Information for those who counsel people with Medicare Understanding Medicare Enrollment Periods...

Information for those who counsel people

with Medicare

Understanding Medicare Enrollment Periods

August 2015

Session Objectives

This session will help you explain enrollment periods for Medicare Parts A and B Medigap (Medicare Supplement Insurance) policies Medicare Prescription Drug Plans (Part D) Medicare Advantage Plans (Part C)

August 2015 Understanding Medicare Enrollment Periods 2

Lesson 1—Medicare Enrollment Overview

Medicare Choices Medicare Part A and Part B Enrollment Periods Changes to the Social Security Retirement Age Medicare Enrollment for Immigrants Medicare Enrollment for U.S. Citizens Living

Abroad


Understanding Medicare Enrollment Periods 4

Medicare Enrollment Overview

Health insurance for 3 groups of people• 65 and older• Under 65 with certain disabilities• Any age with End-Stage Renal Disease (ESRD)

Medicare enrollment varies• By your age• If you’re receiving Social Security or Railroad Retirement

benefits• By your employment status

August 2015

Understanding Medicare Enrollment Periods 5August 2015

The Four Parts of Medicare


Your Medicare Coverage Choices

Original Medicare

Part AHospital

Insurance

Part BMedical

Insurance

You can add

Medicare Supplement

Insurance (Medigap)

Policy

Part DPrescription

Drug Coverage

or Medicare Advantage Plan

Part CCombines Part A and

Part BMay include or you may add

Part DPrescription Drug Coverage

(Most Part C plans cover prescription drugs. You may be able to add drug coverage to

some plan types if not already included.)

August 2015


Medicare Parts A and B Enrollment forPeople 65 and Over

Initial Enrollment Period (IEP) General Enrollment Period (GEP) Special Enrollment Period (SEP)

August 2015

Change to Social Security Retirement Age

Before 1983 the eligibility age for Social Security and Medicare were both 65

Before 1983

Eligibility Age for Medicare 65

Full Social Security Retirement Age


Social Security & Medicare Enrollment Ages

Since 1983

Eligibility Age for Medicare 65

Full Social Security Retirement Age

Enrollment isn't automatic if you’re not getting Social Security

Some people don’t know they need to sign up for Part A, even if they don’t want Part B

Source: www.socialsecurity.gov/ retire2/agereduction.htmAugust 2015 Understanding Medicare Enrollment Periods 9

http://www.socialsecurity.gov/


Enrolling in Medicare—Automatic

Automatic enrollment for those receiving• Social Security benefits• Railroad Retirement Board benefits

Initial Enrollment Period Package • Mailed 3 months before

65 or 25th month of disability benefits

• Includes your Medicare card

August 2015


Enrolling in Medicare— When It’s Not Automatic

Apply 3 months before you turn 65• Don’t have to be retired

If you’re not automatically enrolled• You need to enroll with Social Security

Visit socialsecurity.gov, or Call 1-800-772-1213, or Visit your local Social Security office

• If retired from a Railroad, enroll with the Railroad Retirement Board Call your local RRB office or 1 877 772 5772‑ ‑ ‑

August 2015


Initial Enrollment Period (IEP)

Your 7-month Initial Enrollment Period • Starts 3 months before your 65th birthday• Includes the month of your 65th birthday • Ends 3 months after your 65th birthday

If you sign up during your IEP, there is no penalty The age for full Social Security is going up• But the age for Medicare is still 65

You need to sign up for Part A at 65, even if you don’t want Part B, if you aren’t getting Social Security

August 2015


Initial Enrollment Period

No DelayIf you

enroll in Part B

3 months before

the month

you turn 65

2 months before

the month

you turn 65

1 month before

the month

you turn 65

Coverage starts

First day of your birthday

month

First day of your birthday

month

First day of your

birthday month

Delayed StartThe

month you

turn 65

1 month after

the month you turn

65

2 months after the month

you turn 65

3 months after the month

you turn 65

The month

following the

month you

enrolled

The 2nd month

following the month

you enrolled

The 3rd month

following the

month you

enrolled

The 3rd month

following the

month you

enrolled

August 2015


Enrolling During the General Enrollment Period

General Enrollment Period (GEP) • For people who didn’t sign up for Part B (or premium

