Medicare advocates should be aware of two important opportunities with a March 31 deadline:
Medicare General Enrollment Period (GEP): January 1 – March 31
- Individuals who wish to enroll in Medicare Part A and/or Part B can do so ONLY during the annual General Enrollment Period (GEP) from January 1 through March 31, unless they are still within
- Their Initial Enrollment Period; or
- A Special Enrollment Period for enrolling in Medicare (e.g., individuals whose employer-based insurance stopped, individuals who have lost Medicaid coverage, individuals who are leaving incarceration, or individuals in other special circumstances).
- Individuals must apply through the Social Security Administration (SSA).
- Coverage starts at the beginning of the month after an individual applies.
- Individuals who sign up for Medicare during the GEP may have a Part A and or B late enrollment penalty applied.
- More details on enrollment periods can be found at the National Center for Law & Elder Rights, Medicare Interactive, and Social Security.
This deadline is particularly important for individuals in Alabama, Arizona, Colorado, Illinois, Kansas, Kentucky, Missouri, Nebraska, New Jersey, New Mexico, South Carolina, Utah and Virginia who do NOT have premium-free Part A and are financially eligible for the Qualified Medicare Beneficiary (QMB) program. In these states (called “group payer” states), individuals without premium-free Part A coverage can acquire it by applying at SSA for “conditional” Part A during the GEP and then immediately applying with their state Medicaid office for QMB to pay the premium for Part A as well as B. If they miss the March 31 deadline, they must wait until the next year before they can apply for QMB. A Justice in Aging fact sheet explains the process and how it differs from other states (called “Part A buy-in” states) where individuals can apply for conditional Part A at any time of year.
2025 Update
As of January 1, 2025, California became a Part A buy-in state allowing low-income Californians eligible for QMB to apply for conditional Part A at any time in the year. Building on the lessons learned in California, a Justice in Aging issue brief provides advocates in group payer states with strategies to transition to a Part A buy-in state.
Medicare Advantage Open Enrollment Period (MA-OEP): January 1 – March 31
- During the MA-OEP, individuals enrolled in Medicare Advantage (MA) plans can:
- Drop their MA coverage and choose original Medicare with a Prescription Drug Plan (PDP), or
- Change from one MA plan to another, with or without prescription drug coverage.
- During the MA-OEP, individuals in Original Medicare cannot change their stand-alone Part D Plan or join an MA plan, unless they are within another plan enrollment period, such as:
- Their Initial Enrollment Period when they first become eligible for Part A or are new to Part B; or
- A Special Enrollment Period (SEP) for changing plans (e.g., for individuals who have lost Medicaid, individuals leaving incarceration, or individuals in other special circumstances).
- For enrollees without Medicaid or the Low-Income Subsidy (LIS) also known as Extra Help, the MA-OEP is the last opportunity until the annual election period (October 15-December 7) to change coverage during the year unless they qualify for a Special Enrollment Period (SEP).
New Special Enrollment Periods for People with the Low-Income Subsidy and Medicaid
In addition to the MA-OEP, individuals with LIS or who have Medicaid effective January 2025 now have additional SEPs to make changes on a monthly basis:
- Dropping a Medicare Advantage Plan or switching from one standalone Prescription Drug Plan to another standalone Prescription Drug Plan. Medicare enrollees with LIS or Medicaid have an SEP once per month to switch to a different Medicare stand-alone Part D drug plan or drop a Medicare Advantage plan (that has prescription drug coverage) and return to Original Medicare by enrolling in a stand-alone Part D drug plan. This SEP is available to individuals on LIS or Medicaid, whether partial-benefit Medicaid or full-benefit Medicaid. Individuals cannot use this SEP to switch from one Medicare Advantage plan to another Medicare Advantage plan.
- Switching Medicare Advantage Plans. Medicare enrollees with full Medicaid benefits, known as full-benefit dual eligibles – have an additional SEP that provides one opportunity each month to switch Medicare Advantage plans, but only if that plan is an integrated and aligned Dual Eligible Special Needs Plan (D-SNP). Integrated D-SNP plans are types of Medicare Advantage plans that meet specific requirements to provide coordination between Medicare and Medicaid benefits. A D-SNP is aligned with a person’s Medicaid managed care organization if their companies are related. For more information, including more detail on what it means for a plan to be integrated and aligned, see Justice in Aging’s fact sheet on the new SEPs and the “other special situations” in the special enrollment period section via Medicare.gov.
Dually eligible individuals can still switch from one Medicare Advantage Plan to another during MA-OEP and other enrollment periods. Their Medicare Advantage Plans do not have to be integrated and aligned. The integrated and aligned requirement only applies to the Integrated Care SEP.
No one is required to enroll in Medicare Advantage plans. Dually eligible individuals can choose to receive their Medicare benefits through Traditional Medicare, through a Medicare Advantage plan (including through a Special Needs Plan like a dual eligible special needs plan, also known as a D-SNP), through the Program for All-Inclusive Care for the Elderly (PACE) (when offered in their area), or through a state Medicaid-Medicare Plan (when offered in their area).
Medicare plan marketing is intense during both the fall enrollment period and the MA-OEP. The supplemental benefits that MA plans offer also make choosing a plan more complex and confusing. The MA-OEP is a good opportunity for advocates to urge Medicare enrollees to seek unbiased assistance from SHIP counselors to ensure that they are making appropriate choices, have access to their preferred providers, and are getting prescription drug coverage that meets their needs.
