How Do I Enroll in a Medicare Advantage Plan?

You must have Medicare Parts A and Part B in order to join a Medicare Advantage Plan (MAP), and there are certain times of the year when you can enroll, depending on your circumstance. Before you enroll, you should take the time to compare plans that are offered in your area.

Enrolling in a Medicare Advantage Plan, also known as Part C, is fairly straightforward and simple to do, once you have selected which plan you want to join. You receive your Medicare benefits through the plan, not through Original Medicare.

The most common times to enroll in a MAP are during your initial enrollment period when you are first eligible for Medicare, and during open enrollment if you want to switch from Original Medicare to a MAP. There are also opportunities to enroll in a MAP during special enrollment periods that are open when your circumstances change.

When you are first eligible for Medicare, and when you have Parts A and B, whether you have been automatically enrolled, or you sign up yourself, you can join a MAP. Here are your initial enrollment periods:

• If you are newly eligible for Medicare because you are turning 65, you can sign up during the seven-month period that starts three months before the month you turn 65, includes your birthday month, and ends three months after the month you turn 65.
• If you are newly eligible for Medicare because you have a disability and you are under 65, you can sign up in the seven-month period that begins 21 months after you get disability benefits and ends 28 months after.
• If you already have Medicare Part A, and you get Part B for the first time during the General Enrollment Period (January 1 – March 31), you can sign up for a MAP between April 1 – June 30.

During Medicare’s annual open enrollment period (October 15 – December 7), you can switch from Original Medicare coverage to a MAP, or you can switch from one MAP to another.

During Medicare Advantage open enrollment period (January 1 – March 31), you can switch from one MAP to another.

When certain events happen in your life, you may be able to enroll in a MAP during a Special Enrollment Period (SEP); for instance:

• If you move back to the U.S. after living outside the country, you can join a MAP for up to two full months after the month you move.
• If you live in, or recently moved out of an institution (such as a nursing home or rehabilitation hospital), you can join a MAP as long as you live in the institution and for two full months after the month you move out.
• If you are released from jail, you can join a MAP for up to two full months after the month you are released.
• If you were receiving Medicaid or Extra Help, but you are no longer eligible, you can join a MAP for up to three full months after you have been notified that you are no longer eligible, or after you are no longer eligible, whichever is later.
• If you leave coverage from your employer, union, or Program of All-inclusive Care for the Elderly (PACE), you can join a MAP for up to two full months after the month your coverage ends.
• If you are eligible for Medicare and Medicaid, you can join a MAP once during four different periods: January – March; April – June; July – September, and during the annual open enrollment period.

Once you have selected a MAP and understand the plan’s rules, you can visit the plan’s website to see how to join. This is typically done on-line, but you will have the option of a paper enrollment form. It is a good idea to call the plan you want to join using the contact information on the plan’s website.

You will have to provide your Medicare number and the date your Part A and Part B coverage started. This information is on your Medicare card.

After you submit your information, you can check the status of your application while your plan is making sure they have what they need from you. Your plan will notify you when your coverage will start, which is typically the first of the month following your enrollment.

You should receive an ID card and a new member package in the mail. You can then choose your providers and pharmacies, if you haven’t already done so, and make an appointment with your primary provider for an initial welcome visit. Be sure to bring your medical records, health history, list of current medications and any questions you may have. All of your providers and pharmacy will need a copy of your new insurance information.

It should be possible for your healthcare records to be transferred electronically to your new providers, but you may need to sign release forms. Likewise, prescriptions can be transferred from one pharmacy to another.

When you start your MAP, you will use the insurance card provided by your plan to get your services, not the red, white, and blue Medicare card. But you should keep that original Medicare card in case you ever switch back from a MAP to Original Medicare.

As you move forward with your new MAP, keep track of expenses and explanations of benefits so that you can review and evaluate how well the plan meets your needs.

Allow yourself time to make an informed choice based on your healthcare preferences and needs. Consider what is most important to you; for instance, are you willing to change primary physicians or do you want to make sure your physician is in network? What level of dental coverage do you need? What additional benefits, like help with paying for hearing aids, interest you? How much can you afford for premiums and potential annual out-of-pocket costs?

The best place to start your search is here at Medicare.gov. This website will provide prompts for you to be able to compare types, costs, and benefits of plans that are offered in your area. There is plenty of assistance available to help you navigate through and understand all of your options. You can speak with a Medicare agent or call directly the plan you are considering.

Contact your current preferred providers to ask if they are in-network in the plan(s) you are considering. If you, for instance, routinely get physical therapy or access mental health benefits, check into how your plan options cover those services.

As you are conducting your research and comparing plans, it is important to be aware that each plan has details included in the Evidence of Coverage document, which should be available online.

If you need help, you can reach out to Medicare advocate programs, such as Senior Medicare Patrol. These free resources are available for you to take advantage of. Insurance agents can be helpful in education and enrollment, and using their expertise, may be able to solve problems faster than you can on your own.