Election Periods

Special Enrollment Period (SEP) for Non-Renewals

-A Special Election Period exists for members of an MA plan that has their contract with CMS terminated or is not-renewed. -The intention of this SEP is to provide members who are enrolled in a plan that will not continue the following year ample time to review and select a new MA plan.

Special Enrollment Period (SEP) Contract Violation

-A Special Election Period exists if CMS has determined than an MA plan has violated a provision of their contract -Examples of contract violation include misrepresenting the plan and/or it's benefits in marketing materials, false information provided by an agent of the MA organization, or failure to honor the terms of the plan as described to the enrollee.

Special Enrollment Period (SEP65) for Beneficiaries over 65

-A special election period exists for those who enrolled into an MA plan during the Initial Election Period upon turning 65 -The SEP allows members to disenroll from the MA plan and return to Original Medicare anytime during the 12-month period that begins on the effective date of their MA coverage.

Medicare Advantage Disenrollment period (MADP)

-An election period exists that allow MA enrolees to disenroll from an MA plan and return to original Medicare -Occurs January 1 through February 14 annually -The effective of the disenrollment is the 1st of the month following receipt of the disenrollment request

Open Enrollment for Institutionalized Individuals (OEPI)

-Continuous election period for institutionalized individuals -An institutionalized individual is someone who moves into, resides in, or moves out of a nursing or skilled nursing facility, intermediate care facility, psychiatric hospital, rehabilitation hospital, or long-term care facility -The OEPI ends two months after the individual moves out of the institution -Plans must also accept requests for disenrollment during the OEPI -Effective Date: 1st day of the month after application was received

Employer Group (EGHP) Special Enrollment Period (SEP)

-Exists for individuals making enrollment requests into an employee/union-sponsored MA plan OR for individuals to disenroll from an employee/union-sponsored MA plan -The individual may choose an effective date up to three months after the month that the enrolllment/disenrollment request was received.

Initial Coverage Election Period (ICEP)

-Initial enrollment request for applicants newly eligible for Medicare. -The ICEP election period frequently correlates with an individual's 65th birthday OR their 25th month of being deemed disabled. -Election period begins three months before the individual's first entitlement to Medicare Parts A and B -Election period ends the later of: The last day of the month preceding entitlement to 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 a 7-month period: 3 months prior to eligibility, the month of, and 3 months after -Effective Date: (Pre-Entitlement) 1st Day of the month of entitlement to Parts A and B -Effective Date: (Post-Entitlement) 1st day of the month after application was received (if entitlement already existed)

Special Enrollment Period (SEP) For CMS Sanctions

-Is a disenrollment SEP only -Is granted by CMS on a case-by-case basis if a member disenrolls in connection with a situation that resulted from a sanction to the plan by CMS -The start date and length of the SEP is determined by CMS and is dependent on the specifics of the sanction

Annual Enrollment Period (AEP)

-October 15 - December 7 -Also known as: Fall Open Enrollment and Open Enrollment Period for Medicare Advantage -Medicare Advantage-eligible individuals may enroll into or disenroll from a Medicare Advantage plan -If individuals submit applications for multiple plans, the application with the latest application date will take effect -Effective date January 1

Initial Enrollment Period for Part D (IEP)

-Period which an individual is first eligible to enroll in a Part D plan -Generally the IEP coincides with an individual's Initial Enrollment Period for Part B: The 7-month period beginning 3 months prior to eligibility, the month of, and 3 months after -If the IEP does not coincide with an individuals Initial Enrollment Period for Part B, the IEP is the 7-month period beginning 3 months prior to Part D eligibility, the month of, and 3 months after -Individuals eligible for Medicare prior to age 65 will have another IEP upon reaching age 65 -Effective Date: Open(Pre-Entitlement) 1st Day of the month of entitlement to Parts A and B -Effective Date: (Post-Entitlement) 1st day of the month after application was received (if entitlement already existed)

2. SEP Election Period Hierarchy

-SEP for Individuals Who Dropped a Medigap Policy and are in a "Trial Period" -SEP for Disenrollment from Part D to Enroll In/Maintain Creditable Coverage -SEP for Individuals in Cost Plans with Non-Renewing Contracts

1. ICEP/IEP Election Period Hierarchy

-SEP for Individuals Whose Medicare Entitlement Determination Made Retroactively -SEP for Individuals Who Belong/Lose State Pharmaceutical Assistance (SPAP) -SEP for 5-Star Plans

