The Medicare Advantage Open Enrollment Period (MA OEP) is another enrollment period allowing people currently enrolled in a Medicare Advantage plan (MAPD or MA
) an opportunity to change Medicare Advantage plans - or drop their Medicare Advantage plan, return to original Medicare Part A and Part B coverage, and join a stand-alone Medicare Part D prescription drug plan (PDP).
The MA OEP:
In this FAQ
» Why would I use the MA OEP to change my Medicare Advantage plan enrollment?
» Can I change my Medicare Advantage plan enrollment to any MA plan in my Service Area during the MA-OEP?
» A little background on the MA OEP
» Reminder about the timing of your enrollment or dis-enrollment during the MA OEP and premium deductions
» The Medicare Advantage Plan Trial Right
Why would I use the MA OEP to change my Medicare Advantage plan enrollment?
- Begins on January 1st and continue through March 31st,
- Is only available to people already enrolled in a Medicare Advantage plan,
- Provides one additional chance to change your Medicare Advantage plan enrollment outside of the annual Open Enrollment Period (October 15th through December 7th),
- Replaces the Medicare Advantage Disenrollment Period, and
- May not be available for all Medicare Advantage plans in your area (see more below).
You may wish to change Medicare Advantage plan coverage if:
Can I change my Medicare Advantage plan enrollment to any MA plan in my Service Area during the MA-OEP?
- You wrongly enrolled in a Medicare Advantage plan that does not have drug coverage (MA) and you wanted to enroll in an MA with drug coverage (MAPD).
- You find that another Medicare Advantage plan in your area provides more affordable overall coverage - and maybe has a lower maximum out-of-pocket limit (MOOP) for your Medicare Part A and Medicare Part B costs.
- A Special Needs Medicare Advantage Plan (SNP) is available in your area and provides benefits tailored specifically to your health needs, chronic condition, Long Term Care (LTC) residence, or financial status.
- Your healthcare providers (e.g., doctor or specialist) have moved to another healthcare network and they are no longer available (or out-of-network) through your chosen Medicare Advantage plan.
- Your MA or MAPD no longer provides SilverSneakers (tm) or other fitness program coverage and you wish to a change to a plan that includes this benefit.
- You found another Medicare Advantage plan in your area with better supplemental benefits such as vision and dental coverage.
- Your Medicare Advantage (MAPD) plan no longer includes your neighborhood pharmacy within the plan's pharmacy network - or your chosen pharmacy is no longer a preferred network pharmacy and you are paying a higher cost for your formulary medications because your pharmacy is a standard network pharmacy.
- Your Medicare Advantage (MAPD) plan's drug formulary no longer covers all of your medications, and even though you can ask your MAPD for a formulary exception, you would rather change to another Medicare Advantage plan in your area that provides coverage for all of your prescription drugs.
Each Medicare Advantage plan has the option of closing enrollment during the MA OEP and is not required to allow new plan members to enroll into the plan during the MA OEP.
As noted by the Centers for Medicare and Medicaid Services (CMS),
"Unlike the mandatory election periods (AEP [Annual Enrollment Period], ICEP [Initial Coverage Election Period and Initial Enrollment Period for Part D] and SEP [Special Enrollment Periods]), an MA organization has the option to voluntarily close one or more of its MA plans to OEP [Medicare Advantage Open Enrollment Period (MA OEP)] or OEPI [Open Enrollment Period for Institutionalized Individuals] enrollment requests. If an MA plan is closed for OEP and OEPI enrollments, then it is closed to all individuals who are making OEP or OEPI enrollment requests for that plan. [However, a]ll MA plans must accept OEP and OEPI disenrollment requests, regardless of whether or not it is open for enrollment."
A little background on the MA OEP
The MA OEP was implemented in 2019 and, as noted by CMS:
"The 21st Century Cures Act eliminates the existing MA disenrollment period [MADP] that currently takes place from January 1st through February 14th of every year and, effective for 2019, replaces it with a new Medicare Advantage open enrollment period (OEP) that will take place from January 1st through March 31st annually."
The OEP will allow people “enrolled in an MA plan, including newly MA-eligible individuals, to make a one-time election to go to another [Medicare Advantage] plan” - or to leave their Medicare Advantage plan, join a stand-alone Medicare Part D plan, and return to Original Medicare Part A and Part B."
"For example, an individual enrolled in an MA-PD plan may use the MA-OEP to switch to:
(1) another MA-PD plan;
(2) an MA-only plan; or
(3) Original Medicare [Part A and Part B] with or without a [stand-alone Medicare Part D prescription drug plan] PDP.
The MA-OEP will also allow an individual enrolled in an MA-only plan to switch to:
(1) another MA-only plan;
(2) an MA-PD plan; or
(3) Original Medicare with or without a PDP."
"However, this enrollment period does not allow for [Medicare] Part D [PDP] changes for individuals enrolled in Original Medicare, including those with enrollment in stand-alone PDPs."
Reminder about the timing of your enrollment or dis-enrollment during the MA OEP
When you disenroll from your Medicare Advantage plan, the dis-enrollment begins the first day of the next month after dis-enrollment.
For example, if you disenroll from your Medicare Advantage plan on February 10th, your Original Medicare Part A and Part B coverage begins on March 1st. At the same time, you can also join a stand-alone Medicare Part D prescription drug plan and your new Medicare prescription drug plan will also start on March 1st.
Reminder about your automatic SSA premium deductions
The Social Security Administration (SSA) will probably need a little time adjusting your Social Security check deductions if you decide to use the MA OEP. So if you dropped (or changed) your Medicare Advantage plan in January during the MA OEP and joined another Medicare Advantage plan or a stand-alone Medicare Part D plan (PDP), you may still see payments for your old Medicare Advantage plan deducted in February and maybe even March, then in April, any over-payments from the February and March Medicare Advantage plan premiums will be reversed and the February and March premium payments for your newly chosen Medicare Advantage or Medicare Part D plan deducted from your Social Security check.
The Medicare Advantage Plan Trial Right
If you joined a Medicare Advantage plan or Programs of All‑inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at age 65, and within the first year
of joining, you decide you want to switch to Original Medicare - you will have a you have a guaranteed issue right to join any Medicare Supplement that is available in your state.
Trial Right (Part II) - You have a guaranteed issue right if...
You dropped a
Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare
SELECT policy) for the first time, you have been in the Medicare Advantage plan less than a year,
and you want to switch back to your Medicare Supplement (or Medigap plan). You have the right to buy the Medigap policy you had
before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the
same insurance company you had before still sells it. (If your former Medigap
policy is not available, you can buy Medigap Plan A, B, C, F, K, or L that is
sold in your state by any insurance company.)
CMS Finalizes Policy Changes and Updates for Medicare Advantage and the Prescription Drug Benefit Program for Contract Year 2019 (CMS-4182-F)
Medicare Managed Care Manual, Chapter 2 - Medicare Advantage Enrollment and Disenrollment, Updated: August 19, 2011 (Revised: November 16, 2011, August 7, 2012, August 30, 2013,August 14, 2014, July 6, 2015, September 1, 2015, September 14, 2015, December 30, 2015, May 27, 2016, August 25, 2016,June 15, 2017 & July 31, 2018)