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Medicare Enrollment Period Dates, Chart, ICEP, AEP, Open Enrollment Dates

The Annual Election Period (#AEP) aka Open Enrollment  §30.1 

When you Turn 65 

Learn all about enrolling in Medicare A Hospital & B Outpatient and your options for extra coverage

When you #turn65

The Initial Coverage Election Period (ICEP)

Understanding C & D Enrollment Periods

  • The ICEP (Initial Enrollment Period) is the period during which an individual newly eligible for Medicare Advantage  may make an initial enrollment request to enroll in an MA plan. This period begins three months immediately before the individual’s first entitlement (Turning 65) to both Medicare Part A and Part B and ends on the later of:
    • 1. The last day of the month preceding entitlement to both Part A and Part B, or;
    • 2. 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.   See 42 CFR 407.14 for additional information.
  • Once an ICEP enrollment request is made and enrollment takes effect, the ICEP election has been used.   Section 30.2 *  Understanding Medicare Enrollment Periods # 11219 *
  • Yes, I know this is all very complicated!   Email us or post your specific question below.
  • EXAMPLES
  • HI CAP CA Health Care Advocates Medicare Enrollment Periods
Learn all about enrolling in Medicare A Hospital & B Outpatient and your options for extra coverage

Federal Medicare Charts & Rules on

when you can enroll or get out of in Part D Rx and MAPD Medicare Advantage

#Special, Annual & Initial Enrollment Periods CHARTS

For MAPD Medicare Advantage aka Part C & Medicare + Choice & Part D Rx

 

Understanding Medicare Advantage & Rx Enrollment #Periods Publication # 11219

Enrollment Period Chart

Click on link above or the chart to see the full brochure

 

 

Medicare Managed Care Manual

Chapter 2 Enrollment and #Disenrollment

Medicare Managed Care Manual Chapter 2 Election Periods

 

 

 

 

 

 

 

 


All Special Election Periods (SEP);

How the Medicare Advantage Application  #typically asks the "Special" Enrollment Period questions:

  1. I am new to Medicare.
  2. It's Annual Election Period aka Open Enrollment October 15th through December 7th
  3. I am enrolled in a Medicare Advantage plan and want to make a change during the Medicare Advantage Open Enrollment Period (MA OEP).
  4. I recently moved outside of the service area for my current plan or I recently moved and this plan is a new option for me. I moved on (insert date) –––––––––––.
  5. I recently was released from incarceration. I was released on (insert date) –––––––––––.
  6. I recently returned to the United States after living permanently outside of the U.S. I returned to the U.S. on (insert date) –––––––––––.
  7. I recently obtained lawful presences status in the United States. I got this status on (insert date) –––––––––––.
  8. I recently had a change in my Medicaid Medi Cal  (newly got Medicaid, had a change in level of Medicaid assistance, or lost Medicaid) on (insert date) –––––––––––.
  9. I recently had a change in my Extra Help paying for Medicare prescription drug coverage (newly got Extra Help, had a change in the level of Extra Help, or lost Extra Help) on (insert date) –––––––––––.
  10. I have both Medicare and Medicaid (or my state helps pay for my Medicare premiums) or I get Extra Help paying for my  Medicare prescription drug coverage, but I haven’t had a change.
  11. I am moving into, live in, or recently moved out of a Long-Term Care Facility (for example, a nursing home or long-term care facility). I moved/will move into/out of the facility on (insert date) –––––––––––.
  12. I recently left a PACE program on (insert date) –––––––––––.
  13. I recently involuntarily lost my creditable prescription drug coverage (coverage as good as Medicare’s). I lost my drug coverage on (insert date) –––––––––––.
  14. I am leaving employer or union coverage on (insert date) –––––––––––.
  15. I belong to a pharmacy assistance program provided by my state.
  16. My plan is ending its contract with Medicare, or Medicare is ending its contract with my plan.
  17. I was enrolled in a plan by Medicare (or my state) and I want to choose a different plan.  My enrollment in that plan started on (insert date) –––––––––––.
  18. I was enrolled in a Special Needs Plan (SNP) but I have lost the special needs qualifications required to be in the plan. I was disenrolled from the SNP on (insert date) –––––––––––.
  19. I was affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency (FEMA). One of the other statements here applied to me, but I was unable to make my enrollment because of the natural disaster

