What happens with Medicare in January?

The Medicare maze requires some new navigating in 2023 with added benefits and lower costs for some customers. Even the word “enrollment” has many Medicare meanings. What is the General Enrollment period for Medicare, and how is it different from Open Enrollment? The team at Blue Cross and Blue Shield of Kansas offers direct services and guidance through the maze to get the best healthcare options for you and your family. 

Medicare enrollment periods explained

As soon as the ball dropped on New Year’s Eve, two new enrollment periods started. One impacts those who missed their initial Medicare enrollment deadline, and the other applies to Medicare Advantage plan holders. At the same time, there are specific circumstances where enrollment is ongoing. Where do you fall on this enrollment rollercoaster? We’re going to simplify it for you. 

It’s essential to work with experts like the team at Blue Cross and Blue Shield of Kansas because missing your enrollment period can leave you with a lifetime of penalty fees. More than 776,000 people were paying the price in 2020. Let’s make sure you aren’t one of them in the future. 

Who is eligible to enroll in Medicare?

There are two categories a person can fall into to get Medicare coverage. 

  • People 65 and older, regardless of health conditions.
  • People under 65 with a disability, end-stage renal disease, or ALS

Initial Enrollment Period (IEP)

WHO THIS APPLIES TO: First-time Medicare enrollees

This is the first Medicare enrollment period for recipients as they become eligible. IEP lasts seven months, starting three months before a person turns 65, through the birthday month, and three months after. Social security recipients are automatically enrolled at 65. 

New changes in 2023 give IEP applicants coverage starting the month after they sign up, which accelerated coverage kickoff by several months.  

What happens if you miss the Initial Enrollment Period? Don’t take this lightly – if you simply forgot or didn’t know enough to enroll initially, you already have a penalty building for when you do enroll. Read on to see how to resolve the issue. 

Special Enrollment Period (SEP)

WHO THIS APPLIES TO: People who meet the criteria for special enrollment outside of other standard enrollment periods.

Qualified recipients can enroll outside more standard enrollment periods under unique sets of circumstances. In 2023, several new SEPs were added by the government in a sweeping Medicare reform bill

  • Those impacted by emergencies or disasters have six months after the emergency declaration ends to enroll. 
  • A six-month extension to cases when an employer or health plan made a reporting error to Medicare.
  • People who were incarcerated will have 12 months after release to enroll. 
  • Those who are terminating Medicaid coverage and switching to Medicare will have more options during the transition.
  • Any other “Exceptional Circumstances.” 

Those elements are in addition to the pre-existing SEP qualifying conditions.

Annual Enrollment Period (AEP)

WHO THIS APPLIES TO: Any current Medicare recipients, not first-time or late enrollees. 

The gathering of the Medicare masses happens annually from October 15 through December 7 each year. It’s open to any current Medicare recipient. Even if your first-time eligibility happens during this time frame, you’ll still be applying for an IEP and not taking part in the AEP. Your first AEP will be on the fall dates mentioned above AFTER your initial enrollment. 

This is the time to evaluate your finances, plan benefits, coverage gaps, and additional services needed. Recipients can make plan adjustments, such as: 

  • Join a Medicare Advantage Plan
  • Switch from Medicare Advantage to Original Medicare (Part A & Part B)
  • Choose a different Medicare Advantage Plan
  • Add or drop Part D

PENALTY ALERT: If any point in Medicare coverage changes, you go without a Part D prescription plan for more than 63 days, a 1% fee accumulates for every month you don’t have coverage. The fee is based on the national premium, which changes each year. This is a life-long penalty.

You do not have to participate in annual enrollment if you already get Medicare and don’t want to change your coverage. It is wise for every recipient to at least explore the options out there, as cost savings, cost increases, and plan coverage can change.

With so many changes for Medicare recipients in 2023 aimed to lower costs and provide added vaccination and prescription benefits, it’s important for those who can participate in GEP or MA OEP to know the new standards.

FACT: Your plan is required to send a Plan Annual Notice of ChangeThis will be mailed in September, so save the document for review and decision-making once AEP starts. 

General Enrollment Period (GEP)

WHO THIS APPLIES TO: Medicare-eligible people who didn’t enroll in the designated time frame. 