Part A) during their Initial Enrollment Period• Occurs January 1 through March 31 annually• Coverage starts July 1

May have to pay a lifetime Part B penalty• 10% for each 12-months eligible but not enrolled• Limited exceptions

August 2015


Enrolling During theSpecial Enrollment Period

There are few Special Enrollment Periods (SEP) for Medicare Parts A and B• Most people don't qualify for an SEP

Must have group health plan coverage based on active, current employment of you or your spouse• Not COBRA, retiree coverage, long-term workers’ compensation or Veterans

Affairs coverage

Can enroll• Anytime still covered by group health plan, or

• Within 8 months of the loss of coverage or current employment, whichever happens firstAugust 2015

Medicare Enrollment for Immigrants

An immigrant may purchase Medicare Part A and/or Part B if he or she meets all of these criteria• 65 or older• Lawfully admitted for permanent residence• Have lived in the U.S. without a break for the 5-year period

immediately before the month they file for enrollment


Medicare Enrollment for U.S. Citizens Living Abroad

Medicare enrollment rules apply to citizens living abroad Medicare generally only covers care received in the U.S.


You live abroad and Enrollment Considerations

You turn 65 and are getting Social Security benefits.

You are automatically enrolled in Medicare Part A. You must proactively enroll in Medicare Part B.

If you don’t take Part B when you are first eligible, you may only apply for Part B during the General Enrollment Period (January 1 through March 31) and you may have to pay higher premiums.

You’re over 65 and are eligible for Social Security benefits but you’re not yet taking them.

You may file an application for Social Security benefits and Part A.

You’ll have to file for Medicare Part B during the General Enrollment Period (January 1 through March 31) and you may have to pay higher premiums.

You’re not eligible for Social Security benefits and you’ve just turned 65.

You must live in the U.S. to enroll in Medicare Part B.

You’re first eligible to enroll in Part B the month you return to the U.S. to establish your new residence. You won’t have to pay a higher premium if you enroll in Part B within the first 4 months of your return to the U.S.

Check Your Knowledge—Question 1

For people born in 1960 and later, the full Social Security retirement age isa. 62 yearsb. 65 yearsc. 67 yearsd. 70 years



If you enroll in Part B during the General Enrollment Period (January 1 – March 31) your coverage will start ona. The first day of the

month after you enrollb. April 1c. May 1d. July 1



Which of the following is not a criteria for an immigrant to purchase Medicare Part A and/or Part B? He or she musta. Be 65 or olderb. Must have blood relative

that’s a legal U.S. citizenc. Be lawfully admitted for

permanent residenced. Have lived in the U.S. without

a break for the 5-year period immediately before the month they file for enrollment


Lesson 2—Medicare Enrollment Based On a Disability

Qualifying for Medicare Based on a Disability Medicare Enrollment for People With a

Disability Retroactive Medicare Coverage Medicare & End-Stage Renal Disease (ESRD)• Enrollment Considerations• Rules for ESRD coverage



Qualifying for Medicare Based on Disability

Medicare usually begins after getting Social Security Disability Insurance (SSDI) for 24 months• Unless you have Amyotrophic Lateral Sclerosis

Medicare begins first month entitled to SSDI Generally, this means you get Medicare in the 30th

month after you become disabled• 5-month waiting period for SSDI benefits• Followed by 24-month waiting period for Medicare

August 2015

Medicare Enrollment for People with Disabilities

You’re automatically enrolled in Medicare if you qualify based on disability

You’ll get an Initial Enrollment Period package • 3 months before 25th month of disability benefits• If you have Amyotrophic Lateral Sclerosis – about 4 weeks

after Medicare entitlement You need to decide whether to• Keep Part B• Enroll in Part D



