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
The Medicare Advantage Open Enrollment Period ( #MAOEP)
- During the MA OEP, Open Enrollment MA plan enrollees customers may:
- enroll in another MA PD plan or disenroll from their MA plan and return to Original Medicare.
- Individuals may make only one election during the MA OEP.:
- enroll in another MA PD plan or disenroll from their MA plan and return to Original Medicare.
-
Who can use the MA OEP: MA OEP occurs: Individuals enrolled in MA plans as of January 1 January 1 – March 31 New Medicare beneficiaries who are enrolled in an MA plan during their ICEP (Initial Coverage Election Period) The month of entitlement to Part A and Part B – the last day of the 3rd month of entitlement - Individuals may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MAPD or MA-only plans can switch to:
- • MA-PD (Medicare Advantage)
• MA-only
• Original Medicare (with or without a stand-alone Part D plan)
The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.
- • MA-PD (Medicare Advantage)
- NOTE:
- The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join a MA PD 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. Medicare Managed Care Manual Chapter 2 * Section 30 - Election Periods * CA Health Advocates.org * 42 CFR §§ 422.62 & 422.68 * Medicare & You - See link in Side Panel *
You have the opportunity to make one change to your health coverage during the annual Medicare Advantage Open Enrollment Period.
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 * Page 52 Medicare Manual * 42 CFR 422.62(a)(3) * insuremekevin.com/new-medicare-advantage-open-enrollment-period-for-2019/
New MAPD Open Enrollment Period 1.1 to 3.31
VIDEO on MAPD NEW Open Enrollment Period
Medicare & You - See link in Side Panel
The Annual Election Period (#AEP) §30.1
- AEP – Annual Enrollment is from October 15 through December 7 every year. Medicare Advantage eligible individuals may enroll in or disenroll from a Medicare Advantage plan, such as:
- The last enrollment request made, determined by the application date, will be the enrollment request that takes effect. CMS.gov *
When you turn 65
The Initial Coverage Election Period (ICEP)
- 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.
- 1. The last day of the month preceding entitlement to both Part A and Part B, or;
- 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
#Understanding Medicare Advantage Plans (PDF) #12026
Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan.
That's why the premium is very low or ZERO!
- Set a phone or Skype Meeting
- #Intake Form - We can better prepare for the meeting
- Get Quotes, Full Information and Enroll
Blue Shield Authorized Agent
No extra charge to you
Steve Video @ Blue Shield Headquarters
- #Get Quotes & Enroll with Blue Shield
- Individual & Family Direct *** Covered CA
- Medi Gap, Part D Rx & Medicare Advantage
- Employer Group
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
- 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.
- At the beginning of the Medicare prescription drug coverage program, all current Part D eligible individuals had an IEP for Part D that began on November 15, 2005, and ended on May 15, 2006. 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.
#Medicare10050 and You 2021
Everything you want to know - Read Along
Your Medicare Benefits # 10116
- Enroll in Blue Cross
- Learn about UHC United Health Care
- Enroll in Blue Shield
- Don't like computers? Prefer a printed version be mailed to you? Audio MP 3
- Use our scheduler to Set a phone, Skype or Face to Face meeting
- #Intake Form - We can better prepare for the meeting
#Special, Annual & Initial Enrollment Periods
Medicare Interactive - Rights to Special Enrollment
Plain English Medicare.Gov Special Enrollment periods
Understanding Medicare Advantage & Rx Enrollment Periods Publication # 11219
Official Details & Rules from
Medicare Managed Care Manual Chapter 2 Enrollment and Disenrollment
All Special Election Periods (SEP);
- Special election periods constitute periods outside of the usual times when an individual may elect a plan or change his or her current plan election.
- Here's the official technical Medicare Marketing Manual or simple
- plan English, Understanding Medicare C & D enrollment periods Pub # 11219 or see
- our section on materials & guides below, there are 36 various types of SEPs, including SEPs for dual eligibles, and for individuals whose current plan terminates, who change residence and who meet “exceptional conditions” as CMS may provide, consistent with §1851(e)(4) of the Act and §422.62(b) of the MA regulations.
- check with us about special enrollment, like when you turn 65 or lose coverage at work.
