Medicare Enrollment Period Dates, Chart, ICEP, AEP, Open Enrollment Dates
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
Jump to section on:
- Medicare Advantage Open Enrollment Period ( MAOEP)
- Part D IEP Initial Election Period
- Annual Election Period (AEP) §30.1
- ACA – Obamacare – under 65
- Turn 65 Initial Coverage Election Period (ICEP)
- Medi Gap – Supplemental
- Special, Annual & Initial Enrollment Periods
- Medicare Part B Dr. Visits & Outpatient
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:
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.
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
When you #turn65
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
It's best to enroll in Medicare A & B 3 months #before you turn 65
Graphic of when you can enroll based on turning age 65 * Publication 11036 *
- Chart from Medicare.Gov on when coverage starts
- Be sure to work on your Enrollment in Parts A & B as soon as your eligible to do so. We will NOT take the flack if you run into SNAFU's. Some brokers make you sign this form, if you don't enroll early.
- Video from HHS.Gov on Initial Enrollment Period
- Use this Medicare tool to Find out when you’re eligible for Medicare.
- The best time to sign up is 3 months before your 65th birthday and coverage will start on the 1st of the month of your birthday. Be sure to let your prior carrier know at least 30 days in advance that you have new coverage and want to cancel. Especially if it's Covered CA! That way you don't have double premiums and duplicate coverage.
- Consolidated Appropriations Act, 2021 to starting January 1, 2023 change the effective date to the month after enrollment! If you're late. CMS.Gov Fact Sheet * Proposed Rule *
- Once you enroll in Parts A & B, you are then eligible to get a Medi Gap Plan and part D Rx or Medicare Advantage (HMO) to fill in the gaps that Medicare doesn't pay. Please note that prescription drug coverage is effectively mandatory as there is a penalty when you eventually sign up, if you didn't sign up when you are supposed to.
The Annual Election Period (#AEP) aka Open Enrollment §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. We offer:
- The last enrollment request made, determined by the application date, will be the enrollment request that takes effect. CMS.gov *
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.
#Understanding Medicare Advantage Plans (PDF) #12026
Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan. MAPD Plans must cover all A & B services Medicare.Gov *
That's why the premium is very low or ZERO!
- Set a phone or Skype Meeting
- We can now do SOC Scope of Appointment, before the Meeting via a 3 minute recorded meeting 2 days before. AHIP Training Module 4 Page 14 *
- #Intake Form - We can better prepare for the meeting
- HMO - Narrow Networks?
- Do I just sign up with a Medicare Advantage Company and automatically get * Parts A & B or do I have to get those from Medicare.Gov * VIDEO
- Get Quotes, Full Information and Enroll
- MANDATED wording!: Think Advisor * ‘‘We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.’’
- We disagree with the above wording, as we can use the same tools on Medicare.gov as they do!
- FYI a 4.27.2022 HHS Office of the Inspector General report found that MAPD plans denied 13% of prior authorizations that would have been covered under original Medicare (Conversely, Medi Gap, just follows what Medicare pays.)
- 88% of MAPD enrollees are happy
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MAPD plans often include Dental & Part D - Rx Prescriptions and often have NO premiums! How is that possible? The Federal Government pays them around $700/month to handle your medical care. You must continue to pay your Medicare Part B premium of about $170/month. It's best to apply when you turn 65 for the supplement plans or advantage plans, as that's the main "Open Enrollment" period, guaranteed issue for any plan.
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Medicare Advantage Plans also have an annual open enrollment now known as AEP Annual Election Period October 7 to December 15th.
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Additional Coverage is important as Medical Bills are increasing Seniors Credit Card Debt or leading to possible bankruptcy?
Blue Shield of California Authorized Agent - Broker
#Medicare10050 and You 2024
Everything you want to know
- Steve's Video Seminar Introduction to Medicare & You
- Audio from Medicare.Gov
- Clear View to Medicare Patient Advocate.org - 36 pages
***********
- Your Medicare #Benefits # 10116
- Don't like computers? Prefer a printed version be mailed to you? Audio MP 3
- Inpatient ONLY - How Medicare Pays for your Surgery Part A vs Part B Very Well Health.com
- medicare.gov/coverage
- Enroll in Blue Cross
- Learn about UHC United Health Care
- Enroll in Blue Shield
- Use our scheduler to Set a phone, Skype or Face to Face meeting
- TITLE XVIII—HEALTH INSURANCE FOR THE AGED - Medicare AND DISABLE
#Special, Annual & Initial Enrollment Periods CHARTS
For MAPD Medicare Advantage aka Part C & Medicare + Choice & Part D Rx
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 Annual Election Period aka 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 Medi Cal (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
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/
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
Child & Related Pages – Site Map
[child-pages]
My son receives ssi Supplemental Security Benefits and was approved by my employer to continue to stay on my plan after age 26; Its been 8 months now.
He is on medication and feeling better and stronger.
He wants to try working.
Do I need to have him cancel his insurance policy with my employer before attempting work?
Please read the definition of being able to stay on the parents plan if disabled three times and when you think you understand it read it again.
Then check out – working while disabled and read that 3 times.
After you’ve done that, set a zoom meeting and we can discuss it. Mind you I’m not an attorney.
https://www.modernhealthcare.com/medicare/cms-proposes-5-medicare-special-enrollment-periods
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 for list of qualifying questions in the application
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