The difference between Anniversary Rule and AEP 

The first thing that we need to establish is that there is a significant difference between Annual Enrollment and Open Enrollment Period. Most Medicare beneficiaries often think that they are the same when it comes to purchasing Medigap policies, but actually, those two periods are quite different. 

Of course, there are also certain differences between the AEP, OEP, and Anniversary Rule which will be explained in this blog.

What is the difference between AEP and OEP?

Medicare Supplement Open Enrollment is different from Medicare Annual Election Period (AEP) and only applies to Medicare Supplement selection. AEP pertains to Medicare Advantage and Medicare Part D and occurs at the same time every year (from the 15th of November to the 7th of December). Many new beneficiaries mistakenly believe they can enroll in a Medigap plan and bypass health questions during AEP, but this is not true. Disenrolling from a Medicare Advantage plan during AEP allows you to enroll in Medicare Part D and Medigap, but you may need to undergo the underwriting process and may be denied due to pre-existing conditions. It’s essential to understand Medicare enrollment periods to avoid confusion and problems for seniors.

On the other hand, Medicare Supplement Open Enrollment is a six-month period that begins when you enroll in Medicare Part B. During this period, you may enroll in a Medigap plan without answering underwriting health questions. This is your guaranteed issue right, so long as you qualify based on your Medicare enrollment date. Outside of this period, answering health questions is standard practice, and your answers will determine if you’re admitted to the plan or not. You may apply for Medigap coverage at any time, but passing underwriting is crucial. The best time to apply for Medigap coverage without underwriting is during your Medicare Supplement Open Enrollment Period.

What To Do If I Miss My Open Enrollment Period?

There are a few rare situations where you can get a second Medigap Open Enrollment Period. If you retire and enroll in Medicare Part B, then go back to work and join your employer’s group health care coverage, you’ll get a second Open Enrollment when you retire again and enroll back into Medicare Part B. If you get Medicare due to a disability before 65, you’ll receive two Open Enrollment Periods. However, some states only offer limited Medigap options to those under 65, which is why a second enrollment period is crucial. 

However, if you miss this is a specific time frame when you can enroll in or change your Medicare Supplement plan without facing medical underwriting, which means insurers cannot deny you coverage or charge you more based on your health condition, you have other options. If you miss this window, and you have a severe health condition that causes a Medigap carrier to deny you coverage, you should consider some of the other possibilities.

One option is to consider enrolling in a Medicare Advantage plan, which provides an alternative way to receive your Medicare benefits. These plans usually include additional benefits such as prescription drug coverage and dental care, which are not covered by Original Medicare or Medigap plans. However, you will need to wait until the Annual Enrollment Period, which runs from October 15th to December 7th each year to enroll.

How Are Annual Open Enrollment and Medigap Anniversary Rule Different?

The Annual Enrollment Period (AEP) and Anniversary Rule are both related to health insurance, but they are different concepts.

The Annual Enrollment Period (AEP) is a yearly period during which individuals can make changes to their health insurance coverage. This period usually occurs between October 15 and December 7 each year, and during this time, individuals can switch from one Medicare Advantage plan to another, switch from Original Medicare to a Medicare Advantage plan, or enroll in or drop Part D prescription drug coverage. The changes made during the AEP typically take effect on January 1 of the following year.

On the other hand, the Anniversary Rule in the state of Missouri applies to individuals who are already enrolled in a Medicare Supplement insurance plan. The rule allows individuals to switch to the same Medicare Supplement plan but to a different carrier within 30 days of the anniversary date of their current plan. The anniversary date is the date that the individual’s Medicare Supplement coverage began.

So, while the AEP is a yearly period during which individuals can make changes to their Medicare coverage, the Anniversary Rule is a one-time opportunity for individuals to switch carriers of their Medicare Supplement plan.

Can Anniversary Rule Help Me Avoid Denying Coverage if I Miss OEP?

It can’t help you if you already don’t have a Medigap policy.  However, Missouri has an “anniversary rule” allowing for a two-month window each year for guaranteed-issue switching between Medigap insurers for those with the same plan level. Missouri also regulates how much insurers can charge under-65 enrollees, resulting in only slightly higher premiums than those charged to 65-year-olds. Medicare enrollees also have a chance to switch to lower-cost Medigap coverage when they turn 65.

Therefore, if you have missed your Medigap Open Enrollment which is your initial enrollment period you can enroll in Medigap policy any other time. However, you may be denied coverage by an insurer if you have some severe health conditions. So, it is recommended that if you have Original Medicare and want to purchase a Medigap policy, to do so when first eligible. Especially because during this specific period of time, you have a guaranteed issue right and no carrier can deny your application based on pre-existing medical conditions.

Final Thoughts 

In conclusion, it is essential for Medicare beneficiaries to understand the differences between the various enrollment periods and rules when it comes to purchasing Medigap policies. While the Annual Enrollment Period and Open Enrollment Period are often confused, they are distinct and apply to different types of coverage. The Medicare Supplement Open Enrollment Period is crucial for Medigap coverage, as it allows for guaranteed issue rights without answering underwriting health questions. If you miss this period, you may face denial of coverage or higher premiums based on your health conditions. While some states, such as Missouri, have an Anniversary Rule that allows for a one-time opportunity to switch to a different Medigap policy insurer, it is still recommended to enroll during the initial enrollment period to ensure guaranteed coverage. Finally, considering other options such as Medicare Advantage plans may be necessary if you miss the Medigap Open Enrollment Period or face denial of coverage.

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