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Medicare News
Two Medicare Enrollment Periods Will Close at End of
March
Medicare Advocacy Center offers a guide of the
various enrollment periods
 March 19, 2007 Two open enrollment periods for
Medicare will close at the end of March the General Enrollment Period
for those who did not add Part B earlier, and the Open Enrollment Period
for those who want to enroll, cancel or change a Medicare Advantage
Plan. The Medicare enrollment periods have become extremely confusing
for many senior citizens but, below, the Medicare Advocacy Center
attempts go provide an understandable road map.
Medicare Enrollment Periods - AEP, GEP, OEP, L-OEP,
SEP - Know Your Acronyms to Know Your Rights
By Medicare Advocacy Center
So much attention is focused on the Annual
Coordinated Election Period (AEP) for Medicare Advantage (MA) plans and
prescription drug plans (PDPs) that beneficiaries and their advocates
may be unaware of other Medicare enrollment periods. These enrollment
periods and their acronyms are confusing and overlapping. A beneficiary
who does not act carefully may lose needed Part B or Part D coverage or
may affect the way Medicare services are received. In some situations
beneficiaries have only days left, until the end of March, to effectuate
a change.
Annual Coordinated Election Period (AEP)
The Annual Coordinated Election Period runs from
November 15 through December 31 each year. During this time
beneficiaries may change prescription drug plans, change Medicare
Advantage plans, return to original Medicare, or enroll in a Medicare
Advantage plan for the first time. Enrollment changes take effect on
January 1.
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.
Beneficiaries who delay enrollment in Part B will
be assessed a late enrollment penalty on their Part B premium. The
penalty is 10% for each full year of delayed enrollment for as long as
the beneficiary remains covered under Part B.
Someone who enrolls in Part B during the General
Enrollment Period also has a Special Enrollment Period (SEP) for Part
D. From April through June of each year a new Part B enrollee may make
one election to join a Part D plan. Because beneficiaries who only have
Part A and not Part B are not eligible to enroll in a Medicare Advantage
plan, the SEP enables beneficiaries who elect Part B during the General
Enrollment Period to enroll in a Medicare Advantage plan with drug
coverage (MA-PD).
Open Enrollment Period (OEP)
The Open Enrollment Period 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.
Only beneficiaries who are eligible to enroll in a
Medicare Advantage plan may make a change during the Open Enrollment
Period.
In other words, a beneficiary who wants to change
must have both Medicare Part A and Medicare Part B and must live in the
area served by the Medicare Advantage plan.
Beneficiaries may not add or drop Part D drug
coverage during the Open Enrollment Period. Those who already have drug
coverage can only change to another option with drug coverage.
Those who do not have drug coverage may not change
to an option that provides drug coverage. Permissible changes during
the Open Enrollment Period include:
● MA-PD to a different MA-PD
● MA-PD to Original Medicare and a PDP
● Original Medicare and a PDP to an MA-PD
● MA-only plan to a different MA-only plan
● MA-only plan to original Medicare
● Original Medicare to an MA-only plan
Beneficiaries who want to use the Open Enrollment
Period to return to Original Medicare from an MA-PD must do so by
enrolling in a PDP. Enrollment in a PDP during either the Annual
Coordinated Election Period or the Open Enrollment Period terminates
enrollment in a Medicare Advantage plan. Because beneficiaries are
generally limited to changing their prescription drug coverage during
the Annual Coordinated Election Period, MA-PD enrollees who want to
return to Original Medicare during the Open Enrollment Period have a
Part D Special Enrollment Period that allows them to make one enrollment
into a PDP.
Limited Open Enrollment Period (L-OEP)
Congress created a new enrollment period for 2007
and 2008, the Limited Open Enrollment Period, as part of the Tax Relief
and Health Care Act of 2006. The Limited Open Enrollment Period allows
someone in Original Medicare to enroll in a Medicare Advantage plan
without drug coverage (MA-only plan) at any time of the year.
Enrollment becomes effective the month after the
choice is made. A beneficiary in an MA-only plan may not use the Limited
Open Enrollment Period to return to Original Medicare.
The Centers for Medicare & Medicaid Services (CMS)
has indicated that beneficiaries who use the Limited Open Enrollment
Period to join a private fee-for-service plan without drug coverage will
be able to keep their PDP.
However, those who use the limited open enrollment
period to enroll in an HMO, local PPO, or regional PPO that does not
offer drug coverage will lose their prescription drug coverage.
Beneficiaries who lose drug coverage as a result of
a choice made during the Limited Open Enrollment Period will be assessed
a late enrollment penalty on their Part D premiums for any month in
which they did not have drug coverage.
CMS has stated that MA-only plans will be required
to contact potential enrollees to make sure they understand that they
will lose their prescription drug coverage and to confirm that they
still want to join the plan before enrollment is effectuated.
In response to a letter from beneficiary advocates
raising concerns about CMSs interpretation of the new law, CMS has
indicated that it will establish a Special Enrollment Period on a
case-by-case basis to allow beneficiaries to disenroll from the MA-only
plan and to return to their PDP if they were unaware that they would
lose their drug coverage.
Special Enrollment Period (SEP)
Special Enrollment Periods allow beneficiaries to
make an enrollment change outside of the GEP, the AEP, the OEP and the
L-OEP.
Beneficiaries who delay enrolling in Part B because
they are covered by employer-sponsored health insurance as an active
worker or as a dependent of an active worker are not limited to
enrolling in Part B during the GEP. They have an SEP that runs for eight
months from the time they (or their spouse) retire or they lose their
health insurance. Part B coverage starts the month after the election is
made, and no late premium penalty is assessed.
A number of SEPs exist for Medicare Advantage and
PDP enrollment and disenrollment. For example, someone who moves out of
a Medicare Advantage Plan or PDP service area has an SEP to enroll in a
plan that serves their new home. Beneficiaries who move into, reside in,
or move out of a nursing home may also have an SEP. Individuals who are
eligible for Medicare and Medicaid have an SEP that allows them to
change Part D drug plans at any time. CMS has the authority to create
SEPs for exceptional circumstances.
For more details about Part D SEPs see the PDP
Eligibility, Enrollment and Disenrollment Guidance,
http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/CurrentPDPEnrollmentGuidance.pdf.
The Medicare Advantage SEPS are described in the
Medicare Managed Care Manual, Chapter 2, Medicare Advantage Enrollment
and Disenrollment,
http://www.cms.hhs.gov/HealthPlansGenInfo/Downloads/mc86c02.pdf.
Center for Medicare Advocacy
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