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Information for those who counsel people
with Medicare
Understanding Medicare Enrollment Periods
August 2015
Session Objectives
This session will help you explain enrollment periods for Medicare Parts A and B Medigap (Medicare Supplement Insurance) policies Medicare Prescription Drug Plans (Part D) Medicare Advantage Plans (Part C)
August 2015 Understanding Medicare Enrollment Periods 2
Lesson 1—Medicare Enrollment Overview
Medicare Choices Medicare Part A and Part B Enrollment Periods Changes to the Social Security Retirement Age Medicare Enrollment for Immigrants Medicare Enrollment for U.S. Citizens Living
Abroad
August 2015 Understanding Medicare Enrollment Periods 3
Understanding Medicare Enrollment Periods 4
Medicare Enrollment Overview
Health insurance for 3 groups of people• 65 and older• Under 65 with certain disabilities• Any age with End-Stage Renal Disease (ESRD)
Medicare enrollment varies• By your age• If you’re receiving Social Security or Railroad Retirement
benefits• By your employment status
August 2015
Understanding Medicare Enrollment Periods 6
Your Medicare Coverage Choices
Original Medicare
Part AHospital
Insurance
Part BMedical
Insurance
You can add
Medicare Supplement
Insurance (Medigap)
Policy
Part DPrescription
Drug Coverage
or Medicare Advantage Plan
Part CCombines Part A and
Part BMay include or you may add
Part DPrescription Drug Coverage
(Most Part C plans cover prescription drugs. You may be able to add drug coverage to
some plan types if not already included.)
August 2015
Understanding Medicare Enrollment Periods 7
Medicare Parts A and B Enrollment forPeople 65 and Over
Initial Enrollment Period (IEP) General Enrollment Period (GEP) Special Enrollment Period (SEP)
August 2015
Change to Social Security Retirement Age
Before 1983 the eligibility age for Social Security and Medicare were both 65
Before 1983
Eligibility Age for Medicare 65
Full Social Security Retirement Age
August 2015 Understanding Medicare Enrollment Periods 8
Social Security & Medicare Enrollment Ages
Since 1983
Eligibility Age for Medicare 65
Full Social Security Retirement Age
Enrollment isn't automatic if you’re not getting Social Security
Some people don’t know they need to sign up for Part A, even if they don’t want Part B
Source: www.socialsecurity.gov/ retire2/agereduction.htmAugust 2015 Understanding Medicare Enrollment Periods 9
Understanding Medicare Enrollment Periods 10
Enrolling in Medicare—Automatic
Automatic enrollment for those receiving• Social Security benefits• Railroad Retirement Board benefits
Initial Enrollment Period Package • Mailed 3 months before
65 or 25th month of disability benefits
• Includes your Medicare card
August 2015
Understanding Medicare Enrollment Periods 11
Enrolling in Medicare— When It’s Not Automatic
Apply 3 months before you turn 65• Don’t have to be retired
If you’re not automatically enrolled• You need to enroll with Social Security
Visit socialsecurity.gov, or Call 1-800-772-1213, or Visit your local Social Security office
• If retired from a Railroad, enroll with the Railroad Retirement Board Call your local RRB office or 1 877 772 5772‑ ‑ ‑
August 2015
Understanding Medicare Enrollment Periods 12
Initial Enrollment Period (IEP)
Your 7-month Initial Enrollment Period • Starts 3 months before your 65th birthday• Includes the month of your 65th birthday • Ends 3 months after your 65th birthday
If you sign up during your IEP, there is no penalty The age for full Social Security is going up• But the age for Medicare is still 65
You need to sign up for Part A at 65, even if you don’t want Part B, if you aren’t getting Social Security
August 2015
Understanding Medicare Enrollment Periods 13
Initial Enrollment Period
No DelayIf you
enroll in Part B
3 months before
the month
you turn 65
2 months before
the month
you turn 65
1 month before
the month
you turn 65
Coverage starts
First day of your birthday
month
First day of your birthday
month
First day of your
birthday month
Delayed StartThe
month you
turn 65
1 month after
the month you turn
65
2 months after the month
you turn 65
3 months after the month
you turn 65
The month
following the
month you
enrolled
The 2nd month
following the month
you enrolled
The 3rd month
following the
month you
