Medicare AEP vs OEP: What’s the Difference?

As if Medicare weren’t confusing enough, everywhere you look there are confusing acronyms! These two are particularly important to not confuse because they affect when you can change your plans based on your current enrollment. So, let’s jump right in.AEP is the Annual Enrollment Period, which runs every year from October 15th to December 7th. It is during this time that plan benefits for the upcoming year are announced (read about your Annual Notice of Change letter). With Medicare Advantage and Part D plans, premiums could increase, benefits can change, and prescription drug formularies can be changed. The announcement of these changes gives Medicare beneficiaries the option to consult with an independent representative to find out if their plan is still the best for their medical and financial needs. Changes made during this time frame are effective on January 1st of the next year. What can Medicare beneficiaries change during the Annual Election Period? You can…

• Switch from one Medicare Advantage plan to another
• Switch from an Advantage plan to Original Medicare (enrolling in a Prescription Drug Plan is recommended)
• Switch from Original Medicare to a Medicare Advantage Plan (also known as a Part C or MA Plan)
• Join, drop or switch a Prescription Drug Plan (also known as Part D Plan)

OEP is the Open Enrollment Period, which takes place every year from January 1^st – March 31^st. To make changes during this enrollment period, you must already be enrolled in a Medicare Advantage plan. (The new OEP is replacing the Medicare Advantage Disenrollment Period, which used to be January 1 – February 14.)  You may consider taking advantage of this election period if your provider network changes or your coverage isn’t as comprehensive as you’d like. Changes to Medicare plans made during this time will take effect the 1^st of the following month of applying. For example, changes made in March will be effective April 1^st. What can Medicare Advantage beneficiaries change during the Open Enrollment Period? You can…

• Switch from one Medicare Advantage plan to another
• Switch back to Original Medicare (enrolling in a Prescription Drug Plan is recommended)
• Join, drop or switch a Prescription Drug Plan (also known as Part D Plan)

While these are the two main election periods during the year, keep in mind there are many scenarios that could qualify you for an SEP, or Special Election Period. (I know, another acronym!) Some examples that qualify you for special enrollment are:

• You have a Medicare Advantage Plan and the insurance company left your service area
• Your Medicare Advantage Plan has been discontinued or is leaving Medicare
• You have moved out of your Medicare Advantage Plan’s service area

We know these rules are confusing. We recommend that you speak to a licensed insurance agent that specializes in Medicare to make sure you know all your options and are getting the most from your entitled benefits. Contact us today for a review of your plan benefits, to compare the cost of plans, or to help with enrollment.