Retroactive Entitlement to Medicare

In some cases, your entitlement to Medicare may be retroactive• If your disability benefits are retroactive• Your Medicare card will show effective date• If you’ve received Medicare-covered services prior

You may request that your provider submit those claims to Medicare

Services must have been received after the effective date on your Medicare card

August 2015


Information Received with Retroactive Determination

You’ll get this information with your determination:• Your effective date of Part A coverage (the 25th month of

disability benefit entitlement)• Your effective date of Part B coverage (the month of

processing), and the option to elect Part B coverage starting with the 25th month of disability benefit entitlement

To exercise your option for retroactive Part B coverage you must submit a written request and agree to pay all retroactive premiums due

August 2015


How Long Are You Entitled to Medicare?

As long you meet the Social Security definition of disability

Social Security has work incentives if you go back to work• Medicare continues if you’re working but still disabled• You can get premium-free Part A for 8½ years after you

return to work• You may purchase Part A coverage afterward

The reason for your Medicare entitlement changes at 65• Any penalty you may have had for late enrollment is

removed at that timeAugust 2015


Applying for Disability Benefits

To apply for disability benefits, you’ll need your• Social Security number• Proof of age• Health care provider information• Medical records, including lab/test results and medications• Work history• Most recent W-2 or self-employment tax return

Don’t wait to apply • Even if you’re still gathering information

August 2015

Medicare Enrollment Based on End-Stage Renal Disease

Eligibility requirements• Any age• Kidneys no longer function, and • Must have worked the required amount of time or• Getting or be eligible for Social Security, Railroad

Retirement, or federal retirement benefits or An eligible child or An eligible spouse (including through same-sex marriage)



Medicare Part B (Medical Insurance) Eligibility

You can enroll in Part B if entitled to Part A based on ESRD• You pay the monthly Part B premium• You may pay a penalty if you delay taking Part B

You need both Part A and Part B for complete coverage For more information• Call Social Security at 1-800-772-1213

TTY users should call 1-800-325-0778• Railroad retirees call the Railroad Retirement Board at 1-877-

772-5772 TTY users should call 1-312-751-4701

August 2015


Enrolling in Medicare Part B

Enrollment based on ESRD may eliminate your Part B penalty if you already had Medicare due to age or disability• If you didn’t enroll when you were first eligible

If you have Medicare due to ESRD and reach 65• You have continuous coverage• Those not enrolled in Part B will be enrolled• You can decide whether or not to keep it

August 2015


Delaying Medicare Part B

If you enroll in Part A and delay enrolling in Part B• You must wait for a General Enrollment Period

January 1 to March 31 each year, coverage effective July 1 of the same year

• You may have to pay a higher premium for as long as you have Part B

10% for each 12-month period, you were eligible but not enrolled

No Special Enrollment Period for those with End-Stage Renal Disease

August 2015


Medicare and Group Health Plan (GHP) Coverage (30-Month Coordination Period)

If enrollment is based solely on ESRD• GHP/employer is the only payer during first 3 months

Medicare is the secondary payer during the 30-month coordination period• Begins when first eligible for Medicare even if not enrolled

Separate coordination period each time enrolled based on ESRD• No 3-month waiting period• New 30-month coordination period if you have GHP

coverage

August 2015


Enrollment Considerations– Immunosuppressive Drugs

If You Your Immunosuppressive Drugs

Are entitled to Part A at time of transplant and Medicare paid for your transplant

and the transplant took place in a Medicare-approved facility or

Medicare was secondary payer but made no payment

Are covered by Part B Medicare pays 80% You pay 20%• Coinsurance costs don’t count

toward catastrophic coverage under Part D

Didn’t meet the transplant conditions above

May be covered by Part D (unless you would be covered by Part B, but you haven't enrolled in Part B) Costs vary by plan Helps cover drugs needed for

other conditions

August 2015


Enrollment Considerations– 30-Month Coordination Period

You might want Medicare during the coordination period• To pay the group health plan deductible/coinsurance• If you're getting a transplant soon