enrolled
The 3rd month
following the
month you
enrolled
August 2015
Understanding Medicare Enrollment Periods 14
Enrolling During the General Enrollment Period
General Enrollment Period (GEP) • For people who didn’t sign up for Part B (or premium
Part A) during their Initial Enrollment Period• Occurs January 1 through March 31 annually• Coverage starts July 1
May have to pay a lifetime Part B penalty• 10% for each 12-months eligible but not enrolled• Limited exceptions
August 2015
Understanding Medicare Enrollment Periods 15
Enrolling During theSpecial Enrollment Period
There are few Special Enrollment Periods (SEP) for Medicare Parts A and B• Most people don't qualify for an SEP
Must have group health plan coverage based on active, current employment of you or your spouse• Not COBRA, retiree coverage, long-term workers’ compensation or Veterans
Affairs coverage
Can enroll• Anytime still covered by group health plan, or
• Within 8 months of the loss of coverage or current employment, whichever happens firstAugust 2015
Medicare Enrollment for Immigrants
An immigrant may purchase Medicare Part A and/or Part B if he or she meets all of these criteria• 65 or older• Lawfully admitted for permanent residence• Have lived in the U.S. without a break for the 5-year period
immediately before the month they file for enrollment
August 2015 Understanding Medicare Enrollment Periods 16
Medicare Enrollment for U.S. Citizens Living Abroad
Medicare enrollment rules apply to citizens living abroad Medicare generally only covers care received in the U.S.
August 2015 Understanding Medicare Enrollment Periods 17
You live abroad and Enrollment Considerations
You turn 65 and are getting Social Security benefits.
You are automatically enrolled in Medicare Part A. You must proactively enroll in Medicare Part B.
If you don’t take Part B when you are first eligible, you may only apply for Part B during the General Enrollment Period (January 1 through March 31) and you may have to pay higher premiums.
You’re over 65 and are eligible for Social Security benefits but you’re not yet taking them.
You may file an application for Social Security benefits and Part A.
You’ll have to file for Medicare Part B during the General Enrollment Period (January 1 through March 31) and you may have to pay higher premiums.
You’re not eligible for Social Security benefits and you’ve just turned 65.
You must live in the U.S. to enroll in Medicare Part B.
You’re first eligible to enroll in Part B the month you return to the U.S. to establish your new residence. You won’t have to pay a higher premium if you enroll in Part B within the first 4 months of your return to the U.S.
Check Your Knowledge—Question 1
For people born in 1960 and later, the full Social Security retirement age isa. 62 yearsb. 65 yearsc. 67 yearsd. 70 years
August 2015 Understanding Medicare Enrollment Periods 18
Check Your Knowledge—Question 2
If you enroll in Part B during the General Enrollment Period (January 1 – March 31) your coverage will start ona. The first day of the
month after you enrollb. April 1c. May 1d. July 1
August 2015 Understanding Medicare Enrollment Periods 19
Check Your Knowledge—Question 3
Which of the following is not a criteria for an immigrant to purchase Medicare Part A and/or Part B? He or she musta. Be 65 or olderb. Must have blood relative
that’s a legal U.S. citizenc. Be lawfully admitted for
permanent residenced. Have lived in the U.S. without
a break for the 5-year period immediately before the month they file for enrollment
August 2015 Understanding Medicare Enrollment Periods 20
Lesson 2—Medicare Enrollment Based On a Disability
Qualifying for Medicare Based on a Disability Medicare Enrollment for People With a
Disability Retroactive Medicare Coverage Medicare & End-Stage Renal Disease (ESRD)• Enrollment Considerations• Rules for ESRD coverage
August 2015 Understanding Medicare Enrollment Periods 21
Understanding Medicare Enrollment Periods 22
Qualifying for Medicare Based on Disability
Medicare usually begins after getting Social Security Disability Insurance (SSDI) for 24 months• Unless you have Amyotrophic Lateral Sclerosis
Medicare begins first month entitled to SSDI Generally, this means you get Medicare in the 30th
