Medicare Advantage and Change in Coverage Eligibilty - Mature Health Center

Information you need to live a happy, worry-free retirement!

Aug 23, 2012

Medicare Advantage and Change in Coverage Eligibilty

Unless you are enrolling in Medicare for the first time, Medicare Advantage enrollments are limited to specific times of year or following specific events (changes in coverage). Read below to see if you qualify for any of these enrollment periods.

Initial Coverage Election Period
The Initial Coverage Election Period ICEP (not to be confused with the Initial Enrollment Period IEP for Medicare Part D) is a one-time event when an individual first has the opportunity to enroll in a Medicare Advantage (MA) plan. It occurs for most people when turning age 65 and enrolling in Medicare Parts A & B for the first time. This period begins three months before an individual is first eligible for both Medicare Part A and Part B, and ends on the later of:

  • the last day of the month before the individual is eligible for Parts A and B, or;
  • the last day of the individual's Part B initial enrollment period. The initial enrollment period for Part B is the seven month period that begins three months before the month an individual meets the eligibility requirements for Part B, and ends three months after the month of eligibility.

The Initial Coverage Election Period for a Medicare Advantage (MA) enrollment election will frequently relate to either the individual's 65th birthday or the 25th month of disability, but it must always relate to the individual's entitlement to both Medicare Part A and Part B. When an individual enrolls in a Medicare Advantage-Prescription Drug (MA-PD) plan she/he used both the Initial Coverage Election Period and the Initial Enrollment Period (IEP) for Part D.

The Initial Enrollment Period for Medicare Part D Drug Plans (PDP) is the same as the Initial Enrollment Period for Medicare Part B (the seven month period that begins 3 months before the month an individual meets the eligibility requirement for Part B, and ends 3 months after the month of eligibility.

During the Initial Enrollment Period for Part D, individuals may make one Part D enrollment choice, including enrollment in an MA-PD plan. Individuals eligible for Medicare prior to age 65 (such as disability) will have another Initial Enrollment Period for Part D based on upon attaining age 65.

Annual Election Period (AEP)
The Annual Election Period for coverage effective in a calendar year begins October 15th of the previous calendar year and ends December 7th. During this period, anyone who is enrolled in Medicare may enroll for the first time in a Medicare Advantage Plan; or change from one Medicare Advantage Plan to another; or return to Original Medicare from a Medicare Advantage Plan.

If during this period you enroll in a Medicare Advantage Plan that includes Medicare Part D prescription drug coverage—these plans are known as MA-PD plans—then any prior Medicare Part D Plan coverage is automatically cancelled and replaced by the new plan. Enrollments during this period have an effective date of January 1st.

Special Election Period (SEP)
A Special Election Period means that you are allowed to enroll in Medicare Advantage after the IEP and/or AEP because you meet certain conditions set forth by the government. Below are some specific situations which might qualify you for a SEP.

You may qualify for a Special Election Period if:

  • You are a disaster evacuee and reside in certain zip codes as identified by the Federal Emergency Management Agency at the time of the disaster.
  • You move permanently outside your plan's service area.
  • You're enrolled in another prescription drug plan or a Medicare Advantage plan whose contract is terminated.
  • You are not adequately informed about creditable prescription drug coverage.
  • You lose your previous creditable coverage through no action of your own*.
  • Your enrollment or non-enrollment is caused by an error by a federal employee or contractor hired by the federal government.
  • You were eligible for both Medicare and Medicaid (a "dual eligible") but you lost your dual eligibility status.
  • You want to move from an employer-sponsored prescription drug plan to a Medicare Prescription Drug Plan.
  • You want to leave your current Medicare Prescription Drug Plan because it was reprimanded by the federal government or the federal government has determined the plan violated a material provision of its Medicare contract in relation to services provided to you.
  • You're enrolled in a Cost Plan that isn't renewing its contract with Medicare. This SEP begins 90 calendar days prior to the end of the contract year (i.e., October 1) and ends on December 31st of the same year.
  • You want to move from a Program of All-Inclusive Care for the Elderly—PACE—to a Medicare Prescription Drug Plan.
  • You live in—or are moving in or out of—a skilled nursing facility, nursing facility, intermediate care facility for the mentally retarded, psychiatric hospital or unit, rehabilitation hospital or unit, long-term care hospital or swing-bed hospital.
  • Your Medicare entitlement determination is made retroactively.
  • You are not eligible for premium free Part A and enroll in Medicare Part B during the January-March Part B General Enrollment Period.
  • You have a low-income subsidy.
  • The federal government may authorize other special election periods.

Can I change my Medicare Advantage plan after I enroll?
Once enrolled in an MA or MA-PD Plan you must wait to change plans until the next Annual Election Period (AEP) every year: October 15th – December 7th. Some categories of beneficiaries are not bound by the lock-in rules and may enroll or disenroll from an MA plan in other than the AEP. An individual may at any time, during a designated Special Election Period (SEP), discontinue the election of an MA plan offered by an MA organization and change his or her election to original Medicare or to a different MA plan. Examples of situations which may entitle an individual to an SEP include the termination or discontinuation of a plan, a change in residency out of the service area, the organization violating a provision of a contract or misrepresenting the plan's provisions, or the individual meeting other exceptional conditions as CMS may provide. CMS has also designated an SEP for individuals entitled to Medicare A and B and who receive any type of assistance from Title XIX (Medicaid), including full-benefit dual eligible individuals, as well as those eligible only for the Medicare Savings Programs. This SEP lasts from the time the individual becomes dually eligible until such time as they no longer receive Medicaid benefits. Individuals who are eligible for an SEP under the guidance for Part D enrollment and disenrollment may use that SEP to also make an election into or out of an MA-PD plan.

Important Medicare Advantage Dates to Remember

October 15th
Annual Election Period begins. First day you may elect to enroll in a Medicare Part D Plan, effective next calendar year.

December 7th
Last day you can enroll or change Medicare Part D Prescription Drug plans for the next calendar year, unless you qualify for an exception.

January 1
First day you can use your Part D Prescription Drug Plan (PDP) card for that plan year.

Some categories of beneficiaries are not bound by the lock-in rules and may enroll or disenroll from a PDP plan in other than the AEP. An individual may at any time, during a designated Special Election Period (SEP), discontinue the election of a PDP plan offered by an PDP organization and change his or her election to original Medicare or to a different PDP plan. Examples of situations which may entitle an individual to an SEP include the termination or discontinuation of a plan, a change in residency out of the service area, the organization violating a provision of a contract or misrepresenting the plan’s provisions, or the individual meeting other exceptional conditions as CMS may provide. CMS has also designated an SEP for individuals entitled to Medicare A and B and who receive any type of assistance from Title XIX (Medicaid), including full-benefit dual eligible individuals, as well as those eligible only for the Medicare Savings Programs. This SEP lasts from the time the individual becomes dualy eligible until such time as they no longer receive Medicaid benefits. Individuals who are eligible for an SEP under the guidance for Part D enrollment and disenrollment may use that SEP to also make an election into or out of an MA-PD plan.