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

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MAPD & Part D Various Enrollment Dates & Opportunities

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 Page 6.

Email us to discuss further and enroll.

There are six types of election periods for MAPD & Part D during which individuals may make enrollment requests.

The Initial Coverage Election Period (ICEP) 
When you turn 65

Understanding C & D Enrollment Periods

  • The ICEP is the period during which an individual newly eligible for MA 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
    EXAMPLES

The Annual Election Period (AEP) §30.1 

  • During the AEP, MA eligible individuals may enroll in or disenroll from an MA plan. The last enrollment request made, determined by the application date, will be the enrollment request that takes effect (refer to §60.1 for information on multiple transactions).
  • Beginning in 2011, the AEP is from October 15 through December 7 of every year. The AEP is also referred to as the “Fall Open Enrollment” season and the “Open Enrollment Period for Medicare Advantage AND Medicare prescription drug coverage” in Medicare beneficiary publications and other tools. CMS.gov  *  

     

     

MA and Part D Enrollment Periods
Brief SummaryAHIP Summary Open Enrollment PeriodsClick on image to enlarge –  Courtesy AHIP 

Get More Detail

Special Enrollment Periods – Chart from Medicare Interactive 

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

Understanding Medicare C & D enrollment periods Pub # 11219 for more detail.

Medicare Rights – 16 page pdf on Special Enrollment Periods for Advantage and Part D Plans

Medicare Managed Care Manual Chapter 2 *   Section 30 – Election Periods

All Special Election Periods (SEP);

  • Special election periods constitute periods outside of the usual IEP, AEP or MA OEP when an individual may elect a plan or change his or her current plan election.
    • Click here for detail in official technical Medicare Marketing Manual or simple plan English, Understanding Medicare C & D enrollment periods Pub # 11219  or see our section on materials & guides below, there are 36 various types of SEPs, including SEPs for dual eligibles, and for individuals whose current plan terminates, who change residence and who meet “exceptional conditions” as CMS may provide, consistent with §1851(e)(4) of the Act and §422.62(b) of the MA regulations.
    • check with us about special enrollment, like when you turn 65 or lose coverage at work.
    • See also Medicare & You – Link in Side Panel

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 (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:

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

5 comments on “Enrollment Dates for MAPD – Medicare Advantage

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

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