Beyond Open Enrollment

Both the ICEP and IEP are for people who are just becoming eligible for Medicare. They need to enroll in both Medicare Part A and Part B to use these eligibility timeframes. They can do this at a Social Security office.

If an individual chooses to delay enrollment in Part B (usually because they have health coverage through an employer or a spouse’s employer) their ICEP will also be delayed.

Individuals may:

• Enroll in a Medicare Advantage plan or Medicare Part D plan

• Enroll the month before their employer coverage ends or up to two months after coverage ends

Effective date will be the first of the following month.

Retroactive Medicare Part D entitlement provides a four-month enrollment period. This period begins the month the individual is notified of their Medicare entitlement. Their coverage effective date is generally the first day of the month after the health plan receives the enrollment request.

Each year, Medicare-eligible individuals may enroll in a Medicare plan during October 15 through December 7.

Individuals may:

• Enroll in a Medicare Advantage plan from Original Medicare only

• Switch enrollment between Medicare Advantage plans

• Enroll in a Medicare plan for the first time

Annually during January 1 through March 31, Medicare Advantage beneficiaries may make an enrollment change. Does not apply to those with Medicare Savings Accounts or other Medicare plan types (such as Cost, PACE, or Original Medicare only)

Individuals enrolled in a Medicare Advantage – Prescription Drug (MA-PD) plan or a medical only Medicare Advantage (MA-only) plan may:

• Switch between or enroll in a MA-PD plan
• Switch to an MA-only plan
• Drop MA to go to Original Medicare only (with or without a Part D standalone plan)

 

This continuous enrollment period allows an individual who moves into, resides in, or moves out of an institution (as defined in § 10) to change their Medicare enrollment. The OEPI ends two months after the month the individual moves out of the institution. The individual can make an unlimited number of Medicare Advantage (MA) enrollment requests during the OEPI.

Eligible scenarios:

• Individual moves permanently outside of their current MA plan service area
• Individual is now eligible for an MA plan because they have been recently released from incarceration
• Individual has moved permanently, and is now eligible for the MA plans in their new geographical area

The SEP lasts for three months. If the plan is notified in advance, the SEP begins on the first day of the month of permanent move. If the individual notifies the plan after the move, the SEP begins the month of the notification. The individual can choose an effective date up to three months after the month they send the enrollment request, but it may not begin prior to their move date.

Example:
An individual is a member of an MA plan in Minnesota and intends to move to Arizona on June 7. They have an SEP from May 1 through August 31.

When notify plan/enroll	SEP begins	SEP ends	Effective date options
The month before the move or earlier (May or before)	The month before the move (May)	Two months after the move (August)	July, August or September
The month of the move (June)	The month of the move (June)	Two months after the move (August)	July, August or September
After the move (July)	The month of the enrollment request (July)	Two months after the SEP begins (September)	August, September or October

When CMS does not renew a Cost or Medicare Advantage plan contract, the plan’s enrollees may select a Medicare Advantage plan in their area. They must meet MA eligibility requirements.

The SEP is available December 8 through the last day of February.

Effective dates:

• Enrollments received in December will be effective January 1
• Enrollments received in January will be effective February 1
• Enrollments received in February will be effective March 1

 

Eligible scenarios

When an individual has an opportunity to:

• Enroll in an employer-sponsored Medicare Advantage plan (Medicare Group plan)
• Disenroll from a Medicare Advantage plan to enroll in employer sponsored coverage of any kind
• Disenroll from employer sponsored coverage or COBRA to enroll in an MA plan

This SEP is available during the employer’s open enrollment season, or other employer eligibility timeframes. The SEP ends two months after the employer or union coverage ends.

Effective date can be:

• Up to three months after the month when they submitted an enrollment or disenrollment request
• Must begin after the first day of entitlement to both Medicare Part A and Part B
• For example, if the submission was sent in March, the effective date could be April 1, May 1 or June 1

 

Each year, CMS rates Medicare Advantage, Cost and standalone Part D prescription drug plans on performance and quality categories based on member surveys and other information. Ratings are between 1 and 5 stars, with 5 stars indicating excellence. These ratings can change each year.

