MAPD & Part D Various Enrollment Dates & Opportunities

 

There are only certain times that you can enroll in various Medicare Advantage, Rx and Medi Gap Plans.  The Federal & State Governments and Insurance Companies need to collect premiums in order to pay claims. See our webpage on Medical Loss Ratio.   These plans are guaranteed issue, when you enroll at the right time.  Thus, no matter how sick you are, they must accept you!  They would like to collect some premium before paying out claims.   Even then, a lot of plans don’t collect enough money and it comes from taxes or somewhere.   

It can get very confusing as Medicare Advantage Plans, Part D and Medi Gap Supplements may have different dates, double check!

Yes, we know that some of the explanations below are not in plain English and appear complex…  We are working on better ways to explain it.  One simple way is to look at for example the Blue Shield MAPD Paper Application.

Email us to discuss further and enroll.

 

Check out the various guaranteed enrollment times  below for MAPD & Part D during which you can disenroll or transfer  and it’s guaranteed issue, no pre-X

NEW Open Enrollment Period January 1 through March 31

The Annual Election Period (AEP) §30.1 

  • AEP – Annual Enrollment is from  October 15 through December 7 every year.    Medicare Advantage eligible individuals may enroll in or disenroll from a Medicare Advantage plan,  such  as:
  • The last enrollment request made, determined by the application date, will be the enrollment request that takes effect. CMS.gov  *

When you turn 65

The Initial Coverage Election Period (ICEP)

Understanding C & D Enrollment Periods

  • The ICEP (Initial Enrollment Period) is the period during which an individual newly eligible for Medicare Advantage  may make an initial enrollment request to enroll in an MA plan. This period begins three months immediately before the individual’s first entitlement (Turning 65) to both Medicare Part A and Part B and ends on the later of:
  • The initial enrollment period for Part B is the seven (7) month period that begins 3 months before the month an individual meets the eligibility requirements for Part B, and ends 3 months after the month of eligibility.   See 42 CFR 407.14 for additional information.
  • Once an ICEP enrollment request is made and enrollment takes effect, the ICEP election has been used.   Section 30.2Understanding Medicare Enrollment Periods # 11219 *
  • Yes, I know this is all very complicated!   Email us or post your specific question below.
  • EXAMPLES

Anthem Blue Cross Authroized agent

Authorized Blue Cross Anthem Agent # GFKGQSJSRZ
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Instant Enrollment & Full Information

Click here to set a phone, skype or face to face complementary consultation 

Blue Shield Authorized Agent
No extra charge to you -
Learn more and enroll online

Blue Shield Logo & Enroll

Paper Application
MAPD Medicare Advantage

* Short Form - Transfers  65 Inspire, Plus, Choice & Trio

Medi Gap  Paper Application

set a phone, skype, Zoom or face to face complementary consultation

Get Plan Documents 
Be sure though to use THIS link to enroll, so we get paid for helping you!

Steve Video @ Blue Shield Headquarters
steve at blue shield video

The Open Enrollment Period for Institutionalized Individuals (OEPI)

  • The OEPI is continuous for eligible individuals. For purposes of enrollment under the OEPI election period, an institutionalized individual is defined as an individual who moves into, resides in, or moves out of an institution, as defined in §10. The OEPI ends two months after the month the individual moves out of the institution.  Medicare Managed Care Manual § 30.3  * 

Initial Enrollment Period for Part D Rx

(IEP for Part D)  §30.2.1 

  • The Initial Enrollment Period for Part D (IEP for Part D) is the period during which an individual is first eligible to enroll in a Part D plan. In general, an individual is eligible to enroll in a Part D plan when he or she is entitled to Part A OR is enrolled in Part B, AND permanently resides in the service area of a Part D plan. Ultimately, CMS provides a part D eligibility effective date and maintains it in CMS systems.
  • At the beginning of the Medicare prescription drug coverage program, all current Part D eligible individuals had an IEP for Part D that began on November 15, 2005, and ended on May 15, 2006.   During the IEP for Part D, individuals may make one Part D enrollment choice, including enrollment in an MA-PD plan.
  • Generally, individuals will have an IEP for Part D that is the same period as the Initial enrollment Period for Medicare Part B.
    • The initial enrollment period for Part B is the seven (7) month period that begins 3 months before the month an individual meets the eligibility requirements for Part B, and ends 3 months after the month of eligibility. See 42 CFR 407.14 & §30.2.1  for additional information. 
    • Click for EXAMPLES:

Special, Annual & Initial Enrollment Periods 

Medicare Advantage & Rx Special Enrollment periods exceptions

Medicare Interactive - Rights to Special Enrollment

Plain English Medicare.Gov  Special Enrollment periods

PDP Part D Rx

Understanding Medicare Advantage & Rx Enrollment Periods Publication # 11219
MAPD & Rx Drug Plan Enrollment Periods

Official Details & Rules from
Medicare Managed Care Manual Chapter 2 Enrollment and Disenrollment

All Special Election Periods (SEP);

  • Special election periods constitute periods outside of the usual times when an individual may elect a plan or change his or her current plan election.