Election Periods

-SEP for Individuals in the Program of All-Inclusive Care for the Elderly (PACE) -SEP for Individuals Who Dropped a Medigap Policy and are in a "Trial Period" -SEP for Individuals with ESRD- Entitlement Determination Made Retroactively -SEP for Individuals Whose Medicare Entitlement Determination Made Retroactively -SEP for Non-US Citizens who become Lawfully Present -SEP for Disenrollment from Part D to Enroll In/Maintain Creditable Coverage -SEP for Individuals Who Lose Special Needs Status (SNPs) -SEP for Individuals Who Belong/Lose State Pharmaceutical Assistance (SPAP) -SEP for Chronic Care Special Needs -SEP for Individuals in Cost Plans with Non-Renewing Contracts -SEP to Coordinate with Part D Enrollment Periods -SEP for 5-Star Plans

3. AEP/MADP Election Period Hierarchy

-SEP for Individuals in the Program of All-Inclusive Care for the Elderly (PACE) -SEP for Non-US Citizens who become Lawfully Present -SEP for Chronic Care Special Needs

4. OEPI Election Period Hierarchy

-SEP for Individuals with ESRD- Entitlement Determination Made Retroactively -SEP for Individuals Who Lose Special Needs Status (SNPs) -SEP to Coordinate with Part D Enrollment Periods

Special Enrollment Period (SEP) Change of Residence

Questions _Have you moved recently? -If so, what was the date of your move? -Where did you move from SEP Exists for -Individuals who are no longer eligible for their current MA plan's coverage due to moving outside of that plan's service area -Formerly incarcerated individuals who have been released and now reside inside an MA plan's service area -Individuals moving into an MA plan's service area Guidelines -Enrollment elections only -SEP begins on the date of the permanent move OR the date the individual provides notification of the permanent move; the SEP continues for two months following the month it begins OR the two months following the month of the move, whichever is later -Effective date of the enrollment may not be earlier than the effective date of the move; but, can be the 1st of the month up to 3 months after the application is received Additional Information _Because a member must reside in the plan's service area to remain enrolled, an individual who moves out of the service area must be involuntarily disenrolled from the plan -When a member is involuntarily disenrolled for moving outside of the service area, their coverage ends on the last day of the month that they moved. Their disenrollment effective date is considered to be the 1st day of the following month. -A member who is outside of the service area for 6 months must be involuntarily disenrolled - unless the plan offers a "continuation" or "visitors" program. Blue Cross Blue Shield of Michigan offers a 12-month visitors program; members must be disenrolled after being outside of the service area for one year. -If an involuntarily disenrolled member does not enroll in a new MA plan effective the month after their move (or involuntary disenrollment), the member will return to Original Medicare until he/she elects a new MA plan during a valid enrollment period. Contract Violation

Special Election Period (SEP) for Dual Eligible Individuals Or loss of Dual Eligibility

SEP exists for... -Individuals who are entitled to Medicare Parts A and B and receive any type of Medicaid assistance ("Extra Help") -Individuals who are MA-eligible and are no longer eligible for Medicaid assistance ("Extra Help") Guidelines -Applies to both Enrollment and Disenrollment elections -If this SEP is used by individuals as they become dual-eligible, the SEP begins the month of dual-eligibility and exists for as long as the beneficiary is receiving Medicaid benefits. -If this SEP is used by individuals when they lose dual-eligibility status, the SEP begins the month the beneficiary is notified of the loss of Medicaid benefits plus two additional months. -Effective Date: 1st day of the month after application was received

Special Election Period (SEP) For Non-Dual Eligible Individuals with LIS and Individuals who lose LIS

SEP exists for... -Individuals who quality for Low-Income Subsidy but are not receiving Medicaid assistance -Individuals who lose their LIS eligibility Guidelines -Applies to both Enrollment and Disenrollment elections -Valid for Part D plans only -If this SEP is used by individuals who qualify for LIS but are not receiving Medicaid - the SEP begins the month the individual becomes eligible and exists as long as they are LIS-eligible. -If this SEP is used by individuals who lose their LIS eligibility for the following calendar year, the SEP exists from January 1 - March 31; If LIS is revoked mid-year, outside of the standard annual redeeming process, the SEP begins the month the MA organization notifies the individual and continues for two months. -Effective Date:1st day of the month after application was received