month after you become disabled• 5-month waiting period for SSDI benefits• Followed by 24-month waiting period for Medicare
August 2015
Medicare Enrollment for People with Disabilities
You’re automatically enrolled in Medicare if you qualify based on disability
You’ll get an Initial Enrollment Period package • 3 months before 25th month of disability benefits• If you have Amyotrophic Lateral Sclerosis – about 4 weeks
after Medicare entitlement You need to decide whether to• Keep Part B• Enroll in Part D
August 2015 Understanding Medicare Enrollment Periods 23
Understanding Medicare Enrollment Periods 24
Retroactive Entitlement to Medicare
In some cases, your entitlement to Medicare may be retroactive• If your disability benefits are retroactive• Your Medicare card will show effective date• If you’ve received Medicare-covered services prior
You may request that your provider submit those claims to Medicare
Services must have been received after the effective date on your Medicare card
August 2015
Understanding Medicare Enrollment Periods 25
Information Received with Retroactive Determination
You’ll get this information with your determination:• Your effective date of Part A coverage (the 25th month of
disability benefit entitlement)• Your effective date of Part B coverage (the month of
processing), and the option to elect Part B coverage starting with the 25th month of disability benefit entitlement
To exercise your option for retroactive Part B coverage you must submit a written request and agree to pay all retroactive premiums due
August 2015
Understanding Medicare Enrollment Periods 26
How Long Are You Entitled to Medicare?
As long you meet the Social Security definition of disability
Social Security has work incentives if you go back to work• Medicare continues if you’re working but still disabled• You can get premium-free Part A for 8½ years after you
return to work• You may purchase Part A coverage afterward
The reason for your Medicare entitlement changes at 65• Any penalty you may have had for late enrollment is
removed at that timeAugust 2015
Understanding Medicare Enrollment Periods 27
Applying for Disability Benefits
To apply for disability benefits, you’ll need your• Social Security number• Proof of age• Health care provider information• Medical records, including lab/test results and medications• Work history• Most recent W-2 or self-employment tax return
Don’t wait to apply • Even if you’re still gathering information
August 2015
Medicare Enrollment Based on End-Stage Renal Disease
Eligibility requirements• Any age• Kidneys no longer function, and • Must have worked the required amount of time or• Getting or be eligible for Social Security, Railroad
Retirement, or federal retirement benefits or An eligible child or An eligible spouse (including through same-sex marriage)
August 2015 Understanding Medicare Enrollment Periods 28
Understanding Medicare Enrollment Periods 29
Medicare Part B (Medical Insurance) Eligibility
You can enroll in Part B if entitled to Part A based on ESRD• You pay the monthly Part B premium• You may pay a penalty if you delay taking Part B
You need both Part A and Part B for complete coverage For more information• Call Social Security at 1-800-772-1213
TTY users should call 1-800-325-0778• Railroad retirees call the Railroad Retirement Board at 1-877-
772-5772 TTY users should call 1-312-751-4701
August 2015
Understanding Medicare Enrollment Periods 30
Enrolling in Medicare Part B
Enrollment based on ESRD may eliminate your Part B penalty if you already had Medicare due to age or disability• If you didn’t enroll when you were first eligible
If you have Medicare due to ESRD and reach 65• You have continuous coverage• Those not enrolled in Part B will be enrolled• You can decide whether or not to keep it
August 2015
Understanding Medicare Enrollment Periods 31
Delaying Medicare Part B
If you enroll in Part A and delay enrolling in Part B• You must wait for a General Enrollment Period
January 1 to March 31 each year, coverage effective July 1 of the same year
• You may have to pay a higher premium for as long as you have Part B
10% for each 12-month period, you were eligible but not enrolled
No Special Enrollment Period for those with End-Stage Renal Disease
August 2015
Understanding Medicare Enrollment Periods 32
