Navigating Medicare: Important Deadlines and Opportunities

Navigating Medicare: Important Deadlines and Opportunities

For RSCs involved in advocating for Medicare beneficiaries, staying informed about crucial deadlines and opportunities is paramount. With a looming March 31 deadline, two significant avenues demand attention: the Medicare General Enrollment Period (GEP) and the Medicare Advantage Open Enrollment Period (MA-OEP).

Medicare General Enrollment Period (GEP): January 1 – March 31

The GEP, running from January 1 to March 31, serves as a vital window for individuals to enroll in Medicare Part A and/or Part B. Notably, this period is exclusive for enrollment unless individuals fall within their Initial Enrollment Period or qualify for a Special Enrollment Period due to specific circumstances. Applications are processed through the Social Security Administration (SSA), with coverage commencing the month following application submission.

Of particular importance are individuals residing in select states labeled as "group payer" states, such as Alabama, Arizona, and California, among others. In these states, individuals lacking premium-free Part A coverage may leverage the GEP to obtain conditional Part A, subsequently applying for the Qualified Medicare Beneficiary (QMB) program through their state Medicaid office to cover Part A and B premiums. Missing the March 31 deadline necessitates waiting until the following year to apply for QMB.

Medicare Advantage Open Enrollment Period (MA-OEP): January 1 – March 31

Simultaneously, the MA-OEP, spanning from January 1 to March 31, offers Medicare Advantage (MA) plan enrollees opportunities to adjust their coverage. Participants can opt to switch from MA plans to original Medicare with a Prescription Drug Plan (PDP) or transition between different MA plans, including those with or without prescription drug coverage. However, individuals in Original Medicare face limitations during this period unless eligible for specific enrollment periods like the Initial Enrollment Period or a Special Enrollment Period.

Enrollees without the Low-Income Subsidy (LIS) should seize this period, as it represents their final chance, until the annual election period in October, to modify coverage unless qualifying for a Special Enrollment Period. Beneficiaries with LIS or dual eligibility for Medicare and Medicaid benefit from a quarterly SEP for plan coverage adjustments.

Understanding these deadlines and opportunities is essential for effective Medicare advocacy. RSCs are encouraged to steer beneficiaries toward unbiased assistance, such as SHIP counselors, to ensure informed decisions aligning with individual needs and preferences. For further guidance, consultation assistance is available through the National Center on Law & Elder Rights (NCLER) via ConsultNCLER@acl.hhs.gov.

This information is a summary of this document by the National Center on Law & Elder Rights posted in January 2024.