The Medicare open enrollment period runs from October 15 through December 7 each year. During this time, beneficiaries have the opportunity to review and adjust their existing coverage. For those currently enrolled in a Medicare Advantage plan, this window allows them to switch back to traditional Medicare if they choose. In doing so, some will need to consider adding a supplemental plan to maintain comparable coverage. However, if they have never carried a supplement before, they may encounter differences in pricing and plan options. This process can be overwhelming and confusing—not only for beneficiaries trying to make the best choice but also for providers, such as home health agencies, who must navigate the implications of these changes for their patients.
During this period, patients are likely to have many questions, and it’s important to address them. If they are enrolled in Medicare Advantage, be prepared to explain how their chosen plan affects reimbursement and how your agency receives payment under that payer structure.
It’s important to be careful making direct recommendations or providing detailed technical advice. However, if patients ask about how their current coverage works with your home health agency, you can confidently explain the process. This may include outlining the steps your team takes to obtain authorizations and the requirements involved in securing approval for their care.
During the open enrollment period, patients may make coverage changes that you won’t necessarily know about right away. In fact, even after January 1, there’s a chance you still may not have full visibility into their updated plans. For this reason, it’s strongly advised that throughout the first quarter of 2026, you perform Medicare eligibility checks on all active patients who are eligible for Medicare at least once a week, until the quarter concludes.
Patients enrolled in Medicare Advantage have an additional open enrollment window from January 1 through March 31, during which they can switch from one Medicare Advantage plan to another. This means that the process doesn’t necessarily end on December 7. It’s important to continue verifying eligibility for these patients so you can stay up to date on the plans they are actively enrolled in.
With that said, simply checking eligibility is not sufficient. If you determine that a patient is enrolled in a Medicare Advantage plan, you must also confirm directly with that plan to ensure the patient is still an active member before accepting them. Keep in mind that receiving an authorization does not automatically guarantee the patient’s enrollment status, so it’s essential to proceed with caution.
Keep in mind that patients with Medicare Advantage coverage can switch plans during the first quarter of the year. In addition, if they decide to move from their current Medicare Advantage plan to another that has a five-star rating, they are allowed to make that change at any time during the year.
It is strongly advised that you continue performing eligibility checks on a regular basis, even beyond the first quarter, since patients may still make coverage changes. Remember that if the most current payer information does not appear during verification, there may be limited flexibility in securing payment, but only if you maintain proper documentation of the eligibility records from each check. Even then, payment is not always guaranteed, so thorough and consistent recordkeeping is essential.
Navigating the details of which plan a patient is enrolled in and what benefits they have can be challenging. However, it’s necessary to stay diligent, as nearly 60% of all Medicare beneficiaries are now enrolled in a Medicare Advantage plan, making it an increasingly significant part of patient care and reimbursement.
At Healthcare Provider Solutions, we have a dedicated credentialing and contracting department ready to assist you. If you need support with Medicare Advantage billing for patient services, or if you have questions about credentialing or securing Medicare Advantage contracts for your agency, we encourage you to reach out to us.
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