Medicare and Group Health Plan (GHP) Coverage (30-Month Coordination Period)
If enrollment is based solely on ESRD• GHP/employer is the only payer during first 3 months
Medicare is the secondary payer during the 30-month coordination period• Begins when first eligible for Medicare even if not enrolled
Separate coordination period each time enrolled based on ESRD• No 3-month waiting period• New 30-month coordination period if you have GHP
coverage
August 2015
Understanding Medicare Enrollment Periods 33
Enrollment Considerations– Immunosuppressive Drugs
If You Your Immunosuppressive Drugs
Are entitled to Part A at time of transplant and Medicare paid for your transplant
and the transplant took place in a Medicare-approved facility or
Medicare was secondary payer but made no payment
Are covered by Part B Medicare pays 80% You pay 20%• Coinsurance costs don’t count
toward catastrophic coverage under Part D
Didn’t meet the transplant conditions above
May be covered by Part D (unless you would be covered by Part B, but you haven't enrolled in Part B) Costs vary by plan Helps cover drugs needed for
other conditions
August 2015
Understanding Medicare Enrollment Periods 34
Enrollment Considerations– 30-Month Coordination Period
You might want Medicare during the coordination period• To pay the group health plan deductible/coinsurance• If you're getting a transplant soon
Affects coverage for immunosuppressive drugs Coverage for living donor
Delaying Part B or Part D could mean • Waiting for applicable enrollment period to enroll• Possible penalty for late enrollment
August 2015
Understanding Medicare Enrollment Periods 35
How to Enroll in Medicare Part A and Part B Based on ESRD
Enroll at your local Social Security office Get doctor/dialysis facility to fill out Form CMS-2728• If Social Security gets the form before you enroll, they may
contact you to see if you want to enroll
If you have a group health plan, you may want to delay enrolling • Near the end of the 30-month coordination period
• Won’t have to pay Part B premium until you need it
Get facts before deciding to delay• Especially if transplant is planned
August 2015
Understanding Medicare Enrollment Periods 36
When Medicare Coverage Based on ESRD Starts
Your Coverage Starts Under the Following Circumstances
1st day of the 4th month You get a regular course of dialysis in a facility
1st day of the month of the 1st month
You participate in a home dialysis training program during the first 3 months of your regular course of dialysis (with expectation of completion)
1st day of the month You get a kidney transplant
1st day of the month You’re admitted to a Medicare-approved transplant facility for a kidney transplant or procedures preliminary to a kidney transplant if transplant takes place in the same month or within the following 2 months
2 months before the month of your transplant
Your transplant is delayed more than 2 months after you’re admitted to the hospital for the transplant or for health care services you need for the transplant
August 2015
Understanding Medicare Enrollment Periods 37
When Coverage for ESRD Ends, Continues or Resumes
When Coverage Ends
When Coverage Continues
When Coverage Resumes
Entitlement based solely on ESRD• Coverage ends 12
months after the month you no longer require a regular course of dialysis or
• Thirty-six months after the month of your kidney transplant
• No interruption in coverage if you start a regular course of dialysis again within 12 months after regular dialysis stopped or
• You have a kidney transplant or
• Regular course of dialysis starts within 36 months after transplant or you received another kidney transplant within 36 months after transplant
Must file new application and there's no waiting period if• You start a regular
course of dialysis again or get a kidney transplant more than 12 months after you stopped getting a regular course of dialysis
• You have another kidney transplant > 36 months later
August 2015
August 2015 Understanding Medicare Enrollment Periods 38
Check Your Knowledge—Question 4
Kevin has an endocrine disorder and started receiving Social Security Disability Insurance this month. How long will Kevin have to wait until he can get Medicare?
a. 24 monthsb. 36 monthsc. 48 monthsd. There is no waiting period.
He can get Medicare immediately.