Affects coverage for immunosuppressive drugs Coverage for living donor

Delaying Part B or Part D could mean • Waiting for applicable enrollment period to enroll• Possible penalty for late enrollment

August 2015


How to Enroll in Medicare Part A and Part B Based on ESRD

Enroll at your local Social Security office Get doctor/dialysis facility to fill out Form CMS-2728• If Social Security gets the form before you enroll, they may

contact you to see if you want to enroll

If you have a group health plan, you may want to delay enrolling • Near the end of the 30-month coordination period

• Won’t have to pay Part B premium until you need it

Get facts before deciding to delay• Especially if transplant is planned

August 2015


When Medicare Coverage Based on ESRD Starts

Your Coverage Starts Under the Following Circumstances

1st day of the 4th month You get a regular course of dialysis in a facility

1st day of the month of the 1st month

You participate in a home dialysis training program during the first 3 months of your regular course of dialysis (with expectation of completion)

1st day of the month You get a kidney transplant

1st day of the month You’re admitted to a Medicare-approved transplant facility for a kidney transplant or procedures preliminary to a kidney transplant if transplant takes place in the same month or within the following 2 months

2 months before the month of your transplant

Your transplant is delayed more than 2 months after you’re admitted to the hospital for the transplant or for health care services you need for the transplant

August 2015


When Coverage for ESRD Ends, Continues or Resumes

When Coverage Ends

When Coverage Continues

When Coverage Resumes

Entitlement based solely on ESRD• Coverage ends 12

months after the month you no longer require a regular course of dialysis or

• Thirty-six months after the month of your kidney transplant

• No interruption in coverage if you start a regular course of dialysis again within 12 months after regular dialysis stopped or

• You have a kidney transplant or

• Regular course of dialysis starts within 36 months after transplant or you received another kidney transplant within 36 months after transplant

Must file new application and there's no waiting period if• You start a regular

course of dialysis again or get a kidney transplant more than 12 months after you stopped getting a regular course of dialysis

• You have another kidney transplant > 36 months later

August 2015



Kevin has an endocrine disorder and started receiving Social Security Disability Insurance this month. How long will Kevin have to wait until he can get Medicare?

a. 24 monthsb. 36 monthsc. 48 monthsd. There is no waiting period.

He can get Medicare immediately.

Lesson 3—Medigap (Medicare Supplement Insurance Policy) Enrollment Period

Medigap Open Enrollment Switching Medigap Policies



Medigap Open Enrollment Period

Your Medigap Open Enrollment Period (OEP)• 6 months when insurance company must sell• Guaranteed issue period without medical

underwriting• Your one OEP begins when you’re 65 or older and

enrolled in Part B Can’t be changed or repeated

• Some states have more generous rules May buy a Medigap policy any time an insurance

company will sell you oneAugust 2015


Pre-existing Conditions and Medigap

Health problem you had before the new insurance policy starts • Treated or diagnosed 6 months before coverage start date

Pre-existing Condition Waiting Period• Insurance companies can refuse to cover out-of-pocket costs

for excluded condition for up to 6 months (“look-back period”) Without 6 months of prior creditable coverage and no

break in coverage more than 63 days

The Affordable Care Act doesn’t impact the pre-existing condition waiting period for Medigap coverage.

August 2015


Guaranteed Issue Rights

Federal protections in certain situations• Companies must sell you a Medigap policy• All pre-existing conditions must be covered• Can’t be charged more• Must apply within 63 days of date other coverage ends

See Appendix A for all situations

August 2015


Medigap for People With a Disability orEnd-Stage Renal Disease (ESRD)

People with a disability or ESRD may not be able to buy a policy until they turn 65• Some states require insurers to sell Medigap policies

to people with a disability or ESRD Companies may voluntarily sell Medigap policies• May cost more than policies sold to people over 65• Can use medical underwriting

