Medicare Enrollment Timelines and Procedures
An eligible individual may enroll in a Medicare Advantage plan a number of times. Each of these periods has been given an identifying name (and associated acronym). Though other periods are available, the following are most commonly used:
• Initial Election Period (IEP)-Also known as initial coverage enrollment period, the keyword is "initial" This period is when an individual initially becomes eligible for Medicare. Accordingly, an individual may elect to enroll in a Medicare Advantage plan when he or she first becomes entitled to both Part A and Part B of Medicare. The initial election period begins three months before, includes the month of, and ends three months after a person's birthday. This creates a seven-month in initial election period.
This is the same election period as the initial enrollment period of Medicare itself. In MA jargon, this period is known as the "aging in" period (when the enrollee turns 65) and allows the MA producer to enroll prospects who qualify under the IEP at anytime during the year. In other words, prospects within this initial period do not need to wait-coverage begins the first day of the birth month. The IEP rules are the same for all MA plans, regardless of whether they include prescription drug coverage. For those who are receiving Medicare disability benefits, the IEP for enrolling in an MA plan is seven months from the time that the individual receives Medicare disability benefits.
• Annual Coordinated Election Period (ACEP)- Also known as fall open enrollment, or annual enrollment period, the key word is "annual" This is the period every year during which Medicare beneficiaries can sign up for, drop, or change their enrollment in a Medicare Advantage or Part D plan. In previous years, this period was November 15th through December31; however, due to PPACA, it runs from October 15 through December 7 beginning in 2011.
During this annual enrollment period, beneficiaries can elect to remain in their current Medicare Advantage plan, change to a new MA plan, or drop out of Medicare Advantage and enroll in Original Medicare. Those who are enrolled in Original Medicare can switch to an MA plan during this time. Also during this time, beneficiaries can add, change, or drop prescription drug coverage. The member can make one change per year to any plan. A lock-in period applies whereby if an enrollee to an MA plan chooses to elect a plan during this period, he or she must stay in that plan until the next ACEP period.
Beginning in 2012, plans that obtained a " five-star" designation under Medicare's star rating system will be allowed to be sold at any time during the year.
• Medicare Advantage Disenrollment Period (MADP)- This is the period during which individuals can disenroll from a Medicare Advantage plan or an MA Prescription Drug plan and enroll in Original Medicare (either with or without a stand-alone PD plan). This period runs from January I through February 14 of each year. New coverage is effective the first day of the next month following the change. Part D coverage can be added or dropped, and a Medicare supplement policy can be purchased.
• Special Election Period (SEP)- SEPS are special periods (anytime) during which an enrollee is permitted entry into or allowed to discontinue enrollment in a Medicare Advantage plan and change his/her enrollment to another Medicare Advantage plan or return to Original Medicare. The person may enroll in an MA plan if he or she is recently disabled or begins receiving assistance from Medicaid and does not have to wait until the October 15 (annual enrollment) period.
In the event of the following circumstances, a SEP is warranted:
The MA plan in which the member is enrolled is terminated, which is called involuntary disenrollment- involuntary loss of creditable coverage.
The enrollee permanently moves out of the service area or continuation area of the MA plan.
The Medicare Advantage company offering the plan violated a material provision of its contract with the enrollee.
The enrollee meets such other material conditions as CMS may provide, such as an involuntary loss of creditable group coverage.
Enrollment is delayed because an employer's coverage or spouse's employer group health insurance coverage is being tenninated.
The individual experienced a recent disability.
The individual is receiving any assistance from Medicaid. This includes:
full dual eligibles;
partial dual eligib les (Medicare Savings Program enrollces);
beneficiaries residing in long-tenn care facilities; and
other qualifications relating to long-term care facilities, creditable coverage, US
(low-income subsidy) eligibility, Part D coverage, and other circumstances that give
CMS discretion to creatc a SEP.
• General Enrollment Period (GEP)- This is a little-used Medicare period from April I to June 30, with coverage effective July I for those who did not enroll in Part B at the time they became eligible for Part B.
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