Lesson 3—Medigap (Medicare Supplement Insurance Policy) Enrollment Period
Medigap Open Enrollment Switching Medigap Policies
August 2015 Understanding Medicare Enrollment Periods 39
Understanding Medicare Enrollment Periods 40
Medigap Open Enrollment Period
Your Medigap Open Enrollment Period (OEP)• 6 months when insurance company must sell• Guaranteed issue period without medical
underwriting• Your one OEP begins when you’re 65 or older and
enrolled in Part B Can’t be changed or repeated
• Some states have more generous rules May buy a Medigap policy any time an insurance
company will sell you oneAugust 2015
Understanding Medicare Enrollment Periods 41
Pre-existing Conditions and Medigap
Health problem you had before the new insurance policy starts • Treated or diagnosed 6 months before coverage start date
Pre-existing Condition Waiting Period• Insurance companies can refuse to cover out-of-pocket costs
for excluded condition for up to 6 months (“look-back period”) Without 6 months of prior creditable coverage and no
break in coverage more than 63 days
The Affordable Care Act doesn’t impact the pre-existing condition waiting period for Medigap coverage.
August 2015
Understanding Medicare Enrollment Periods 42
Guaranteed Issue Rights
Federal protections in certain situations• Companies must sell you a Medigap policy• All pre-existing conditions must be covered• Can’t be charged more• Must apply within 63 days of date other coverage ends
See Appendix A for all situations
August 2015
Understanding Medicare Enrollment Periods 43
Medigap for People With a Disability orEnd-Stage Renal Disease (ESRD)
People with a disability or ESRD may not be able to buy a policy until they turn 65• Some states require insurers to sell Medigap policies
to people with a disability or ESRD Companies may voluntarily sell Medigap policies• May cost more than policies sold to people over 65• Can use medical underwriting
Get a Medigap Open Enrollment Period at 65
August 2015
Check Your Knowledge—Question 5
Sarah turns 65 next month, and has enrolled in Medicare Parts A and B. How many Medigap Open Enrollment Periods will she get?
a. None – you can sign up for a Medigap plan anytime
b. Onec. One each yeard. Two each year, if you count
Special Enrollment periodsAugust 2015 Understanding Medicare Enrollment Periods 44
Lesson 4—Enrollment Periods for Medicare Prescription Drug Coverage (Part D)
Initial Enrollment Period Open Enrollment Period Special Enrollment Periods
August 2015 Understanding Medicare Enrollment Periods 45
Part D Initial Enrollment Period (IEP)
When you first become eligible to get Medicare• 7-month IEP for Part D
If You Join Coverage BeginsDuring the 3 months before you turn 65
Date eligible for Medicare
During the month you turn 65 First day of the following month
During the 3 months after you turn 65
First day of the month after month you apply
August 2015 Understanding Medicare Enrollment Periods 46
When You Can Join or Switch Plans Part D Plans
Medicare’s Open Enrollment Period is October 15–December 7 each year, coverage starts January 1
You can leave a Medicare Advantage Plan and switch to Original Medicare from January 1–February 14 each year
• You have until February 14 to also join a Part D plan If you don’t have Medicare Part A coverage, and enroll in
Part B during the General Enrollment Period (January 1–March 31), you can sign up for a Medicare Prescription Drug Plan from April 1–June 30 each year
August 2015 Understanding Medicare Enrollment Periods 47
Part D Special Enrollment Period (SEP)
Life events that allow an SEP include You permanently move out of your plan’s service area You lose other creditable prescription coverage You weren’t properly told that your other coverage wasn’t
creditable, or your other coverage was reduced and is no longer creditable
You enter, live at, or leave a long-term care facility You have a continuous SEP if you qualify for Extra Help You belong to a State Pharmaceutical Assistance Program Other exceptional circumstances
August 2015 Understanding Medicare Enrollment Periods 48
5-Star Special Enrollment Period (SEP)
Use Medicare Plan Finder tool at Medicare.gov to see quality and performance ratings
Star ratings are given once a year, assigned in October of the past year
Use 5-star SEP to switch to any 5-star plan one time• December 8–November 30 of following year• Coverage starts first day of month after enrolled• Be careful not to switch from a Medicare Advantage (MA)