The 5-star SEP is available for a one-time switch to a Medicare Advantage, Cost or standalone Part D prescription drug plan with a 5-star rating. The SEP is open December 8 through November 30.

Please note that if a beneficiary moves from a Medicare Advantage plan to a standalone Part D plan, they will be disenrolled from their Medicare Advantage medical coverage and returned Original Medicare for their medical coverage.

Individuals may disenroll from a Part D plan (PDP or MA-PD) to enroll in or maintain other creditable coverage such as TriCare or VA coverage. Their disenrollment effective date is the first day of the month after the month the plan receives the disenrollment request. Individuals who are enrolled in an MA-PD plan may also use this SEP to disenroll in the MA-PD plan and select an MA-only plan.

When an individual is given a retroactive Medicare entitlement determination from CMS, they are also given a three month SEP. The SEP begins the month they receive notice of their Medicare entitlement from CMS and continues for an additional two months.

Individuals who no longer qualify for a Special Needs Plan (SNP) will have to disenroll and select new coverage. This SEP begins when the period of deemed continued eligibility starts (as defined in § 50.2.5) and ends when the individual makes an enrollment request, or three months after the deemed continued eligibility period expires. CMS will send a letter printed on grey paper called a “Loss of Deemed Status notice” to tell the individual if they no longer qualify for a SNP.

An individual who receives “Extra Help” may make one enrollment change, or notify such a change is coming, within three months of any of the following situations.

• Becomes eligible for any type of assistance from Title XIX program (includes those who receive cost-sharing assistance from Medical Assistance (Medicaid), i.e., "partial duals") and individuals who qualify for LIS but do not receive Medical Assistance benefits
• Loses eligibility for any type of assistance
• Has a change in the level of assistance they receive (such as Medical Assistance benefits end but still qualify for LIS, or those who have a change in their cost-sharing level.)

The effective date is the first of the month after the plan receives the enrollment request.

Non-U.S. citizens who become lawfully present in the United States may apply for an MA plan. The plan’s regular eligibility requirements apply. This SEP begins the month the lawful presence begins, and ends either:

• Two full calendar months later or
• When the individual makes an enrollment request

 

Eligible scenarios:

• Dependent is turning age 26 and will lose coverage through parent’s plan
• Losing employer-sponsored coverage (includes COBRA and retiree coverage)
• Employer ends coverage
• Lose or leave a job, thus ending employer-sponsored coverage
• No longer qualify for Medical Assistance or MinnesotaCare
• Lose other government-sponsored coverage such as TRICARE

SEP lasts for 60 days and begins on the last day of coverage from previous Eligible health plan.

 

Non-U.S. citizens who become lawfully present in the United States may apply for an MA plan for which they are eligible. The SEP lasts for 60 days.

Individual moves permanently to a new zip code or county and now has access to different qualified health plan options. The SEP lasts for 60 days and begins the day of your move.

Eligible scenarios:

• Gained or lost dependent
  • Through birth, adoption, foster care or child support order
• Death, divorce, or legal separation
  • Lost coverage on another MNsure plan
• Marriage
  • Household size changed due to marriage

The SEP begins the day of the event (birth, death, court order, marriage) and lasts for 60 days.

Eligible scenarios:

• Agency error
  • If an error, action or inaction by MNsure, navigator or broker prevented enrollment, the individual may qualify for a SEP. The individual has 60 days to report the error to MNsure. If a SEP is granted, the individual has 30 days from the approval date to enroll.
• Violation of qualified health plan terms and conditions
  • If the enrollee can demonstrate that their qualified health plan terms and conditions were violated, the enrollee may qualify for this SEP

The SEP is 60 days and begins on a date set by MNsure.