Medicare HMO Careplus - ENROLLMENT OPTIONS AND PERIODS

Enrollment Options

** Enroll in a Medicare Advantage Plan that has prescription drug coverage;
** Enroll  in  a  stand  alone  Prescription  Drug  Plan  (PDP)  for  the  prescription  drug  coverage,  and receive health care coverage from traditional Medicare;
** Enroll in a Medicare Advantage Plan that doesn’t have prescription drug coverage. 

There are Five types of Election Periods during which individuals may make enrollment changes for MA plans:
** The Annual Election Period (AEP);
** The Initial Coverage Election Period (ICEP);  
** The Open Enrollment Period for Institutionalized Individuals (OEPI);
** All Special Election Periods (SEP); and
** The Medicare Advantage Disenrollment Period (MADP)

People who are new to Medicare have an Initial Coverage Election Period (ICEP) that is similar to the Initial  Enrollment  Period  for  Part  B.  This  period  begins  three  (3)  months  immediately  before  the individual’s first entitlement 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  AEP  is  from  October 15th  through December 7th  of each  year.  During the AEP  the member may enroll or disenroll from an MA plan.  Changes made would take effect January 1st of the following year. 

The  MADP  is  from  January  1st  through  February  14th  of  every  year.  During  the  MADP,  MA  plan enrollees may prospectively disenroll from any MA plan and return to Original Medicare.  

Special Enrollment Periods (SEP)
** Change in Residence
** MA contract violation
** MA Non-renewal or Terminations
** SEPs for Exceptional Conditions
o  Employer/Group Health Plan
o  Individuals who disenroll if CMS sanctions an MA plan
o  Individuals enrolled in Cost Plans that are Non-renewing their contracts
o  Individuals in the Program of All-Inclusive Care for the Elderly (PACE)
o  Dual-Eligible individual(s) or individuals who lose their dual-eligibility
o  Individuals who dropped a Medigap Policy when they are enrolled for the first time in an MA plan, and who are still in a “trial period”
o  Individuals with ESRD whose entitlement determination is made retroactively
o  Individuals whose Medicare entitlement determination is made retroactively
o  MA SEPs to Coordinate with Part D Enrollment Periods
o  Individuals  who has  an involuntary loss of creditable coverage, not including a loss due to failure to pay plan premiums
o  Individuals who lose Special Needs Status

o  Individuals  who  belong  to  a  Qualified  State  Pharmaceutical  Assistance  Program (SPAP) or lose SPAP eligibility
o  Non-Dual Eligible Individuals with LIS and Individuals who lose LIS
o  Enrollment into a Chronic Care SNP and Individuals Found Ineligible for a Chronic Care SNP
o  Disenrollment from Part D to Enroll in or Maintain other Creditable Coverage
o  Enrollment in an MA plan or PDP with a Plan Performance Rating of five (5) stars o  SEPs for Beneficiaries Age 65
o  Individuals entering, residing or leaving a long term care facility

Note: Unless they show proof of “creditable coverage”, people with Medicare who do not enroll in a drug plan when they are first eligible will likely have to pay a penalty if they choose to enroll in a drug plan later.