SEP’s “Special Election Periods” might save the day.
By Ulla-Undine Merritt (Dee) National Producer Number (NPN) 8853366
Medicare AEP “Annual Enrollment Period” was October 15-December 7th for January 1st effective date. This applies to Medicare Advantage Plans and Part D Prescription Drug Plans.
If your current plan was Non-renewed
30.4.3 – SEPs for Non-renewals or Terminations A SEP exists for members of MA plans that will be affected by plan or contract non-renewals and plan service area reductions that are effective January 1 of the contract year. In order to provide sufficient time for members to evaluate their options, the SEP begins December 8 and ends on the last day in February of the following year. Enrollment requests received from December 8 through December 31 will have an effective date of January 1. Enrollment requests received in January will have an effective date of February 1. Enrollment requests received in February will have an effective date of March 1.
30.5 – Medicare Advantage Open Enrollment Period (MA OEP)
42 CFR 422.62(a)(3) (Rev. 2, Issued: August 12, 2020; Effective/Implementation: 01·01·2021) During the MA OEP, MA plan enrollees may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP.
MA OEP occurs: January 1st to March 31st. If your enrolled in a MA plan you may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MA-PO or MA-only plans can switch to one of these 3 options:
*Medicare Advantage with Part D • Medicare Advantage with no Part D • Original Medicare (with or without a stand-alone Part D plan)
The effective date for the MA OEP is the 1st of the month following receipt of the enrollment request.
Note: The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join a MA Plan. It does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone Part D plans. The MA OEP is not available for those enrolled in Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE).
It is very important – Dropping a Medicare Advantage Plan to go back to Original Medicare does NOT guarantee you acceptance in a Medicare Supplement Plan that works together with Original Medicare. Medicare Supplements in this situation require medical qualifications unlike the original enrollment into Part 8 (you have 6-months from Part 8 effective). You can also qualify if you lose coverage due to a plan drop, moving out of the plan service area, loss of creditable employer group coverage. During the guarantee issue period you may not be entitled to all the companies Medicare Supplement Plans.
COVID19 and Hurricane ETA is covered as an SEP The Market Place • Since the 2021 Open Enrollment Period is over, you can now enroll in or change a Health Insurance Marketplace• plan only if you have a life event that qualifies you for a Special Enrollment Period.
Life changes that can qualify you for a Special Enrollment Period.
* Changes in household – marriage, had a baby, adopted a child, or placed a child for foster care. Divorce, legally separated and lost health insurance (must be losing coverage)
* Change in residence – Moving to a new home in a new Zip code or county, Moving to the U.S. from a foreign county or US territory, If you’re a student moving to or from the place you attend school, If you’re a seasonal worker, moving to or from the place you both live and work, Moving to or from a shelter or other transitional housing.
* Loss of Health Insurance – You may qualify for a Special Enrollment Period if you lose health coverage through your employer or the employer of a family member, including if you lose health coverage through a parent or guardian because you are no longer a dependent.
losing individual health coverage for a plan or policy you bought yourself – You may qualify for a Special Enrollment Period if you lose individual health coverage if: Your plan discontinued (no longer exists), lose eligibility for a student health plan, lose eligibility for a plan because you no longer live in the plan’s service area, an individual or group health plan coverage year is ending in the middle of the calendar year and you choose not to renew it, household income decreased, or you qualify for savings on a Marketplace plan.
Losing eligibility for Medicaid or CHIP -You may qualify for a Special Enrollment Period if you lose Medicaid or Children’s Health Insurance Program (CHIP) coverage.
Losing coverage through a family member – You turn 26 (or the maximum dependent age allowed in your state, Florida is 30) and can no longer be on a parent’s health plan- lose job-based health coverage through a family member’s employer because that family member loses health coverage or coverage for depen• dents, lose health coverage through a spouse due to a divorce or legal separation, lose health coverage due to the death of a family member, lose health coverage through a parent or guardian because you’re no longer a dependent.
Information provided ems.gov; med/core.gov, healthcare.gov and FEMA.gov
Dee Merritt
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Dee Merritt
logical Insurance Solutions
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239-362-0855
Dee@logicalinsurance.com
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