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Medicare Enrollment Overview

Published byChad O’Neal’ Modified over 5 years ago

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Presentation on theme: "Medicare Enrollment Overview"— Presentation transcript:

1 Medicare Enrollment Overview
Ginger Rogers Medicare Part D Program Coordinator

2 Topics Medicare Eligibility Enrollment Periods
IEP SEP AEP MAEP GEP Key Dates for Enrollment Changes during the Enrollment Periods

3 Enrollment Periods Initial Enrollment Special Enrollment Period (SEP)
Annual Enrollment Period Medicare Advantage Open Enrollment Period General Enrollment Period Lesson descriptions should be brief.

4 Medicare Eligibility Automatic or Not Automatic
Worked at least 10 years in a job(s) that paid into Social Security United States citizen or permanent legal resident for 5 consecutive years Age 65 - not automatic Must sign up for Medicare at Social Security website or in person at Social Security office Receiving SSDI for 24 months or Railroad Retirement Board Disability - automatic Receiving Social Security Retirement benefits before age 65 - automatic End Stage Renal Disease (ESRD) - automatic Lou Gehrig’s Disease –Amyotrophic Lateral Sclerosis (ALS) - automatic Medicare eligibility is not automatic if not receiving SSA retirement or SSDI benefits. A person must sign up at age 65 during their initial enrollment period or may face penalties.

5 Enrollment Periods Is your client eligible? Yes, No, Maybe. At the end of this short training you will be able to explain the requirement for enrollment in Medicare and Part c and d. Save files to the team Web server. Move files to different locations on the team Web server. Share files on the team Web server.

6 Initial Enrollment Period (IEP)
7 month period surrounding the effective date of Medicare eligibility, or Age 65 Eligibility begins first day of the month of birth 25 month of receiving Social Security Disability Those with ESRD and ALS are waived When first eligible for Medicare, whether a person is 65yo or eligible because of disability, there is an initial enrollment period. The only time the time frame is different is when a person becomes SSDI eligible because of ESRD and ALS. Please ask a SHIP counselor/ben spec for assistance for these individuals.

7 IEP Medicare card will be mailed
For those with automatic enrollment 3 months before effective date of enrollment Anytime during the initial enrollment period after enrollment The 24 month waiting period is waived for a person with ALS or ESRD disability.

8 Special Enrollment Periods (SEP)
Move out of plan’s service area Moving to another state Loss or gain of Medicaid status or Extra Help Death of spouse Loss of Part C or D coverage Loss or gain of employer based health insurance Enter, live in, or leave a Skilled Nursing Facility (nursing home) Other exceptional circumstances Life happens. You move, you lose your health insurance, these are a few times when you can make changes to your Medicare coverage outside of the AEP or IEP.

9 SEPs Allow you to join or switch plans after IEP
SEPs can be used only in a limited time frame, and for specific purposes In some cases, can only be used once per year Change to 5 star plan only one time each year

10 SEP for Dual Eligible Previously, could change Part D or Part C plan every month Changed for 2019 Can change only 3 times per year – once per quarter January – March April – June July – September It is important to remember that dual eligible cannot use the fourth quarter to change their plan for this year. The change they make is a usual AEP choice that will be effective January 1.

11 Annual Open Enrollment Period (AEP)
October 15 – December 7 Coverage begins January 1 Join, switch, or drop Medicare Advantage Plan Medicare Prescription Drug Plan Return to Original Medicare Important to review plan

12 Medicare Advantage Open Enrollment Period (MAOEP)
One time change January 1 – March 31 Can switch to another MA plan with or without drug coverage Disenroll from MA plan and return to Original Medicare. If you return to Original Medicare, you can also join a Part D plan You can join an MA Plan when you first become eligible for Medicare, generally during your Initial Enrollment Period (IEP), which begins 3 months immediately before your first entitlement to both Medicare Part A and Part B. Beginning in 2019, the MA OEP will allow individuals enrolled in an MA Plan to make a one-time election during the first 3 months of the calendar year (January 1–March 31) to switch MA Plans or to disenroll from an MA Plan and obtain coverage through Original Medicare. Coverage begins the first of the month following enrollment.  In addition, newly MA-eligible individuals (those with Part A and Part B) who enroll in an MA Plan, also have the opportunity to also make a one-time election to change MA Plans or drop MA coverage and obtain Original Medicare (Trial Right). However, if you drop a Medicare Supplement Insurance (Medigap) policy to join an MA Plan, you might not be able to get it back. Rules can vary by state and your situation. Changes to Part D coverage is limited for an individual who uses the MA OEP; however, the MA OEP doesn’t provide enrollment rights to an individual who’s not enrolled in an MA Plan during the applicable 3‑month period. Individuals who use the MA OEP to make changes to their MA coverage may also enroll in or disenroll from Part D coverage. For example, an individual enrolled in an MA-PD plan may use the MA OEP to switch to: (1) another MA-PD Plan; (2) an MA-only Plan; or (3) Original Medicare with or without a PDP. The MA OEP will also allow an individual enrolled in an MA-only plan to switch to: (1) another MA-only plan; (2) an MA-PD plan; or (3) Original Medicare with or without a PDP. However, this enrollment period doesn’t allow for Part D changes for individuals enrolled in Original Medicare, including those with enrollment in stand-alone PDPs.

13 General Enrollment Period
January 1 through March 31 Can enroll in Part A or B or both if did not enroll When initially eligible Missed SEP Coverage effective July 1

14 Medicare Mailings Medicare sends letters on different colored paper as part of the enrollment process for Part D. CMS.gov/Medicare/Prescription-Drug- Coverage/LimitedIncomeandResources/Downloads/Consumer- Mailings.pdf Deeming letters on gray paper Will lose LIS at the end of the year

15 Summary of Enrollment Periods

16 Summary of SEPs (continued)

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