Get a Medigap Open Enrollment Period at 65

August 2015


Sarah turns 65 next month, and has enrolled in Medicare Parts A and B. How many Medigap Open Enrollment Periods will she get?

a. None – you can sign up for a Medigap plan anytime

b. Onec. One each yeard. Two each year, if you count

Special Enrollment periodsAugust 2015 Understanding Medicare Enrollment Periods 44

Lesson 4—Enrollment Periods for Medicare Prescription Drug Coverage (Part D)

Initial Enrollment Period Open Enrollment Period Special Enrollment Periods


Part D Initial Enrollment Period (IEP)

When you first become eligible to get Medicare• 7-month IEP for Part D

If You Join Coverage BeginsDuring the 3 months before you turn 65

Date eligible for Medicare

During the month you turn 65 First day of the following month

During the 3 months after you turn 65

First day of the month after month you apply


When You Can Join or Switch Plans Part D Plans

Medicare’s Open Enrollment Period is October 15–December 7 each year, coverage starts January 1

You can leave a Medicare Advantage Plan and switch to Original Medicare from January 1–February 14 each year

• You have until February 14 to also join a Part D plan If you don’t have Medicare Part A coverage, and enroll in

Part B during the General Enrollment Period (January 1–March 31), you can sign up for a Medicare Prescription Drug Plan from April 1–June 30 each year


Part D Special Enrollment Period (SEP)

Life events that allow an SEP include You permanently move out of your plan’s service area You lose other creditable prescription coverage You weren’t properly told that your other coverage wasn’t

creditable, or your other coverage was reduced and is no longer creditable

You enter, live at, or leave a long-term care facility You have a continuous SEP if you qualify for Extra Help You belong to a State Pharmaceutical Assistance Program Other exceptional circumstances


5-Star Special Enrollment Period (SEP)

Use Medicare Plan Finder tool at Medicare.gov to see quality and performance ratings

Star ratings are given once a year, assigned in October of the past year

Use 5-star SEP to switch to any 5-star plan one time• December 8–November 30 of following year• Coverage starts first day of month after enrolled• Be careful not to switch from a Medicare Advantage (MA)

Plan with drug coverage to an MA Plan with no Part D coverage


Low Performing Plan

Low performing star rating status • You may have a one-time option to switch

to another Medicare drug plan with a rating of 3, 4, or 5 stars if your plan’s summary rating was less than 3 stars for 3 years

• Low Performance Icon (LPI) appears on Plan Finder

• Plans may not attempt to discredit their LPI status by showcasing a separate higher rating


Check Your Knowledge—Question 6Check Your Knowledge—Question 6

You can add or switch a Medicare Part D plan during Medicare’s Open Enrollment Period (October 15–December 7) each year.a. Trueb. False


Lesson 5—Enrollment Periods for Medicare Advantage Plans (Part C)

Initial Enrollment Period Open Enrollment Period Special Enrollment Periods 5-Star Special Enrollment Period


When You Can Join or Switch Medicare Advantage Plans

Initial Enrollment Period

7-month period begins 3 months before the month you turn 65 Includes the month you turn 65 Ends 3 months after the month you turn 65

Medicare Advantage Initial Enrollment

You must have both Medicare Part A and Part B to enroll in a Medicare Advantage (MA) Plan.If you didn’t enroll in Part B when you were first eligible, your MA enrollment period: Begins 3 months immediately before your first entitlement to both

Medicare Parts A and B ends, and the later of • The last day of the month preceding entitlement to both

Part A and Part B or• The last day of the individual’s Part B initial enrollment period

Medicare Open Enrollment Period

October 15–December 7 Coverage begins January 1

Medicare due to a Disability

7-month period begins 3 months before the 25th month of disability.

Ends 3 months after the 25th month of disability.


