MEDICARE SOLUTIONS

Medicare can feel complex, but knowing when you can enroll is key to avoiding penalties, securing the right coverage, and making changes as your healthcare needs evolve. Medicare offers several defined enrollment windows, each serving different purposes: the Initial Enrollment Period (IEP), Annual Enrollment Period (AEP), and Special Enrollment Periods (SEPs). For individuals who qualify for both Medicare and Medicaid (dual-eligible individuals), these timelines work a bit differently and offer even more flexibility.

Below is a guide to help you understand exactly when and how you can enroll.

The IEP is the first time most people can sign up for Medicare. You qualify for Medicare at age 65, or earlier if you have certain disabilities.

Your IEP lasts 7 months:

• 3 months before the month you turn 65
• Your birthday month
• 3 months after the month you turn 65

During the IEP, you can enroll in:

• Medicare Part A (hospital coverage)
• Medicare Part B (medical coverage)
• Medicare Part D (prescription drug coverage)
• A Medicare Advantage (Part C) plan if you prefer an all-in-one option

Failing to enroll in Part B or Part D when first eligible can lead to late enrollment penalties, unless you qualify for a Special Enrollment Period.

The AEP, also known as the Medicare Annual Open Enrollment Period, happens every year from:

During AEP, all Medicare beneficiaries can:

• Switch from Original Medicare to a Medicare Advantage plan
• Switch from Medicare Advantage back to Original Medicare
• Change from one Medicare Advantage plan to another
• Add, drop, or switch Part D prescription drug plans

Any changes you make during AEP take effect on January 1 of the following year.

AEP is the main opportunity for most people to review their coverage and adjust if:

• Their premiums increase
• Drug formularies change
• Their doctors change networks
• They want new benefits (dental, vision, hearing, etc.)

A Special Enrollment Period (SEP) allows you to sign up for or change Medicare coverage outside of IEP and AEP when certain life circumstances occur.

Common reasons someone may qualify for a SEP include:

• Losing employer health coverage
• Moving out of your plan’s service area
• Becoming eligible for Medicaid
• Being diagnosed with a chronic condition (qualifying for a Chronic Special Needs Plan, C-SNP)
• Enrolling in or losing eligibility for extra help/Low-Income Subsidy (LIS)
• Joining or leaving a skilled nursing facility or long-term care facility

SEPs vary in length—some last 2 months, some longer—depending on the qualifying event.

People who qualify for both Medicare and Medicaid are known as dual-eligible. They often have access to Dual Eligible Special Needs Plans (D-SNPs) through Medicare Advantage.

Dual-eligible beneficiaries have continuous SEP opportunities, meaning they can enroll in, switch, or drop a D-SNP once per quarter during the first three quarters of the year (Jan–Mar, Apr–Jun, Jul–Sep).
They may also make an additional change during the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31).

This flexibility exists because dual-eligible individuals may experience changing health-care or financial needs more often and benefit from plans tailored to low-income beneficiaries.

• Medicaid eligibility changes throughout the year
• D-SNPs are specifically designed to coordinate Medicare and Medicaid benefits
• Continuous enrollment helps ensure the beneficiary has the right benefits, provider access, transportation, dental/vision benefits, and prescription coverage
• No late enrollment penalties apply for dual-eligibles

Enrollment               Who It Applies            When It                                          What You 

Period                              To                                     Occurs                                              Can Do

IEP                                New Medicare           7 mth window                              Enroll in Parts 

                                         beneficiaries                 around age 65                               A, B, C, D

AEP                            All Medicare                     Oct. 15-                                   Change Medicare

                                      beneficiaries                         Dec. 7                                      Advantage or Part

                                                                                                                                                     D plans

SEP                             Anyone with a                   Various                               Enroll or Change Plans

                                qualifying life event                                                              outside  IEP/AEP 

Dual-Eligible          Individuals with             Once per                                    Enroll or switch

SEP                         Medicare + Medicaid     quarter (Jan-Sept)                 D-SNPs as needed

                                                                                         MA OEP 

Understanding Medicare enrollment timelines is essential for choosing the right coverage and avoiding penalties. Whether you're new to Medicare, reviewing your plan during AEP, adjusting due to life changes, or taking advantage of dual-eligible flexibility, knowing these windows empowers you to get the healthcare benefits you deserve. 