Plan with drug coverage to an MA Plan with no Part D coverage
August 2015 Understanding Medicare Enrollment Periods 49
Low Performing Plan
Low performing star rating status • You may have a one-time option to switch
to another Medicare drug plan with a rating of 3, 4, or 5 stars if your plan’s summary rating was less than 3 stars for 3 years
• Low Performance Icon (LPI) appears on Plan Finder
• Plans may not attempt to discredit their LPI status by showcasing a separate higher rating
August 2015 Understanding Medicare Enrollment Periods 50
Check Your Knowledge—Question 6Check Your Knowledge—Question 6
You can add or switch a Medicare Part D plan during Medicare’s Open Enrollment Period (October 15–December 7) each year.a. Trueb. False
August 2015 Understanding Medicare Enrollment Periods 51
Lesson 5—Enrollment Periods for Medicare Advantage Plans (Part C)
Initial Enrollment Period Open Enrollment Period Special Enrollment Periods 5-Star Special Enrollment Period
August 2015 Understanding Medicare Enrollment Periods 52
When You Can Join or Switch Medicare Advantage Plans
Initial Enrollment Period
7-month period begins 3 months before the month you turn 65 Includes the month you turn 65 Ends 3 months after the month you turn 65
Medicare Advantage Initial Enrollment
You must have both Medicare Part A and Part B to enroll in a Medicare Advantage (MA) Plan.If you didn’t enroll in Part B when you were first eligible, your MA enrollment period: Begins 3 months immediately before your first entitlement to both
Medicare Parts A and B ends, and 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
Medicare Open Enrollment Period
October 15–December 7 Coverage begins January 1
Medicare due to a Disability
7-month period begins 3 months before the 25th month of disability.
Ends 3 months after the 25th month of disability.
Understanding Medicare Enrollment Periods 54
When You Can Join or Switch Plans
Special Enrollment Periods (SEP)
Move out of your plan’s service area Plan leaves Medicare program or reduces its service
area Leaving or losing employer or union coverage You enter, live at, or leave a long-term care facility You have a continuous SEP if you qualify for Extra
Help Losing your Extra Help status You join or switch to a plan that has a 5-star rating Retroactive notice of Medicare entitlement Other exceptional circumstances
August 2015
Understanding Medicare Enrollment Periods 55
When You Can Join or Switch MA Plans5-Star Special Enrollment Period (SEP)
Can enroll in 5-star Medicare Advantage (MA), Prescription Drug Plan (PDP), Medicare Advantage Plan with prescription drug coverage (MA-PD), or Cost Plan
Enroll once per year from December 8, 2014–November 30, 2015
New plan starts first day of month after enrolled Star ratings given once per year• Ratings assigned in October and effective January
1st• Use Medicare Plan Finder to see star ratings
Look at Overall Plan Rating to find eligible plans
August 2015
Understanding Medicare Enrollment Periods 56
Medicare Advantage Plan Disenrollment Between January 1–February 14• You can leave a Medicare Advantage Plan and
switch to Original Medicare• If you make this change, you may also join a
Medicare Prescription Drug Plan to add drug coverage
• Coverage begins the first of the month after the plan gets enrollment form
• Check whether you could get a Medigap policy
August 2015
Check Your Knowledge—Question 7Check Your Knowledge—Question 7
Which of these is not a reason to qualify for a Medicare Advantage Plan Special Enrollment Period?a. You move out of the plan’s
serving areab. Your doctor leaves the
Medicare Advantage Planc. You have a chance to enroll
in other coverage offered by your employer or union
d. You’re released from jailAugust 2015 Understanding Medicare Enrollment Periods 57
National Training Program Contact Information
To view all available NTP training materials, or to subscribe to our email list, visit
CMS.gov/Outreach-and-Education/Training/ CMSNationalTrainingProgram/index.html
For questions about training products email [email protected]
Appendix A—page 1
This chart describes the situations, under federal law, that give you a right to buya policy, the kind of policy you can buy, and when you can or must apply for it.States may provide additional Medigap guaranteed issued rights.
