Medicare Advantage Open Enrollment Period (MA-OEP)
People who are currently enrolled in a Medicare Advantage (MA) plan have an additional opportunity to switch MA plans or disenroll from an MA plan and enroll in traditional Medicare with a Part D prescription drug plan during the first 3 months of the calendar year, ending on March 31st. Note that this enrollment opportunity, called the Medicare Advantage Open Enrollment Period (MA-OEP), is only available to people enrolled in an MA plan – not to individuals who are in traditional Medicare and a stand-alone Part D plan. If you are enrolled in an MA plan and didn’t review your plan during the Annual Open Enrollment Period, or if you are not satisfied with your MA plan choice, now is the time to review your coverage and consider an enrollment change.
Tips for making an enrollment change during the MA-OEP
- Any enrollment change will be effective the first of the month following the month that the plan receives the enrollment request.
- Beneficiaries may only use the MA-OEP to make one enrollment change, so make sure to review your options carefully.
- If you wish to disenroll from MA and return to Traditional Medicare, you can do so by enrolling in a standalone prescription drug plan (PDP).
- If you decide to make an enrollment change using the MA-OEP, there is no need to disenroll from your current MA plan. You will be automatically disenrolled from your current MA plan when you enroll in a new standalone Prescription Drug Plan or MA plan.
Special Enrollment Periods (SEPs)
Outside of the AEP and MA-OEP, there are opportunities to use a Special Enrollment Period (SEP) to change or get out of an MA or Part D plan in certain circumstances. There are a number of SEPs, including when someone receives inaccurate or misleading information from the Medicare Plan Finder, customer service representatives at 1-800-MEDICARE, or an MA or Part D plan (or its agents). For a full list of available SEPs, see, e.g., “The Medicare Advantage and Part D Enrollment and Disenrollment Guidance” (Chapter 2 of the Medicare Managed Care Manual has been merged with the corresponding Part D guidance into one document starting 2025).
Note that effective 2025, there are changes to SEP rights for individuals who are dually eligible for Medicare and Medicaid, and/or have the Part D Low Income Subsidy (LIS, or Extra Help). Instead of the current right to make quarterly changes to their MA or Part D plans during the first 3 quarters of the calendar year, dual eligibles and LIS enrollees will be able to change stand-alone Part D plans on a monthly basis.
There is also a new “Integrated Care” SEP to allow dual eligibles to elect an integrated dual eligible special needs plan (D-SNP) monthly when the individual receives Medicare and Medicaid services through a “fully integrated” or “highly integrated” managed care plan (known as FIDE-SNPs and HIDE-SNPs, respectively). Note that dual eligibles and others with the Part D LIS cannot use this SEP to elect a non-integrated D-SNP or other MA plan. In short, this means that with the changes to the LIS SEP and with the new Integrated Care SEP, dual eligibles no longer have an SEP to change between non-integrated MA plans during the year. Not all states have managed Medicaid, and not all managed Medicaid plans qualify for the Integrated Care SEP. To help clarify which plans do qualify, CMS has published a list of qualifying plans on its D-SNP integration page, which you can download and sort by state.
For a good summary of these changes, see Justice in Aging’s “Upcoming Changes for Dually Enrolled Individuals: The Final 2025 Medicare Advantage Rule” (July 2024).There is help available to navigate Medicare these enrollment decisions from your State Health Insurance Assistance Program (SHIP). Find contact information for your SHIP program at shiphelp.org (In CT, known as CHOICES, at (800) 994-9422.)
January 2025 – M. Lambert