Special Election Periods (SEPs) for Parts C & D

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Special Election Periods (SEPs) exist for Part C (Medicare Advantage) and Part D (Prescription Drug) plans under certain circumstances. SEPs allow you to enroll in or disenroll from a Medicare Advantage (MA) plan or Part D plan depending on your situation:

  • If you’re in an MA or Part D plan that is terminating at the end of the year (December 31), you have an SEP to enroll in a different MA or Part D plan or return to Original Medicare. This SEP is from December 8 of the current year through the end of February of the next year. Note that this SEP gives you another chance to enroll in an MA or Part D plan in addition to the Annual Election Period, also known as Open Enrollment, from October 15 through December 7, when you can switch, enroll in or disenroll from MA and Part D plans. Any plan changes made before December 31 are effective January 1. Plan changes made after December 31 would be effective the first day of the following month.
  • If Medicare terminates its contract with your MA or Part D plan because of misconduct and/or other reasons, your plan must give you 30 days notice before the termination date. Your SEP to switch to another plan begins 1 month before the termination happens and lasts for 2 months afterward. You can choose to have your new MA or drug plan coverage begin up to 3 months after the month your previous plan ended.
  • You have an SEP to enroll in a Part D plan if you want to disenroll or have disenrolled from an MA plan during the Medicare Advantage Disenrollment Period (MADP) from January 1 – February 14. The SEP ends at the end of the MADP (February 14) or when your new Part D plan becomes effective, whichever is sooner.
  • If you move out of your plan's service area, you have a 2-month SEP to enroll in a new plan offered in your new residence area. This SEP begins either the date of your permanent move or the date you notify your plan of your move, whichever is later.
  • If you enroll in an MA plan during the Initial Coverage Election Period (ICEP) around your 65th birthday, you have a 12-month SEP to disenroll and return to Original Medicare.
  • If your creditable prescription drug coverage through your employer health plan ends, you have a 2-month SEP to enroll in a Part D plan, starting the day you

    lose coverage.

  • If you live in an area with a Medicare Advantage and/or Part D plan(s) that has an overall plan performance rating of 5 stars, and you’re otherwise eligible to enroll in the plan, you have an SEP to join that plan. Medicare releases plan performance ratings each fall and the ratings apply for the following calendar year. Your SEP is from December 8 through November 30. Your new coverage will become effective the first day of the following month. You can use this SEP to enroll in a 5-star plan only once during the SEP.
  • If you are eligible for full Medi-Cal benefits, you have an ongoing SEP to enroll in or change Medicare Advantage Prescription Drug plans (MA-PDs) or Part D plans on a monthly basis.
  • If you lose your full Medi-Cal benefits, you have a 3-month SEP to change MA-PD or Part D plans, starting the month you receive notice of the eligibility loss.
  • If you become eligible for the Part D Low-Income Subsidy (LIS) or Extra Help, you have an ongoing SEP to change MA-PD or Part D plans as long as you qualify for the Extra Help. You can change plans on a monthly basis.
  • If you lose the Extra Help, you have a 2-month SEP to change MA-PD or Part D plans starting the month you receive notice of the subsidy loss.
  • If you are institutionalized (live in a nursing home, skilled nursing facility, etc), you have an SEP to enroll into, switch or disenroll from your MA and/or Part D plan on a monthly basis. Also, if you move out of the facility, you have a 2-month SEP to change plans. Your new coverage is effective the first of the following month.
  • If you enroll in Part B during the General Enrollment Period (GEP). but are not entitled to Part A without paying a premium, you have a SEP to enroll in a Part D plan between April 1 and June 30. If you enroll in a Part D plan during this SEP, your plan becomes effective July 1.

Note: Part B also has a SEP, but it stands for Special Enrollment Period. This SEP is for people who have employer group coverage and delay enrollment in Part B. When a person's employer coverage or employment ends (whichever is sooner), he/she has an 8-month SEP to enroll in Part B without a penalty. See If You Delay Enrolling in Part B.

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Source: cahealthadvocates.org

Category: Insurance

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