August 2015 Understanding Medicare Enrollment Periods 59
Appendix A—page 2
This chart describes the situations, under federal law, that give you a right to buya policy, the kind of policy you can buy, and when you can or must apply for it.States may provide additional Medigap guaranteed issued rights. (Continued)
August 2015 Understanding Medicare Enrollment Periods 60
Special Enrollment Periods (SEPs)for Part C and Part D—page 1
August 2015 61Understanding Medicare Enrollment Periods
Changes in where you live
If this describes you… You can… At this time…
You move to a new address that isn’t in your plan’s service area.
Switch to a new Medicare Advantage or Medicare Prescription Drug Plan.
If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move. If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months.
You move to a new address that’s still in your plan’s service area, but you have new plan options in your new location.You move back to the U.S. after living outside the country.
Join a Medicare Advantage or Medicare Prescription Drug Plan.
Your chance to join lasts for 2 full months after the month you move back to the U.S.
August 2015 62Understanding Medicare Enrollment Periods
Special Enrollment Periods (SEPs)for Part C and Part D—page 2
Changes in where you live If this describes you… You can… At this time…
You just moved into, currently live in, or just moved out of an institution (like a skilled nursing facility or long-term care hospital).
Join a Medicare Advantage or Medicare Prescription Drug Plan.
Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan.
Drop your Medicare Advantage Plan and return to Original Medicare.
Drop your Medicare prescription drug coverage.
Your chance to join, switch, or drop coverage lasts as long as you live in the institution and for 2 full months after the month you move out of the institution.
You’re released from jail.
Join a Medicare Advantage or Medicare Prescription Drug Plan.
Your chance to join lasts for 2 full months after the month you’re released from jail.
Special Enrollment Periods (SEPs)for Part C and Part D—page 3
Changes that cause you to lose your current coverageIf this describes you… You can… At this time…
You’re no longer eligible for Medicaid.
Join a Medicare Advantage or Medicare Prescription Drug Plan.
Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan.
Drop your Medicare Advantage Plan and return to Original Medicare.
Drop your Medicare prescription drug coverage.
Your chance to change lasts for 2 full months after the month you find out you’re no longer eligible for Medicaid.
You leave coverage from your employer or union.
Join a Medicare Advantage or Medicare Prescription Drug Plan.
Your chance to join lasts for 2 full months after the month your coverage ends.
August 2015 Understanding Medicare Enrollment Periods 63
64Understanding Medicare Enrollment Periods
Special Enrollment Periods (SEPs)for Part C and Part D—page 4
Changes that cause you to lose your current coverage
If this describes you… You can… At this time…
You involuntarily lose other drug coverage that’s as good as Medicare drug coverage (creditable coverage), or your other coverage changes and is no longer creditable.
Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.
Your chance to join lasts for 2 full months after the month you lose your creditable coverage or are notified of the loss of creditable coverage, whichever is later.
You have drug coverage through a Medicare Cost Plan and you leave the plan.
Join a Medicare Prescription Drug Plan.
Your chance to join lasts for 2 full months after the month you drop your Medicare Cost Plan.
August 2015
Special Enrollment Periods (SEPs)for Part C and Part D—page 5
Changes that cause you to lose your current coverage
If this describes you… You can… At this time…
You drop your coverage in a Program of All-inclusive Care for the Elderly (PACE) plan.
Join a Medicare Advantage or Medicare Prescription Drug Plan.
Your chance to join lasts for 2 full months after the month you drop your PACE plan.
You find out that you won’t be eligible for Extra Help for the following year.
Join a Medicare Advantage or Medicare Prescription Drug Plan.
Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan.
Drop your Medicare Advantage Plan and return to Original Medicare.
Drop your Medicare prescription drug coverage.
Your chance to change is between January 1–March 31.
August 2015 Understanding Medicare Enrollment Periods 65
Special Enrollment Periods (SEPs)for Part C and Part D—page 6
You have a chance to get other coverage
If this describes you… You can… At this time…
You have a chance to enroll in other coverage offered by your employer or union.
Drop your current Medicare Advantage or Medicare Prescription Drug Plan to enroll in the private plan offered by your employer or union.
Whenever your employer or union allows you to make changes in your plan.
You have or are enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage).