- Here's the official technical Medicare Marketing Manual or simple
How the Medicare Advantage Application #typically asks the "Special" Enrollment Period questions:
- I am new to Medicare.
- It's Open Enrollment October 15th through December 7th
- I am enrolled in a Medicare Advantage plan and want to make a change during the Medicare Advantage Open Enrollment Period (MA OEP).
- 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) –––––––––––.
- I recently was released from incarceration. I was released on (insert date) –––––––––––.
- I recently returned to the United States after living permanently outside of the U.S. I returned to the U.S. on (insert date) –––––––––––.
- I recently obtained lawful presences status in the United States. I got this status on (insert date) –––––––––––.
- I recently had a change in my Medicaid (newly got Medicaid, had a change in level of Medicaid assistance, or lost Medicaid) on (insert date) –––––––––––.
- 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) –––––––––––.
- 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.
- 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) –––––––––––.
- I recently left a PACE program on (insert date) –––––––––––.
- I recently involuntarily lost my creditable prescription drug coverage (coverage as good as Medicare’s). I lost my drug coverage on (insert date) –––––––––––.
- I am leaving employer or union coverage on (insert date) –––––––––––.
- I belong to a pharmacy assistance program provided by my state.
- My plan is ending its contract with Medicare, or Medicare is ending its contract with my plan.
- 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) –––––––––––.
- 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) –––––––––––.
- 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
COVID 19 SEP Special Enrollment
A special enrollment period available for beneficiaries who were eligible for — but unable to make — an election because they were affected by the COVID-19 pandemic. See May 5th letter from CMS with details
Additional Resources & Links
Reference Materials
- Medicare and You #10050 for an introduction or
- Medicare Rights – 16 page pdf on Special Enrollment Periods for Advantage and Part D Plans
- Medicare Managed Care Manual Chapter 2 * Section 30 – Election Periods
- CA Health Advocates.org
- Medi-Gap Dates & Guaranteed Enrollment on this website.
Get More Detail
See all the links and Footnotes above, along with brochures.
Special Enrollment Periods – Chart from Medicare Interactive
Understanding Medicare C & D enrollment periods Pub # 11219 for more detail.
Medicare Rights – 16 page pdf on Special Enrollment Periods for Advantage and Part D Plans
Medicare Managed Care Manual Chapter 2 * Section 30 – Election Periods
https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/
Child & Related Pages – Site Map
Hello Steve,
I found your helpful website and have a 93 year old dad with later stage Alzheimer’s who’s finishing a hospitalization and will be sent to subacute care.
Presently he has managed Medicare on AARP Medicare Advantage from UnitedHealth (UHC) and UHC has been very strict and difficult in paying for the hospital stay which is ending today or tomorrow.
I was told that I should switch my father before March 31 to Medicare as primary and find a secondary insurer by changing the Part D plan to a Medicare one.
As Medicare as primary will be more generous than managed Medicare during my father’s time in rehab. Do you have any tips to do this because from your website it says as an agent you are uninterested in assisting “those who wait until the last minute.”
In our case we were not aware of these options until the hospitalization occurred and discussing changing healthcare coverage wasn’t something they were interested in discussing till they had a problem with coverage which is now obvious.
Is there any guidance you can provide so that this switch happens properly and my father isn’t caught in the middle since it is only two days before March 31 and your website says “things get lost”?
Thank you.
We just worked on a client with a similar situation….
CA Department of Health Care Services — Sub acute Care
In home supportive care Medi Cal – Medicaid
Physical therapy Medicare Rules…
Medicare Website Skilled Nursing SNF
Our Webpage Medicare Skilled Nursing & Home Health Care
Requirements to qualify for Skilled Nursing Care
Physical & Speech Therapy
Requirements for Physical & Occupational Therapy
Medicare.Gov MAPD Medicare Advantage Plans must cover all Medicare Services!
Medicare Quality of Care Complaint Form
Medi-Cal Medicaid Long Term and Nursing Home coverage – Estate Recovery
Medi Cal Medicaid Share of Cost
Risk Adjustment Fraud
Livanta – Medicare Contractor to make sure MAPD meets Medicare guidelines
Our webpage on Long Term Care
Our webpage on Blue Shield Medicare Advantage
See the MAOEP Medicare Advantage Open Enrollment Period as opposed to AEP Annual Enrollment Period above on the rules and deadlines to change MAPD Plans, Rx Plans and/or go back to original medicare.