Details of each SEP Special Enrollment Period

MAPD & Part D Various Enrollment Dates & Opportunities

There are only certain times that you can enroll in various Medicare Advantage, Rx and Medi Gap Plans.  The Federal & State Governments and Insurance Companies need to collect premiums in order to pay claims. See our webpage on Medical Loss Ratio.   These plans are guaranteed issue, when you enroll at the right time.  Thus, no matter how sick you are, they must accept you!  They would like to collect some premium before paying out claims.   Even then, a lot of plans don’t collect enough money and it comes from taxes or somewhere.

It can get very confusing as Medicare Advantage Plans, Part D and Medi Gap Supplements may have different dates, double check!

Yes, we know that some of the explanations below are not in plain English and appear complex…  We are working on better ways to explain it.  One simple way is to look at for example the Blue Shield MAPD Paper Application.

Email us to discuss further and enroll.

Check out the various guaranteed enrollment times  below for MAPD & Part D during which you can disenroll or transfer  and it’s guaranteed issue, no pre-X

NEW Medicare Advantage Open Enrollment Period January 1 through March 31

ENROLL TODAY with Anthem Blue Cross
Get Quotes, Full information and ENROLL ONLINE Blue Shield medicare 2025

Federal Emergency Management Agency (FEMA)

 

  • Did you know a FEMA emergency might qualify you for a Medicare Special Enrollment Period? It generally depends on what state or county you live in, among other things.
  • FEMA is the U.S. Federal Emergency Management Agency.
  • When there’s an event like a severe storm, wildfire, pandemic illness, or other disaster, FEMA might declare an emergency.
    Medicare realizes that if you’re affected by a FEMA emergency, you might miss an opportunity to enroll in a Medicare Advantage plan or a stand-alone Medicare prescription drug plan.
  • That’s why Medicare has Special Enrollment Periods (SEPs). Usually, you can only enroll in a Medicare Advantage plan or Medicare prescription drug plan during certain times. But a Medicare SEP lets you enroll outside of the regular Medicare open enrollment periods, if you qualify for it. You might be able to make other coverage changes, as described below.
  • FEMA emergency: general rules for a Medicare SEP
  • You might qualify for a Medicare SEP for a FEMA emergency if all the following are true:
    • • You live in a specific county and state where FEMA has declared an emergency, or you lived in that specific county and state at the start of the FEMA emergency declaration.
    • • An election (enrollment) period was in effect during the FEMA emergency.
    • • You weren’t able to enroll in a Medicare plan, or switch Medicare plans, during an election period that was going on during the incident period.
    • You might qualify for this type of Medicare SEP even if you don’t live in one of the affected areas, but you rely on someone (like a family member) for help with healthcare matters. The person helping you does have to live in one of the affected areas.
  • Please note:
  • • You don’t qualify for this Medicare SEP if you already used a Medicare open enrollment period to make a coverage change during the FEMA incident period.
  • • This SEP only applies to Medicare Advantage plans (and other Medicare health plans), and Medicare prescription drug plans.
    If you think you might qualify for a FEMA emergency Medicare SEP, don’t let too much time pass by. SEPs are limited.

 

On February 4, 2024, California Governor Gavin Newson issued a state of emergency declaration, affecting four new counties – Los Angeles, Orange, Riverside and San Bernardino, in addition to San Diego and Ventura for which BCP was activated on January 24th.

