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When can one change or enroll in a Medicare Advantage Plan, Part D RxMedi Gap or Medicare Parts A & B ?

Latest changes and Information for 2012

 

AEP Change

The Annual Coordinated Election Period (AEP) runs from October 15 through December 7 each year.  During this time beneficiaries may change prescription drug plans, change Medicare Advantage plans, return to original Medicare and look into Medi Gap plans, or enroll in a Medicare Advantage plan for the first time.  Enrollment changes take effect on January 1.
Medicare Acronyms

Medicare & You
 

Medicare and you
Medicare and You
Join, switch or Drop Medicare Advantage
Part D Rx

Part D Application
Blue Cross
Blue Shield

 

 

Medicare Enrollment Periods
Understanding Enrollment Periods
Medicare Enrollment Periods
CA Extra Rules

 

Medicare Eligibility Tool
Medicare Eligibility Tool

 

Federal Guaranteed Issue Matrix
Medi Gap - Federal
Guaranteed Issue Matrix
CA Law - Loss of Part B

Blue Cross's
Blue Shield
Health Net
Guaranteed Issue Matrix

Initial Enrollment Period (IEP)
Initial Coverage Election Period ICEP
Available at specific times throughout the year for qualifying individuals such as those who are aging into Medicare (3 months before you turn age 65 to 3 months after the month you turn age 65) or are newly eligible for Medicare Part B.
questions.medicare.gov 

 

Open Enrollment Period (OEP)  
From January 1 until March 31, Medicare Advantage eligible individuals may make one enrollment request.

However, you are limited in the type of plan you can join. You can’t join or leave Medicare prescription drug coverage at this time. For example, if you have a Medicare Advantage plan with prescription drug coverage, you can only choose to join another Medicare Advantage plan that offers Medicare prescription drug coverage, or choose to return to the Original Medicare Plan and join a Medicare Prescription Drug Plan. If you don’t have Medicare prescription drug coverage, you can’t use this chance to get it. 

The Open Enrollment Period (OEP)  provides Medicare beneficiaries with one opportunity to enroll in, disenroll from, or change a Medicare Advantage plan.  Like the General Enrollment Period, the Open Enrollment Period extends from January 1 through March 31 each year.  Unlike enrollment in Part B, the change in Medicare Advantage enrollment or disenrollment becomes effective the month after the change is made.
Medicare Acronyms

General Enrollment Period (GEP) Medicare beneficiaries who did not enroll in Part B when they first became eligible for Medicare may elect Part B coverage during the General Enrollment Period, which extends from January 1 through March 31 each year.  Enrollment becomes effective on July 1 of the same year.
Medicare Acronyms
questions.medicare.gov

Special Enrollment Period (SEP)
Special Election Period SEP  
The following individuals qualify to enroll anytime throughout the year:
 Moved from another state within 60 days
 Dropped by an employer plan within 63 days
 Turned 65 in the past 3 months (or will turn 65 in the next 3 months)
 Newly eligible for Medicare Part B
 Qualify for some assistance through Medicaid

Special Enrollment Periods (SEP) allow beneficiaries to make an enrollment change outside of the GEP, the AEP, the OEP and the L-OEP. 
Medicare Acronyms

questions.medicare.gov/

 

PLEASE NOTE:
Eligible individuals may only enroll in one Medicare prescription drug plan at a time and may not also be enrolled in a Medicare Advantage Plan (HMO, PPO) at the same time, unless they are a member of a Medicare Private-Fee-For-Service plan or are enrolled in an 1876 Cost Plan which does not have Part D coverage built in.

If you are enrolled in a Medicare Advantage HMO or PPO plan without prescription drug coverage, you’ll be disenrolled if you join a Medicare Part D prescription drug plan.

 

The Medicare program limits when and how often you can change the way you get Medicare, or switch health plans. If you switch from one plan to another plan this counts as making a change. 
Generally, you can’t make any other changes during the year unless you meet special exceptions, such as if you move or if you have Medicaid coverage. Under certain circumstances, you will be able to enroll in or change your Medicare Advantage plan outside of the standard enrollment periods. The length of your Special Enrollment Period (SEP) and when your new coverage starts will vary. The plan, and in some cases, the Center for Medicare and Medicaid Services (CMS), will determine whether an SEP applies to you. Later in the year, from November 15 to December 31, anyone with Medicare can switch their way of getting Medicare to another way for the following year.
  Blue Cross

Rules on changing Medicare Advantage Plans
Medicare Website FAQ's

Medicare Enrollment Periods

Technical Links

Medicare Managed Care Manual
Chapter 2 - Medicare Advantage Enrollment and Disenrollment
Medicare Managed Health Care Manual

Chapter 3Marketing Guidelines

 

Instant Quotes
More Information!!! Medicare Residency?
Dental
Medi-Gap Plans for under 65
 

 

Disenrollment

Disruptive Behavior

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Some of the print screens below may not be authorized for viewing by the public---so don't look.  They are for Brokers Reference ONLY

Medicare Advantage Election Periods

Here's information on when you can change plans:

Medicare Enrollment Center
Health Net's Explanation
Aetna's Explanation
CA Health Advocates.org
Medicare Managed Care Manual Chapter 2 - Full Details on Medicare Advantage Enrollment and Disenrollment 164 pages

 

Medicare Election Periods

Election Periods and Ranking

Medicare Open Enrollment

When you can use Open Enrollment
When can you use Open Enrollment Medicare Advantage

 

Instant Medi Gap & Medicare Advantage Quotes

secure horizons.com/

It doesn't say anything about if you cancel, they won't enroll you or if you have medical problems.