Drop your current Medicare Advantage Plan with drug coverage or your Medicare Prescription Drug Plan.
Anytime.
August 2015 Understanding Medicare Enrollment Periods 66
Special Enrollment Periods (SEPs)for Part C and Part D—page 7
You have a chance to get other coverage
If this describes you… You can… At this time…
You enroll in a Program of All-inclusive Care for the Elderly (PACE) plan
Drop your current Medicare Advantage or Medicare Prescription Drug Plan
Anytime
You live in the service area of one or more Medicare Advantage or Medicare Prescription Drug Plans with an overall quality rating of 5 stars
Join a Medicare Advantage, Medicare Cost, or Medicare Prescription Drug plan with an overall quality rating of 5 stars
One time between December 8, 2012–November 30 each year
August 2015 Understanding Medicare Enrollment Periods 67
August 2015 68Understanding Medicare Enrollment Periods
Special Enrollment Periods (SEPs)for Part C and Part D—page 8
Changes in your plan’s contract with Medicare
If this describes you… You can… At this time…
Medicare takes an official action (called a “sanction”) because of a problem with the plan that affects you
Switch from your Medicare Advantage or Medicare Prescription Drug Plan to another plan
Your chance to switch is determined by Medicare on a case-by-case basis
Your plan’s contract ends (terminates) during the contract year
Switch from your Medicare Advantage or Medicare Prescription Drug Plan to another plan
Your chance to switch starts 1 months before and ends 2 full month after the contract ends
Your Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan’s contract with Medicare isn’t renewed for the next contract year
Join another Medicare Advantage or Medicare Prescription Drug Plan
Between October 15 and the last day in February
August 2015 69Understanding Medicare Enrollment Periods
Special Enrollment Periods (SEPs)for Part C and Part D—page 9
Changes due to other special situations
If this describes you… You can… At this time…
You’re eligible for both Medicare and Medicaid
Join, switch, or drop a Medicare Advantage Plan or Medicare prescription drug coverage
Anytime
You qualify for Extra Help paying for Medicare prescription drug coverage
Join, switch, or drop Medicare prescription drug coverage
Anytime
You’re enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility
Join either a Medicare Prescription Drug Plan or a Medicare Advantage Plan with prescription drug coverage
Once during the calendar year
August 2015 70Understanding Medicare Enrollment Periods
Special Enrollment Periods (SEPs)for Part C and Part D—page 10
Changes due to other special situations
If this describes you… You can… At this time…
You dropped a Medicare Supplemental Insurance (Medigap) policy the first time you joined a Medicare Advantage Plan
Drop your Medicare Advantage Plan and enroll in Original Medicare. You’ll have special rights to buy a Medigap policy
Your chance to drop your Medicare Advantage Plan lasts for 12 months after you join the Medicare Advantage Plan for the first time
You have a severe or disabling condition, and there’s a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with your condition
Join a Medicare Chronic Care Special Needs Plan (SNP) that serves people with your condition
You can join anytime, but once you join, your chance to make changes using this SEP ends
August 2015 71Understanding Medicare Enrollment Periods
Special Enrollment Periods (SEPs)for Part C and Part D—page 11
Changes due to other special situations
If this describes you… You can… At this time…
You weren’t properly told that your other private drug coverage wasn’t as good as Medicare drug coverage (creditable coverage)
Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan
Your chance to join lasts for 2 full months after the month you get a notice of the error from Medicare
You weren’t properly told that you were losing private drug coverage that was as good as Medicare drug coverage (creditable coverage)
Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan
Your chance to join lasts for 2 full months after the month you get a notice of the error from Medicare
August 2015 72Understanding Medicare Enrollment Periods
Special Enrollment Periods (SEPs)for Part C and Part D—page 12
Changes due to other special situations
If this describes you… You can… At this time…
You joined a plan, or chose not to join a plan, due to an error by a federal employee
Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan
Switch from your current plan to another Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan
Drop your Medicare Advantage Plan with drug coverage and return to Original Medicare
Drop your Medicare prescription drug coverage
Your chance to change coverage lasts for 2 full months after the month you get a notice of the error from Medicare