When You Can Join or Switch Plans

Special Enrollment Periods (SEP)

Move out of your plan’s service area Plan leaves Medicare program or reduces its service

area Leaving or losing employer or union coverage You enter, live at, or leave a long-term care facility You have a continuous SEP if you qualify for Extra

Help Losing your Extra Help status You join or switch to a plan that has a 5-star rating Retroactive notice of Medicare entitlement Other exceptional circumstances

August 2015


When You Can Join or Switch MA Plans5-Star Special Enrollment Period (SEP)

Can enroll in 5-star Medicare Advantage (MA), Prescription Drug Plan (PDP), Medicare Advantage Plan with prescription drug coverage (MA-PD), or Cost Plan

Enroll once per year from December 8, 2014–November 30, 2015

New plan starts first day of month after enrolled Star ratings given once per year• Ratings assigned in October and effective January

1st• Use Medicare Plan Finder to see star ratings

Look at Overall Plan Rating to find eligible plans

August 2015


Medicare Advantage Plan Disenrollment Between January 1–February 14• You can leave a Medicare Advantage Plan and

switch to Original Medicare• If you make this change, you may also join a

Medicare Prescription Drug Plan to add drug coverage

• Coverage begins the first of the month after the plan gets enrollment form

• Check whether you could get a Medigap policy

August 2015

Check Your Knowledge—Question 7Check Your Knowledge—Question 7

Which of these is not a reason to qualify for a Medicare Advantage Plan Special Enrollment Period?a. You move out of the plan’s

serving areab. Your doctor leaves the

Medicare Advantage Planc. You have a chance to enroll

in other coverage offered by your employer or union

d. You’re released from jailAugust 2015 Understanding Medicare Enrollment Periods 57

National Training Program Contact Information

To view all available NTP training materials, or to subscribe to our email list, visit

CMS.gov/Outreach-and-Education/Training/ CMSNationalTrainingProgram/index.html

For questions about training products email [email protected]

http://www.cms.gov/Outreach-and-Education/Training/CMSNationalTrainingProgram/index.html

http://www.cms.gov/Outreach-and-Education/Training/CMSNationalTrainingProgram/index.html

mailto:[email protected]

Appendix A—page 1

This chart describes the situations, under federal law, that give you a right to buya policy, the kind of policy you can buy, and when you can or must apply for it.States may provide additional Medigap guaranteed issued rights.


Appendix A—page 2

This chart describes the situations, under federal law, that give you a right to buya policy, the kind of policy you can buy, and when you can or must apply for it.States may provide additional Medigap guaranteed issued rights. (Continued)


Special Enrollment Periods (SEPs)for Part C and Part D—page 1

August 2015 61Understanding Medicare Enrollment Periods

Changes in where you live

If this describes you… You can… At this time…

You move to a new address that isn’t in your plan’s service area.

Switch to a new Medicare Advantage or Medicare Prescription Drug Plan.

If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move. If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months.

You move to a new address that’s still in your plan’s service area, but you have new plan options in your new location.You move back to the U.S. after living outside the country.

Join a Medicare Advantage or Medicare Prescription Drug Plan.

Your chance to join lasts for 2 full months after the month you move back to the U.S.



Changes in where you live If this describes you… You can… At this time…

You just moved into, currently live in, or just moved out of an institution (like a skilled nursing facility or long-term care hospital).


Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan.

Drop your Medicare Advantage Plan and return to Original Medicare.

Drop your Medicare prescription drug coverage.

Your chance to join, switch, or drop coverage lasts as long as you live in the institution and for 2 full months after the month you move out of the institution.

You’re released from jail.


Your chance to join lasts for 2 full months after the month you’re released from jail.


Changes that cause you to lose your current coverageIf this describes you… You can… At this time…

You’re no longer eligible for Medicaid.





Your chance to change lasts for 2 full months after the month you find out you’re no longer eligible for Medicaid.

You leave coverage from your employer or union.


Your chance to join lasts for 2 full months after the month your coverage ends.


64Understanding Medicare Enrollment Periods


Changes that cause you to lose your current coverage


You involuntarily lose other drug coverage that’s as good as Medicare drug coverage (creditable coverage), or your other coverage changes and is no longer creditable.

Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.

Your chance to join lasts for 2 full months after the month you lose your creditable coverage or are notified of the loss of creditable coverage, whichever is later.

You have drug coverage through a Medicare Cost Plan and you leave the plan.

Join a Medicare Prescription Drug Plan.

Your chance to join lasts for 2 full months after the month you drop your Medicare Cost Plan.

August 2015


Changes that cause you to lose your current coverage


You drop your coverage in a Program of All-inclusive Care for the Elderly (PACE) plan.


Your chance to join lasts for 2 full months after the month you drop your PACE plan.

You find out that you won’t be eligible for Extra Help for the following year.





Your chance to change is between January 1–March 31.



You have a chance to get other coverage


You have a chance to enroll in other coverage offered by your employer or union.

Drop your current Medicare Advantage or Medicare Prescription Drug Plan to enroll in the private plan offered by your employer or union.

Whenever your employer or union allows you to make changes in your plan.

You have or are enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage).

Drop your current Medicare Advantage Plan with drug coverage or your Medicare Prescription Drug Plan.

Anytime.



You have a chance to get other coverage


You enroll in a Program of All-inclusive Care for the Elderly (PACE) plan

Drop your current Medicare Advantage or Medicare Prescription Drug Plan

Anytime

You live in the service area of one or more Medicare Advantage or Medicare Prescription Drug Plans with an overall quality rating of 5 stars

Join a Medicare Advantage, Medicare Cost, or Medicare Prescription Drug plan with an overall quality rating of 5 stars

One time between December 8, 2012–November 30 each year




Changes in your plan’s contract with Medicare


Medicare takes an official action (called a “sanction”) because of a problem with the plan that affects you

Switch from your Medicare Advantage or Medicare Prescription Drug Plan to another plan

Your chance to switch is determined by Medicare on a case-by-case basis

Your plan’s contract ends (terminates) during the contract year

Switch from your Medicare Advantage or Medicare Prescription Drug Plan to another plan

Your chance to switch starts 1 months before and ends 2 full month after the contract ends

Your Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan’s contract with Medicare isn’t renewed for the next contract year

Join another Medicare Advantage or Medicare Prescription Drug Plan

Between October 15 and the last day in February



Changes due to other special situations


You’re eligible for both Medicare and Medicaid

Join, switch, or drop a Medicare Advantage Plan or Medicare prescription drug coverage

Anytime

You qualify for Extra Help paying for Medicare prescription drug coverage

Join, switch, or drop Medicare prescription drug coverage

Anytime

You’re enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility

Join either a Medicare Prescription Drug Plan or a Medicare Advantage Plan with prescription drug coverage

Once during the calendar year





You dropped a Medicare Supplemental Insurance (Medigap) policy the first time you joined a Medicare Advantage Plan

Drop your Medicare Advantage Plan and enroll in Original Medicare. You’ll have special rights to buy a Medigap policy

Your chance to drop your Medicare Advantage Plan lasts for 12 months after you join the Medicare Advantage Plan for the first time

You have a severe or disabling condition, and there’s a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with your condition

Join a Medicare Chronic Care Special Needs Plan (SNP) that serves people with your condition

You can join anytime, but once you join, your chance to make changes using this SEP ends





You weren’t properly told that your other private drug coverage wasn’t as good as Medicare drug coverage (creditable coverage)

Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan

Your chance to join lasts for 2 full months after the month you get a notice of the error from Medicare

You weren’t properly told that you were losing private drug coverage that was as good as Medicare drug coverage (creditable coverage)


Your chance to join lasts for 2 full months after the month you get a notice of the error from Medicare





You joined a plan, or chose not to join a plan, due to an error by a federal employee


Switch from your current plan to another Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan

Drop your Medicare Advantage Plan with drug coverage and return to Original Medicare

Drop your Medicare prescription drug coverage

Your chance to change coverage lasts for 2 full months after the month you get a notice of the error from Medicare

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