How the Medicare Advantage Application  typically asks the "Special" Enrollment Period questions:

  1. I am new to Medicare.
  2. It's Open Enrollment October 15th through December 7th
  3. I am enrolled in a Medicare Advantage plan and want to make a change during the Medicare Advantage Open Enrollment Period (MA OEP).
  4. I recently moved outside of the service area for my current plan or I recently moved and this plan is a new option for me. I moved on (insert date) –––––––––––.
  5. I recently was released from incarceration. I was released on (insert date) –––––––––––.
  6. I recently returned to the United States after living permanently outside of the U.S. I returned to the U.S. on (insert date) –––––––––––.
  7. I recently obtained lawful presences status in the United States. I got this status on (insert date) –––––––––––.
  8. I recently had a change in my Medicaid (newly got Medicaid, had a change in level of Medicaid assistance, or lost Medicaid) on (insert date) –––––––––––.
  9. I recently had a change in my Extra Help paying for Medicare prescription drug coverage (newly got Extra Help, had a change in the level of Extra Help, or lost Extra Help) on (insert date) –––––––––––.
  10. I have both Medicare and Medicaid (or my state helps pay for my Medicare premiums) or I get Extra Help paying for my  Medicare prescription drug coverage, but I haven’t had a change.
  11. I am moving into, live in, or recently moved out of a Long-Term Care Facility (for example, a nursing home or long-term care facility). I moved/will move into/out of the facility on (insert date) –––––––––––.
  12. I recently left a PACE program on (insert date) –––––––––––.
  13. I recently involuntarily lost my creditable prescription drug coverage (coverage as good as Medicare’s). I lost my drug coverage on (insert date) –––––––––––.
  14. I am leaving employer or union coverage on (insert date) –––––––––––.
  15. I belong to a pharmacy assistance program provided by my state.
  16. My plan is ending its contract with Medicare, or Medicare is ending its contract with my plan.
  17. I was enrolled in a plan by Medicare (or my state) and I want to choose a different plan.  My enrollment in that plan started on (insert date) –––––––––––.
  18. I was enrolled in a Special Needs Plan (SNP) but I have lost the special needs qualifications required to be in the plan. I was disenrolled from the SNP on (insert date) –––––––––––.
  19. I was affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency (FEMA). One of the other statements here applied to me, but I was unable to make my enrollment because of the natural disaster

MA and Part D Enrollment Periods
Brief Summary

Click on image to enlarge –  Courtesy AHIP

AHIP Summary Open Enrollment Periods

 

COVID 19 SEP Special Enrollment

A special enrollment period available for beneficiaries who were eligible for — but unable to make — an election because they were affected by the COVID-19 pandemic.  See May 5th letter from CMS with details  

 

 

The Medicare Advantage Open Enrollment Period ( MA OEP)

  • During the MA OEP, Open Enrollment MA plan enrollees customers may:
    • enroll in another MA PD plan or disenroll from their MA plan and return to Original Medicare.
      • Individuals may make only one election during the MA OEP.:
  • Who can use the MA OEP: MA OEP occurs:
    Individuals enrolled in MA plans as of January 1 January 1 – March 31
    New Medicare beneficiaries who are enrolled in an MA plan during their ICEP (Initial Coverage Election Period) The month of entitlement to Part A and Part B – the last day of the 3rd month of entitlement
  • Individuals may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MAPD or MA-only plans can switch to:
    • MA-PD (Medicare Advantage)
      • MA-only
      Original Medicare (with or without a stand-alone Part D plan)
      The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.
  • NOTE:
  • The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join a MA PD plan. It also does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone Part D plans.  Medicare Managed Care Manual Chapter 2 *   Section 30 - Election Periods   CA Health Advocates.org  * 42 CFR §§ 422.62 & 422.68  *  Medicare & You - See link in Side Panel * 

You have the opportunity to make one change to your  health coverage during the annual Medicare Advantage Open Enrollment Period.

FAQ's 

What type of plan can you switch to during the annual Medicare Advantage Open Enrollment Period?

During this time, you can:

Switch to another Medicare Advantage plan. (You choose a plan that covers prescription drugs or one that does not cover prescription drugs.)

Disenroll from an MAPD plan and obtain coverage through Original Medicare.

You can apply for Medi Gap, but it may not be guaranteed issue and require underwriting.  If that's your plan, get approved for Medi Gap FIRST!!!

If you choose to switch to Original Medicare during this period, you have until March 31 to join a separate Medicare prescription drug plan to add drug coverage.   We are not interested in writing people though who wait till the last minute.  If that's your plan please find another agent or go direct to Medicare.Gov  Things get lost...

When will your membership end?

Your membership will end on the first day of the month after you enroll in a different Medicare Advantage plan or we get your request to switch to Original Medicare. If you also choose to enroll in a Medicare prescription drug plan, your membership in the drug plan will begin the first day of the month after the drug plan gets your enrollment request.    Evidence of Coverage  §2.2 page 240Page 52 Medicare Manual42 CFR 422.62(a)(3)  *   insuremekevin.com/new-medicare-advantage-open-enrollment-period-for-2019

New MAPD Open Enrollment Period  1.1 to 3.31

CA Health Advocates.org

Medicare & You - See link in Side Panel

12 comments on “Enrollment Dates for MAPD – Medicare Advantage

  1. I turned 65 a while back.

    I just enrolled in Part B Outpatient in May.

    Can I enroll in a Part D Rx plan for September?

    I retired and my employer group plan ended in May.

    Is there ANY way I can get around the 2 month limit?

    • Unfortunately, I don’t see new enrollment in Part B as a qualifying event on the Blue Cross Part D Rx Application. Let me check further.

      Part D Enrollment reasons

      2 months part d

      2 months rx

      2 months group plan

      see above to links to Medicare Rights & Medicare Publication 11219 for our source documents

  2. Is there a guaranteed issue SEP for Medicare Advantage signup for 60 days after returning to the USA from having lived overseas?

  3. Aetna medicare PPO has not been working out for me and lacks providers. Am I able to switch to Anthem ?

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