Medicare Special Elections
If you have clients that are currently enrolled in Medicare, Medicare Advantage, Part D Rx or Medicare supplement, you need to be aware of the Medicare special elections. If your client wants to either enroll in or change a Medicare Advantage Plan or Part D (drug plan) there are limits on when you will be able to do this.
Your client can enroll in a Medicare Advantage or Part D plan when they initially qualify for Medicare enrollment. In fact, there is a Medicare Advantage Dis-enrollment Period or MADP. This is from January 1 until February 14 each year. At this time you can change from your Medicare Advantage Plan. You can enroll in Original Medicare as well as a stand alone Medicare drug plan and Medicare supplement , if they would like.
If you are enrolled in Original Medicare you CANNOT change your coverage during the MAPD. You can change your coverage for Medicare/Medicare Drug coverage only during the OEP Open enrollment period. It starts October 15 and goes through December 7 every year. The only other time you are able to change your health coverage is if you qualify for the SEP (Special Enrollment Period). The time of your SEP will depend on the reason for the SEP. At certain times, the Centers for Medicare and Medicaid Services (CMS) will decide if you are able to obtain an SEP.
There is a Penalty if you enroll in Part D late
If for some reason you do not enroll in Part D when you are eligible, and you do not have drug coverage that is equivalent to Medicare’s for over 63 days, you will get stuck with a penalty when you do enroll in a Part D plan. Although the SEPs allow you to enroll in a Part D plan at times other than the normal enrollment period, Medicare will charge you a premium penalty.
This rule has only two exceptions. First if you qualify for extra help (a federal program that will help to pay most of your Medicare Part D costs). The second way is if you can prove that you received misinformation about the other drug coverage you chose to purchase.
There are numerous Medicare special elections. Click on the link below to access a list of all of them. (Updated for 2017)