Summary of Declared Disaster or Other Emergency
Date of Declaration or Proclamation: February 4, 2024
Description: State of Emergency
Declared By: Governor Gavin Newsom
Impacted State(s): CA
Impacted SCAN Service Areas: Los Angeles, Orange, Riverside, San Bernardino, and San Diego and Ventura counties.
SEP Type: Government Entity-Declared Disaster or Other Emergency
Start Date of SEP: February 4, 2024
State of Emergency: Winter storms – Governor’s Declaration
End Date of SEP: TBD

Individuals are eligible for this SEP if they:

  • Reside, or resided at the start of the SEP eligibility period described in this guidance, in an area for which a federal, state or local government entity has declared a disaster or other emergency or they do not reside in an affected area but rely on help making health care decisions from one or more individuals who reside in an affected area; and
  • Were eligible for another election period at the time of the SEP eligibility period; and  
  • Did not make an election during that other valid election period due to the disaster or other emergency.

Links to Declaration
State of Emergency:

Governor’s Press Release (02/04/24)

Jump to section on:

The Medicare Advantage Open Enrollment Period

( #MAOEP)

 

  • During the MA OEP, MA plan enrollees may enroll in another MA [PD] plan or disenroll from their MA [PD]  plan and return to Original Medicare. Individuals may make only one election during the MA OEP.
  • This chart outlines who can use the MA OEP and when:
  • MA Open Enrollment
  • Individuals enrolled in an MA [PD]  plan may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MA-PD or MA-only plans can switch to:
  • • MA-PD
    • MA-only
    • Original Medicare (with or without a stand-alone Part D plan)
    And see if they qualify for a Medi Gap plan
  •                   Check the ANOC Annual Notice of Change from your Medicare Advantage plan - if any                             benefits are lower... that may get you guaranteed issue into Medi Gap!!!
  •  
  • The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.
  • NOTE: The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join a MA plan. It also does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone Part D plans. The MA OEP is not available for those enrolled in Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE).  Medicare Managed Care Manual Chapter 2 *   Section 30 - Election Periods  *  CA Health Advocates.org  * 42 CFR §§ 422.62 & 422.68  *  Medicare & You * 
  • You have the opportunity to make one change to your  health coverage during the annual Medicare Advantage Open Enrollment Period.
  • HI CAP CA Health Care Advocates Medicare Enrollment Periods
  • FAQ's 
  • What type of plan can you switch to during the annual Medicare Advantage Open Enrollment Period?
  • During this time, you can:
    • Switch to another Medicare Advantage plan. (You choose a plan that covers prescription drugs or one that does not cover prescription drugs.)
    • Disenroll from an MAPD plan and obtain coverage through Original Medicare.
    • You can apply for Medi Gap, but it may not be guaranteed issue and require underwriting.  If that's your plan, get approved for Medi Gap FIRST!!!
      • If you choose to switch to Original Medicare during this period, you have until March 31 to join a separate Medicare prescription drug plan to add drug coverage.   We are not interested in writing people though who wait till the last minute.  If that's your plan please find another agent or go direct to Medicare.Gov  Things get lost...
  • When will your membership end?
  • Your membership will end on the first day of the month after you enroll in a different Medicare Advantage plan or we get your request to switch to Original Medicare. If you also choose to enroll in a Medicare prescription drug plan, your membership in the drug plan will begin the first day of the month after the drug plan gets your enrollment request.    Evidence of Coverage  §2.2 page 240 * Medicare Managed Care Manual Chapter 2 * 42 CFR 422.62(a)(3)  *   insuremekevin.com/new-medicare-advantage-open-enrollment-period-for-2019/ 
  • Resources & Links
  • VIDEO by Nick Williams on MAPD NEW Open Enrollment Period
  • CA Health Advocates.org
  • Medicare & You
ENROLL TODAY with Anthem Blue Cross

The 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, as defined in §10. The OEPI ends two months after the month the individual moves out of the institution.  Medicare Managed Care Manual § 30.3  * 

#Initial Enrollment Period for Part D Rx

(IEP for Part D)  §30.2.1

  • 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.
  •  During the IEP for Part D, individuals may make one Part D enrollment choice, including enrollment in an MA-PD plan.
  • 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. See 42 CFR 407.14 & §30.2.1  for additional information.
    • Click for EXAMPLES:

Blue Shield of California Authorized Agent - Broker

Blue Shield Logo

#Get Quotes, latest information & Enroll with Blue Shield 

Trying to prove Contract Violations???