Each year from January 1 through March 31, a certain section of the Medicare crowd can make changes or enroll in Medicare Part B under stricter rules than the AEP.  

This is also the only annual opportunity for those who missed the IEP deadlines and don’t qualify for a SEP to get coverage. If you miss your IEP, you will pay an increased pre-determined penalty fee based on how long you wait. The more months that go by, the higher the fees will be. 

New in 2023, those who sign up during the GEP no longer have to wait until July 1 to have their plan take effect. It will now start on the first day of the month following the enrollment month. If you sign up on February 3, your coverage begins in March. 

NOTE: This does not include any aspect of Medicare Advantage Plans

Medicare Advantage Open Enrollment Period (MA OEP)

WHO THIS APPLIES TO: Medicare Advantage current members, not first-time enrollees.

While this period also runs in tandem with the GEP from January 1 through March 31, it’s different. When is Medicare Advantage open enrollment right for you? This only impacts those with a Medicare Advantage Plan, not those who wish to change to one from Original Medicare (see EAP for that).

What is Medicare Advantage (Part C)? Private Medicare-approved providers like Blue Cross and Blue Shield of Kansas offer bundled plans of insurance that includes Part A, Part B, and (usually) Part D. These plans offer more extensive options at competitive prices, but those options are vendor-specific.

The Blue Cross and Blue Shield of Kansas team offer extensive Medicare Advantage benefit plans in 26 Kansas counties with great value and transparent details. 

“We can’t fix the healthcare system overnight, but we can make getting access to affordable care more convenient and less stressful,” Matt All, President & CEO of Blue Cross and Blue Shield of Kansas, explains. “To do that, we’re taking a hard look at how we can make your experience better. We’re committed to using plain talk, not insurance speak, so you can feel more confident and empowered in your health.”

Additional benefits of a Medicare Advantage Plan can include:

  • Vision coverage
  • Dental plan
  • Hearing 
  • Meal deliveries
  • Counseling & caregiver support
  • Fitness

Medicare Advantage customers can only make one change during this enrollment period, and that decision is locked in through the end of the year. 

CONFUSED?: If this is making your head spin, call the Blue Cross and Blue Shield of Kansas customer service team now, and we’ll explain your options. 

Medicare Simplified: Frequently Asked Questions

Can I join a Medicare Advantage Plan during MA OEP?

No. The Medicare Advantage Open Enrollment is just for current Medicare Advantage customers. Part A and Part B customers can switch to a Medicare Advantage Plan from October 15  through December 7, 2023, during Annual Enrollment. 

What is the out-of-pocket cap for Medicare Advantage? 

In 2023, the cap increased to $8,300. That’s a government-capped limit, not necessarily your preferred plan’s cap, which could be lower. That cap doesn’t include prescription costs under Part D. 

Will the insulin price cap impact my plan?

Yes. Medicare Part D and Medicare Advantage policyholders won’t pay more than $35 per month for specific insulin products in 2023. Starting July 1, those with an insulin pump will also have a $35 cap on monthly insulin. This is in addition to updated vaccine coverage for Part A and Part D recipients.

Why are there Medicare penalties, and what parts are impacted?

Medicare is a delicate balance of premiums for the most healthy to the gravely ill, and the system’s foundation is built on everyone eligible signing up. Medicare Part A, Part B, and Part D have their own penalty structures, and while there’s no Medicare Advantage penalty, Part A and Part B are required to qualify for a MA plan, which defaults back to those same respective penalties. 

What is the Medicare Advantage Risk Adjustment Data Validation, and how does it impact my plan? 

The January 30, 2023 ruling has no impact on any of the Medicare Advantage Plans or policyholders. It’s “inside baseball” accountability between Medicare Advantage Providers and the Centers for Medicare & Medicaid Services (CMS). In short, the ruling hammers out specific reporting and accountability measures between Medical Advantage Organizations and CMS. 

Medicare enrollment help is here

Regardless of your situation, the Blue Cross and Blue Shield of Kansas plan experts want to guide you through the options during this critical enrollment period. Please don’t be embarrassed if you forgot, got confused, or avoided the inevitable. Medicare options through simplified and layman’s terms with compassionate patience are guaranteed when you call us at 866-627-6705 or schedule a virtual consultation

Leave a Reply