Getting a Medi Gap plan is NOT guaranteed. Here’s our webpage on when Medi Gap is guaranteed. Maybe you qualify or can get in through passing underwriting?
You can shop and compare Medicare Part D Rx and Medicare Advantage Plans with ALL companies nationwide here.
If you go with California Blue Cross, United Health Care or Blue Shield please come back to us to enroll. We don’t get paid for providing this website. We only get compensated from the Insurance Company, at no additional cost to you when you enroll though us.
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.
There’s a new rule that allows you to make that change. Medicare Advantage Open Enrollment Period ( #MAOEP) Which is different from the Annual Election Period (#AEP). We are not allowed to advertise it though.
I’d say let’s set a Zoom Meeting to review, but your not in CA. So, here’s an agent finder.
We can also discuss the pros and cons with anyone in CA and comply with Medicare rules about only saying “best” or “better” if we can substantiate it.
We can review the Doctor’s Lists, Formularies, Co-Pays, etc. We have access to all that information and most of it is posted right on this website.
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?
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 to links to Medicare Rights & Medicare Publication 11219 for our source documents
Is there a guaranteed issue SEP for Medicare Advantage signup for 60 days after returning to the USA from having lived overseas?
Yes, Page 7 11219-Understanding-Medicare-Part-C-D
Aetna medicare PPO has not been working out for me and lacks providers. Am I able to switch to Anthem ?
It’s difficult as we are no longer in Open Enrollment – AEP – Annual Enrollment Period.
Here’s a list of qualifying events for Special Enrollment from the Blue Cross application page 4 – I don’t see a reason there.
Are you by chance on Medi-Cal – Medicaid?
Are you getting Extra Help – Low Income Subsidy on your Rx drugs?
https://medicare.healthreformquotes.com/part-d-rx/donut-hole/shop-compare-tools/lis-discounts/
Do you have a severe or Chronic Medical Condition?
Was your enrollment in the Aetna plan due to an error by a federal employee – see Understanding Medicare Enrollment Periods page 12
Were there contract violations or enrollment errors Medicare Rights # 11 & 17
Did Your Medicare Advantage Plan stops contracting with many providers in its network during the course of the calendar year and CMS determines these terminations are substantial. If the terminations are significant enough, you will have a one-time SEP to enroll in a different Medicare Advantage Plan (with or without Part D coverage) or switch to Original Medicare with or without a standalone Part D plan. Your plan will mail you a notice if CMS determines the terminations are substantial.
Medicare Managed Care Manual
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019326.html
Contract Violations? 30.4.2
https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/CY_2018_MA_Enrollment_and_Disenrollment_Guidance_6-15-17.pdf
Are you in a county affected by wildfires?
https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/index.html
Even if your provider is not in network, since it’s a PPO there is still some coverage. the Blue Cross PPO Summary of Benefits is available here:
https://medicare.healthreformquotes.com/mapd/anthem-mediblue-plus/
Here’s an
https://individuals.healthreformquotes.com/definitions-glossary/oop-out-of-pocket-maximum-participating-or-not/
explanation of OOP Out of Pocket Maximum, Co Pay Deductibles, etc on our website
I got Kaiser last June under the 5 star rating enrollment period. They did not explain to me that I would lose my rights under Medicare to go to any provider I wanted. I thought it was just a supplement and I could use Kaiser at my leisure or at POS Point of Service.
We do not sell Kaiser as they only use Captive Agents for their Medicare Advantage products.
We are nicknamed “Mr. Google.” Here is their:
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.
More detail on SEP Special Enrollment for Contract Violation from Medicare Managed Care Manual – Chapter 2 MAPD Enrollment & Disenrollment – Page 34
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 MAPD Enrollment & Disenrollment
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.
Medicare Complaint Form
https://www.medicare.gov/MedicareComplaintForm/home.aspx
https://individuals.healthreformquotes.com/appeal-grievances/
https://medicare.healthreformquotes.com/fraud-waste-abuse/appeals-grievances/
You can also call 1-800 Medicare
My personal opinion though is it’s better to do it in writing
that way you can bring up all your points
put in in a logical fashion and
you have proof that you sent it to them and that the phone call didn’t disappear