Medicare AEP or OEP – What’s the Difference?

As I made my most recent Medicare presentation, I smiled to the familiar comment: “Why do they have to make this so complicated for old people”? This is coming from a PhD scientist, by the way. Like anything else, if it is your job, it seems easy. But if I were to look through the microscope or at the myriad of documents in his profession, I would be lost.

This time of year can be particularly confusing to seniors and their helpers. It starts with the AEP or Annual Election Period for Medicare. This runs from October 15th to December 7th each year.

During this time Medicare beneficiaries have a series of options as follows:

1) Enroll in, change or drop Medicare Part D Prescription Drug plans

2) Change from Original Medicare to a Medicare Advantage Plan.

3) Change from a Medicare Advantage Plan back to Original Medicare.

4) Switch from one Medicare Advantage Plan to another Medicare Advantage Plan, with or without a drug plan included

Any changes elected during this period will be effective on the following January 1.

This is to be contrasted with the Medicare Advantage Open Enrollment Period (OEP) that runs from January 1 to March 31 each year. This period allows beneficiary to make a change only if they are currently enrolled in a Medicare Advantage Plan. The allowed changes are:

· Switch from one Medicare Advantage Plan to another

· Disenroll from a Medicare Advantage Plan and return to Original Medicare

· If you have a Medicare Advantage with Prescription Drug Plan, you could switch to original Medicare and join a separate Medicare Prescription Drug Plan

The biggest distinction is that the current period applies only to people that are currently enrolled in a Medicare Advantage Plan. Changes will be effective on the first day of the month following receipt of the request.

Should one disenroll from a Medicare Advantage Plan within 12 months of joining the Medicare Advantage Plan, it is possible to also purchase a Medigap or Medicare Supplement Plan without underwriting. It is important to note that generally speaking this is a one-time opportunity. Should one make the change and return to Original Medicare after the first 12 months, the insurance company may require the applicant to answer health questions in order to qualify for a Supplement or Medigap plan.

The challenge becomes that one never really knows how good the plan is until it’s time to use it. So if you don’t have much usage in the first year, you might not really know how well the plan works. Taking advantage of the plan benefits in the first year is probably one of the best tests to see how the plan works.

Another confusing feature of Medicare is the Preventive Benefits. There are distinctions between these benefits.

The “Welcome to Medicare” benefit is only allowed once and must be completed within 12 months of in Medicare Part B. This exam is targeted to determine the current state of an individual’s medical and social health history as they relate to overall health. It may include a questionnaire that checks for any cognitive impairment, upon request. If the provider accepts Medicare assignment, there is no cost. If the provider orders additional test or services or any other items not covered by Medicare, there will be a charge.

The Medicare website explains the Annual Wellness benefit: “wellness visits are available once per year after the second year after an individual enrolls in Medicare Part B. These visits serve the same purpose as the “Welcome to Medicare” visit but include any health history updates, detection of any cognitive impairment, personalized health advice, a list of any risk factors one may have and treatment options, and a screening schedule for preventive services. If your provider accepts Medicare assignment, coinsurance and the Part B deductible may apply if the provider performs additional tests or services whether covered or not covered by Medicare during the same visit. https://www.medicare.gov/coverage/yearly-wellness-visits.

Annual physical examinations are generally not covered by Medicare but a host of preventive and screening services are available at little or no cost. “.

The Medicare Advantage Exception: Most Medicare Advantage (Part C) plans include annual physical examinations along with the preventive and screening services on the checklist mentioned above.

A good summary of the Medicare preventive services can be found here: https://www.ncoa.org/wp-content/uploads/NY-Preventive-Benefits-Paycheck.pdf.


Margaret R. Beck

Margaret Beck CLU, ChFC, CEBS started her insurance practice in Redding in 1978. She is the founder of Affiliated Benefit Services where businesses and individuals are assisted in choosing proper products, compliance with complex benefit laws and claims issues once coverage is placed.

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