The Medicare Advantage market is undergoing a significant transformation as Aetna (a subsidiary of CVS Health) announces sweeping reductions in its plan offerings for 2026. The company plans to withdraw nearly 90 Medicare Advantage (MA) plans across 34 states and exit approximately 100 counties entirely, leaving its presence in 43 states — down from its previous coverage. 

In a market already facing headwinds, Aetna’s move underscores mounting pressures on insurers in the MA space:

• The pivots stem from rising medical utilization, increased cost pressures and shrinking federal reimbursement rates under the Centers for Medicare & Medicaid Services (CMS) for managed care plans.
   
• For example, in Maryland Aetna is reducing coverage to just three counties (Frederick, Harford and Montgomery) in 2026, meaning thousands of seniors are being notified that their current MA plan will no longer be offered.
   
• In New Hampshire, Aetna will cover only one county for its MA plan in 2026, dramatically narrowing its footprint. 

These changes translate into fewer choices for Medicare beneficiaries. Nationally, the number of non-Special Needs Plans (non-SNP MA/MAPD) is expected to drop by around 10 % in 2026 — from 3,719 to 3,373 according to industry-analysis. 

Multiple factors are converging:

• Government payments to MA plans are under sustained pressure — one analysis notes payments will have fallen ~20 % by 2026 relative to 2023.
   
• Insurers say medical cost trends, especially among older/sicker beneficiaries, have outpaced expectations, making some geographies unprofitable.
   
• Plans that allow broader provider access (such as PPOs) are being trimmed more heavily than tighter-network HMOs, since flexibility often comes with higher cost risk.  

Aetna itself acknowledges this environment: its October 1, 2025 release affirmed a continued commitment to MA, but cut the number of states served and emphasized focusing on sustainable member experiences. 

For Medicare-eligible individuals, this wave of plan exits means:

• If you are enrolled in an Aetna MA plan that’s being discontinued, you could lose your coverage as of Jan. 1 2026 unless you select a new plan. Aetna’s website states that if you do not choose a new plan by December 31 2025, you’ll default to Original Medicare.
   
• The choice of available plans in affected counties may shrink — fewer carriers or fewer plan options means seniors may face either higher premiums, narrower provider networks or fewer supplemental benefits.
   
• There’s a risk of disruption in care continuity (e.g., needing to change doctors, hospitals, pharmacies) if a plan exits your county and you must move.
   
• While some smaller/regional carriers may step into vacated markets, the transition could create confusion and require seniors to research and select new options during the open enrollment window (Oct. 15 – Dec. 7, 2025). 

The Aetna move is part of a broader recalibration. Other major players — including UnitedHealthcare — are also scaling back, reducing service areas or exiting less-profitable counties. 

From a policy perspective:

• Regulators will likely face pressure to monitor plan exits and ensure beneficiaries aren’t left uninsured or with only inferior options.
   
• For states with high provider cost structures (like Maryland), the exit of national carriers could raise concerns about access in rural or underserved counties.
   
• The shift suggests a recalibrated MA business model: insurers appear to be shifting away from broad growth toward focusing on better-managed risks (e.g., Special Needs Plans) where reimbursement is higher and care coordination stronger. 

If you’re currently enrolled in an Aetna MA plan (or any MA plan), consider these steps:

1. Check your plan status now: Confirm whether your current plan is being offered in your county for 2026. Aetna’s site and county-specific notices provide this information.
    
2. Review your options: During Annual Enrollment (Oct. 15–Dec. 7), compare other MA plans available in your area and weigh costs, provider access, supplemental benefits and network changes.
    
