or switch between Medicare prescription drug plans if enrolled in Medicare. Medicare original.

Why are producers so important to the Medicare enrollment process?

Those seeking Medicare coverage are entering a period in their lives when they will need health care more than ever. As a result, it is critical that they have the right plan to meet their needs.

But understanding the specifics of a Medicare plan and navigating the ins and outs of Medicare enrollment is enough to put even an experienced producer head into the pretzel. That’s why we built this A useful series of best practices To enroll in Medicare for both Producers And the Agencies, Carriers and MGAs/MGUs.

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