Member Rights
secure horizons.com/

Who is eligible for membership in Freedom Blue PPO?
Anyone who meets the following criteria is eligible for membership:
You maintain Part A (Hospital) of Medicare and continue to pay your Part B (Medical) premiums.
If you are not entitled to Medicare Part A benefits, you can purchase Part A through the Social Security Administration, and you must continue to pay the Part A premium to remain eligible for Freedom Blue.
Your permanent residence is within the geographic service area of Freedom Blue PPO.
You do not have kidney failure requiring dialysis or kidney transplantation (End-Stage Renal
Disease [ESRD]), unless you were enrolled as a member of any commercial BC Life & Health
health plan at the time of diagnosis with no lapse in coverage

Page 4 blue cross ca.com

If I need to disenroll what happens to my health care coverage?
Your membership in BC Life & Health's Freedom Blue PPO is automatically renewed on a monthly basis. If you move out of California or decide that Freedom Blue is not right for you, you can disenroll from Freedom Blue. You can do this by writing to Freedom Blue, by going to your Social Security Office or by calling Medicare at 1-800-Medicare (1-800-633-4227).

For requests for disenrollment received by BC Life & Health Freedom Blue PPO by the last day of the month, your effective date of disenrollment will be the first day of the next month. For example, if we receive your disenrollment request on or before April 30th, your effective date of disenrollment will be May 1st. You will receive Medicare benefits through the traditional method of fee-for-service, unless you have enrolled in another Medicare Advantage
HMO, or if you decide to take advantage of our Medicare Supplement Conversion Option, your coverage will convert to the plan you choose. In either case, you will not be penalized by Medicare  in any way.


This might be in your Secure Horizons Agreement

I understand that enrollment in this plan is generally for the entire year. I may disenroll from Freedom Blue only at
certain times of the year, or under certain circumstances, by sending a written request to Freedom Blue Member
Services, the Social Security Office, the Railroad Retirement Board, or by calling 1-800-MEDICARE (TTY/TDD: 1-877-
486-2048). I understand that I must continue to receive all my health care from Freedom Blue providers until
BC Life & Health informs me of the effective date of disenrollment.

C. Effective date of coverage will normally be the first of the month following receipt of the completed application.
Please note: Individuals newly eligible for Medicare may apply up to three months prior to their eligibility date for
Medicare. Their enrollment date will be the same date as their Medicare effective date.
Individuals submitting an application during the Annual Open Enrollment in November must choose an enrollment effective date: December January bluecrossca.com

Technical Links

Rules on changing Medicare Advantage Plans Medicare Website

19 Page report on Part D & MA Plans ca health advocates.org

Summary from BC on Medi Gap Enrollment 2 Pages

Chapter 2 - Medicare Advantage Enrollment and Disenrollment 164 Pages

CMS Marketing Guidelines MA Plans 179 pages

 

Guidance for Eligibility, Enrollment and Disenrollment procedures for Medicare Advantage (MA) plans, including MA-PD plans, is provided in Chapter 2 of the Medicare Managed Care Manual. Similar guidance for 1876 Cost plans is provided in Chapter 17, Subpart D of the same manual.
.. http://www.cms.hhs.gov

.. CMS provides instructions for enrolling Medicare beneficiaries in Medicare Prescription Drug Plans (PDP's) in the Agency's PDP Guidance for Eligibility, Enrollment and Disenrollment.
.. http://www.cms.hhs.gov/

 

SPECIAL ELECTION PERIOD

A set time that a beneficiary can change health plans or return to Original Medicare, such as: you move outside the service area, your Medicare+Choice organization violates its contract with you, the organization does not renew its contract with CMS, or other exceptional conditions determined by CMS. The Special Election Period is different from the Special Enrollment Period (SEP). (See Election Periods; Enrollment; Special Enrollment Period (SEP).)

SPECIAL ENROLLMENT PERIOD

A set time when you can sign up for Medicare Part B if you didn’t take Medicare Part B during the Initial Enrollment Period, because your or your spouse were working and had group health plan coverage through the employer or union. You can sign up at anytime you are covered under the group plan based on current employment status. The last eight months of the Special Enrollment Period starts the month after the employment ends or the group health coverage ends, whichever comes first. Medicare.gov/glossary

CA Insurance Code §10192.11 (h) An individual shall be entitled to an annual open enrollment period lasting 30 days or more, commencing with the individual's birthday, during which time that person may purchase any Medicare supplement policy that offers benefits equal to or lesser than those provided by the previous coverage.

 

 

Up Advantage Plans Medi Gap Part D - Rx Dental Enrollment dates Under 65 Not in CA? Long Term Care Medicare Social Security Publications Site Map

Historical Information

You can enroll in Medicare when:
Medicare Enrollment Periods

If you get Medicare due to a disability, you can join during the three months before to three months after your 25th month of disability. You will have another chance to join three months before the month you turn age 65 to three months after the month you turn age 65 Medicare.Gov/FAQ

Situations
1. Part B effective date: You are eligible for Guaranteed Issue if you are (a) at least 65 years of age, or (b) if you are under age 65 and do not have End Stage Renal Disease; and you apply for an Anthem Blue Cross Medicare Supplement Plan prior to or during the six-month period beginning with the first day of the month of your Part B effective date. With your application, you must submit evidence that you have Medicare Parts A and B.
2. Disabled and receiving Medicare benefits prior to your 65th birthday: Upon your 65th birthday you will receive a 6-month Guaranteed Issue period beginning with the first of the month in which you reach age 65. With your application, you must submit evidence that you have Medicare Parts A and B.  (Anthem Application Page 15)

2011 Enrollment Changes
Enrollment Periods
anthem.com Page 15
See also CMS.gov

 

  

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This is not a complete listing of [Medicare Advantage and Part D] plans available in your service area.
For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov
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