3. Understand fallback options: If your plan ends and you don’t enroll in another MA plan, you’ll revert to Original Medicare (Parts A/B) as of Jan. 1 2026 — plus you may need to add a Part D drug plan or Medicare Supplement.
    
4. Act promptly: Changes are coming and the earlier you review your choices, the better positioned you’ll be to secure a plan that fits your health care needs.
    
5. Seek professional help if needed: State Health Insurance Assistance Programs (SHIPs) or licensed agents can help you navigate the options and understand local network differences.

Aetna’s significant pull-back from the Medicare Advantage space marks a turning point in a market that until recently was seen as growth-oriented. The company — citing unsustainable cost pressures and reduced federal reimbursement — is refocusing its strategy, impacting beneficiaries across dozens of states.

One key development: UnitedHealthcare has publicly stated it will continue serving the Medicare Advantage market.

By coordinating the essential coverage of Medicare with the cost-sharing assistance of Medicaid, Dual Special Needs Plans ensure that beneficiaries can access extensive care, extra benefits, and critical support services with maximum convenience and zero out-of-pocket costs. 

For individuals who qualify for both Medicare and Medicaid, a Medicare Dual Special Needs Plan (D-SNP)—a specific type of Medicare Advantage plan—offers a powerful solution for comprehensive, coordinated, and often $0 cost healthcare. These plans are specifically designed to bridge the gaps between Medicare and Medicaid, providing robust benefits beyond Original Medicare. 

A critical factor for enrollment in a D-SNP is active eligibility for both Medicare (Parts A and B) and Medicaid. This status is referred to as being "dual-eligible."

• Medicare is generally for people aged 65 or older, or those with certain disabilities.
• Medicaid is a joint federal and state program for people with limited income and resources.

D-SNPs rely on your active Medicaid account to cover many of your out-of-pocket costs, such as deductibles, copayments, and coinsurance, which is why maintaining your Medicaid eligibility is essential to remain enrolled in the D-SNP.We offer a range of plans that can be customized to fit the unique needs of self-employed individuals.

One of the most attractive features of a Dual Special Needs Plan is the elimination of common medical costs, often resulting in $0 premium, deductible, and copays for a broad range of services. While specific benefits can vary by plan and location, an example of the comprehensive coverage offered may include: 

•  $0 Pay for Doctor's Visits: This includes primary care, specialist care, and virtual/telehealth visits.
• $0 Inpatient Hospital Care
• $0 Pay for Preventative Services: Such as annual physical exams and certain screenings.
• $0 Deductible for Pharmaceuticals: Includes Medicare Part D prescription drug coverage.
• Diabetes Supplies: Often includes $0 coverage for essential testing supplies and services.
• Diagnostic Services: Typically includes $0 copay for diagnostic radiology services (like X-rays).

D-SNPs frequently go above and beyond Original Medicare by including rich benefits to support overall wellness and quality of life:

Benefit Type / Specific Coverage:

Vision  -  $0 pay for eye exams and an allowance for routine eyewear, often up to $550 for lenses and contacts. 

Dental  -  $0 copay for preventative services (cleanings, exams, X-rays, and fluoride) and a generous allowance for comprehensive dental services, potentially up to $5,000 per year. 

Hearing  -  Coverage for hearing aids, with plans offering up to $3,200 toward devices and routine hearing exams. 

Daily Support  -  A flexible monthly credit for everyday needs, such as a food, Over-the-Counter (OTC), and utility bill credit of up to $418 monthly for qualifying members with chronic conditions. 

Transportation  -  Coverage for routine transportation, like up to 72 one-way trips annually, to and from plan-approved medical visits. 

Wellness  -  Access to various fitness programs (like SilverSneakers® or similar gym memberships). 

By coordinating the essential coverage of Medicare with the cost-sharing assistance of Medicaid, Dual Special Needs Plans ensure that beneficiaries can access extensive care, extra benefits, and critical support services with maximum convenience and zero out-of-pocket costs.