45 Day Disenrollment Period for Medicare Advantage Members

Starting this year, the Medicare Advantage Open Enrollment Period (OEP) has been replaced by a new Medicare Advantage Disenrollment Period (MADP), which lasts from January 1st through February 14th.[1] During the MADP, one can switch from an MA plan to traditional Medicare.  The new MADP also provides an opportunity to pick up Part D drug coverage for those who did not already have it.  When disenrolling from an MA plan during the MADP, the effective date of disenrollment from the plan is the first day of the month following the date the disenrollment request is received.  Thus, disenrollment requests received by MA organizations in January are effective February 1; those received February 1 through February 14 are effective March 1.[2]

New Opportunity to Enroll in a Part D Plan

The OEP was a 3 month period during which individuals could make certain changes to their Medicare Advantage (MA) coverage.  During the OEP, a person could neither pick up Part D coverage if she didn’t already have it, nor drop such coverage if she did have it.  Some beneficiaries were enticed to join an MA plan, not understanding the implications of this choice, simply to change drug coverage.  Others were the subject of marketing abuses by agents and plans that wanted to take advantage of the additional time period for enrolling in a Medicare Advantage plan but not in a stand-alone prescription drug plan (PDP).

Unlike the old OEP, the new MADP does not allow individuals to switch Medicare Advantage plans or to enroll in an MA plan for the first time.  However, during this period, an individual using the MADP to disenroll from an MA plan is eligible for a special enrollment period (SEP) to enroll in a stand-alone Part D prescription drug plan, regardless of whether the MA plan from which the individual disenrolled included the Part D benefit.  Note that this is different from the OEP, which did not allow someone to pick up Part D coverage if she did not previously have such coverage at the beginning of the calendar year.

According to the Medicare Managed Care Manual, “an individual may use this SEP to request enrollment in a PDP subsequent to having submitted a disenrollment request from the MA plan during the MADP or may simply request enrollment in the PDP, resulting in automatic disenrollment from the MA plan.”[3] Beneficiaries are advised to enroll in a PDP as close to disenrollment from the MA plan as possible to avoid going without prescription drug coverage for a period of time.  For example, a beneficiary who disenrolls from an MA plan on January 31 and enrolls in a PDP on February 1would return to traditional Medicare on February 1, but would not have drug coverage until March 1.

The MADP and Private Fee-for-Service (PFFS) and Medical Savings Accounts (MSAs)

Medicare Advantage rules allow an individual enrolled in a Private Fee for Service (PFFS) plan that does not offer Part D coverage (as well as any Medicare Medical Savings Account plan, or MSA) to also be enrolled in a stand alone PDP.[4] According to a memorandum issued by the Centers for Medicare and Medicaid Services (CMS) on December 7, 2010, an individual in both a PFFS plan and a PDP may use the MADP to disenroll from the MA-PFFS plan to Original Medicare, however she cannot disenroll from the PDP or enroll in a different PDP; similarly, individuals already enrolled in a stand-alone PDP must keep their current PDP.   Note that the MADP cannot be used to disenroll from an MSA plan.[5]

Reminder: Some Individuals Can Change Plans on a Monthly Basis

Certain individuals can change their Part D coverage, including a Medicare Advantage Prescription Drug (MA-PD) plan, on a monthly basis.  Individuals enrolled in the Part D Low-Income Subsidy (LIS or “Extra Help”), including those dually eligible for Medicare and Medicaid, as well as those enrolled in Medicare Savings Programs (MSPs), have an ongoing Special Enrollment Period (SEP) to change Part D plans on a monthly basis.[6] Note that there are also SEPs available to other individuals to enroll in, switch, or disenroll from Part D and Medicare Advantage plans when certain designated triggering events occur.[7]

New Medicare Advantage Special Enrollment Period for 2012 Based on Plan Rating

CMS announced in a November 19, 2010 memorandum that, beginning in 2012, there will be a new Special Enrollment Period (SEP) to allow Medicare beneficiaries eligible for a Medicare Advantage plan to enroll in a 5-star MA plan at any point during the year.[8] According to CMS, the “creation of this SEP is part of CMS’ overall quality effort, combined with the quality bonus payment demonstration, to give MA plans greater incentive to achieve 5-star [highest rating] status.”

Conclusion

The new MADP serves as a consumer protection, allowing beneficiaries a 45-day period, after they have enrolled in an MA plan during the open the Open Enrollment Period, to decide whether the plan is right for them.  Beneficiaries who decide to return to traditional Medicare are given the option of enrolling in a PDP to provide them with continuous drug coverage.  Advocates who assist beneficiaries in disenrolling during the MAPD should remind them of the need to choose drug coverage.  If these individuals disenroll from an MA plan and do not have or choose a Part D plan, or have alternative creditable coverage, they will be subject to a late enrollment penalty should they choose drug coverage in the future.

For more information, contact attorney David Lipschutz (dlipschutz @ medicareadvocacy.org) in the Center for Medicare Advocacy’s Connecticut office at (860) 456-7790.


[1] Patient Protection and Affordable Care Act, §3204 (Pub. L. 111-148).
[2] See §30.5, Chapter 2 of the Medicare Managed Care Manual, Chapter 2 (CMS Pub. 100-16, updated August 17, 2010): http://www.cms.gov/MedicareMangCareEligEnrol/Downloads/FINALMAEnrollmentandDisenrollmentGuidanceUpdateforCY2011.pdf; also see CMS Memorandum re: the Medicare Advantage Disenrollment Period (MADP), December 7, 2010, at:  http://www1.cms.gov/NationalMedicareTrainingProgram/Downloads/MADP_Memo_12_06_10.pdf
[3]
Medicare Managed Care Manual, Chapter 2, §30.5.  On January 5, 2011, the Centers for Medicare & Medicare Services (CMS) confirmed in an e-mail that beneficiaries who enroll in an MA plan during the MADP have the entire balance of the MADP to make the corresponding PDP election rather than having to make the PDP election for the same date.  CMS expects to send out clarifying information to plans shortly.
[4] 42 CFR sec. 423.30(b)
[5] Medicare Managed Care Manual, Chapter 2, §30.8.
[6] See, e.g., Medicare Managed Care Manual, Chapter 2, §§30.4.4.5 (dual eligibles) and 30.4.4.12 (non dual-elgible LIS enrollees).
[7] See, generally, Medicare Managed Care Manual, Chapter 2, §30.4, et seq.
[8] CMS Memorandum re: SEP to Enroll in 5-star MA Plans in Plan Year 2010 (11/19/10), available at: http://www.cms.gov/MedicareMangCareEligEnrol/Downloads/SEPtoEnrollin5starplans.pdf