 

30.4.2 – SEPs for Contract Violation

In the event an individual is able to demonstrate to CMS that the MA organization offering the MA plan of which he/she is a member substantially violated a material provision of its contract under MA in relation to the individual, or the MA organization (or its agent) materially misrepresented the plan when marketing the plan, the individual may disenroll from the MA plan and elect Original Medicare or another MA plan. The SEP will begin once CMS determines that a violation has occurred. Its length will depend on whether the individual immediately elects a new MA plan upon disenrollment from the original MA plan or whether the individual initially elects Original Medicare before choosing a new MA plan.  Medicare Managed Care Manual Chapter 2

Our webpage on

 

Medicare.Gov 10 illegal Medi Gap practices!

# 6 Claim that a Medicare Advantage Plan is a Medigap policy.

#10 Sell you a Medicare Advantage Plan when you say you want to keep Original Medicare and buy a Medigap policy. A Medicare Advantage Plan isn’t the same as Original Medicare. If you enroll in a Medicare Advantage Plan, you’ll be disenrolled from Original Medicare and can’t use a Medigap policy.

What if you allege that Kaiser didn’t tell you, that you could only use Kaiser Facilities?

Brief Description with link to Summary of Benefits

Page 234 of the Kaiser EOC mentions that you can exit their MAPD plan if they violate their contract with you. On page 235, the EOC mentions all the research material we have above… Page 236 says you must use Kaiser until your Membership ends!

See publication #12026 and our introductory video on understanding MAPD plans to learn more about how Medicare Advantage works.

Were there contract violations or enrollment errors Medicare Rights # 11 & 17

Medicare Managed Care Manual
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019326.html

Medicare,  Medicare Advantage MAPD and Part D Rx Federal Brochures 

Additional Resources & Links

 

Reference Materials

Get More Detail

#Medicare10050 and You  2025
Everything you want to know 

Steve's video on Medicare & You

***********

your medicare benefits # 101116

 

#Understanding Medicare Advantage Plans (PDF) #12026

Watch Steve's Video Seminar

Medicare booklet on understanding mapd Medicare advantage plans

 

  • MAPD Plans look like a great deal, as the "premium" is paid by fee from the Federal Government, on average $2k/year.Kff *  MAPD Plans must cover all A & B services Medicare.Gov * generally they also cover Part D Rx.
  • That's why the premium is very low or ZERO!

Prescription Drug 2025 #RxGuide
PDF # 11109

Guided to Medicare Rx

part d video explanation

 

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Coverage Gap - Donut Hole $2,000 Cap

Medicare out of pocket part d 2025 max 2k

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22 comments on “Enrollment Dates for MAPD – Medicare Advantage & Part D Rx”

  4. On 1/1/2021 I changed to an HMO with United healthcare.
    I’m Not happy and wish to change to Blue Shield 65+ or something better than what I have.

    Reply

  5. I turned 65 a while back.

    I just enrolled in Part B Outpatient in May.

    Can I enroll in a Part D Rx plan for September?

    I retired and my employer group plan ended in May.

    Is there ANY way I can get around the 2 month limit?

    Reply

    • Unfortunately, I don’t see new enrollment in Part B as a qualifying event on the Blue Cross Part D Rx Application. Let me check further.

      See above for list of qualifying questions in the application

      see above to links to Medicare Rights & Medicare Publication 11219 for our source documents

      Reply

  6. Is there a guaranteed issue SEP for Medicare Advantage signup for 60 days after returning to the USA from having lived overseas?

    Reply

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