here are five types of election periods during which individuals may make enrollment requests. They are:
- The Annual Election Period (AEP)
- The Medicare Advantage Open Enrollment Period (OEP)
- The Initial Coverage Election Period (ICEP)
- The Initial Enrollment Period for Part D (IEP for Part D)
- The Open Enrollment Period for Institutionalized Individuals (OEPI)
- All Special Election Periods (SEP)
Annual Election Period (AEP)
The Annual Election Period (AEP) occurs October 15 through December 7 of every year. The AEP is also referred to as the “Open Enrollment Period of Medicare Advantage and Medicare prescription drug coverage”. The last election made by a beneficiary will be the Plan effective on January 1st of the next year..
Medicare Advantage Open Enrollment Period (OEP)
Medicare beneficiaries who enrolled in a Medicare Advantage (MA) plans have an annual opportunity to prospectively disenroll from any MA plan and return to Original Medicare between January 1 and March 31st of every year. The effective date of a disenrollment request made using the MADP will be the first of the month following receipt of the disenrollment request. A request made in January will be effective February 1, and a request made in February will be effective March 1, etc. The Medicare Advantage Disenrollment Period no longer exists it is now known as OEP and does not provide an opportunity to join or switch MA plans.
Regardless of whether the MA plan included Part D drug coverage, MA enrollees using the MADP to disenroll from MA from January 1 through February 14 are eligible for a coordinating Part D SEP to enroll in a P(Prescription) D(Drug) P(Plan) at any time during the MADP and may request enrollment in a PDP during the same time frame of January 1 and March 31st. An individual may use this SEP to request enrollment in a PDP subsequent to having submitted a disenrollment request from the MA plan during the Medicare Advantage Disenrollment Period or may simply request enrollment in the PDP, resulting in automatic disenrollment from the MA plan. If the individual uses the coordinating Part D SEP to request enrollment in a PDP, the enrollment effective date is the first of the month following the PDP sponsor’s receipt of the enrollment request. Individuals enrolled in MA-only PFFS plans must request disenrollment from the MA-only plan in order to be eligible for this SEP, as enrollment in a PDP will not result in automatic disenrollment from the MA-only plan.
Initial Coverage Election Period (ICEP)
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 to both Medicare Part A and Part B and ends on the later of:
- The last day of the month preceding entitlement to both Part A and Part B, or;
- The last day of the individual’s Part B initial enrollment period.
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. Please call your plan Member Services if you have questions about the ICEP or contact us at (215)355-2121 .
Initial Enrollment Period for Part D (IEP for Part D)
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.
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. Please call our Member Services if you have questions about the IEP or contact us at (215)355-2121.
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. The OEPI ends two months after the month the individual moves out of the institution. Please call your plan’s Member Services, or contact us at (215)355-2121 if you have questions about the OEPI.
All Special Election Periods (SEP)
Special Election Periods constitute periods outside of the usual IEP, AEP or MADP when an individual may elect a plan or change his or her current plan election. As detailed below, there are various types of SEPs, including SEPs for dual eligible beneficiaries and for individuals whose current plan terminates, who change residence and who meet “exceptional conditions” as CMS may provide.
Depending on the nature of the particular special election period, an individual may:
- Discontinue an enrollment in an MA plan and enroll in Original Medicare
- Switch from Original Medicare to an MA plan
- Switch from one MA plan to another MA plan
Certain SEPs are limited to an enrollment or disenrollment request. Please call Member Services at your plan, if you have questions about the SEP and to find out if you qualify for an SEP. If you are a Total Benefit Solutions client already, please contact us at (215)355-2121 with questions about SEP’s.
Medigap or Medicare Supplement Plans
It’s important to understand the difference in a Medicare Supplement or Medigap plan. Medigap plans do not have annual open enrollment periods. The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period, because you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you’re 65 and enrolled in Medicare Part B (Medical Insurance). After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more.
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