Annual Enrollment Period Ends… What If You Missed It?
Part 1: Today (12/7/2011) is the Last Day of the Medicare Annual Enrollment Period, With a Limited Extension
Today, December 7, 2011, is the last day of the Medicare Annual Coordinated Election Period (ACEP), also known as the Annual Election Period (AEP), the period during which people can make changes to their Medicare Advantage or Part D (prescription drug) coverage.
On December 6th, the Centers for Medicare and Medicaid Services (CMS) issued a memorandum entitled “End of AEP Processing” to all Medicare Advantage (MA) and Part D plan sponsors. The memo states that “CMS is providing additional flexibility to the current Enrollment Guidance to ensure that all enrollment requests submitted during the AEP are processed.” It notes two “flexibilities” that are being provided:
- Paper Enrollment Applications Postmarked by December 8th – MA and Part D sponsors must accept and process all paper enrollment requests that are received with a postmark date of December 8, 2011 or earlier (plan sponsors are required to accept and process enrollment requests that are postmarked on or before this date, regardless of when such requests are received by the plan).
- Calls to SHIPs or Plan Sponsors Made By the Close of Business on December 7th, But Enrollments Not Processed By Then – MA and Part D plan sponsors, State Health Insurance Assistance Programs (SHIPs), and other partners who assist beneficiaries “may work with beneficiaries to complete enrollment requests that were initiated prior to December 8. This would only include call-backs to beneficiaries whom sponsors, SHIPs, and other partners were not able to assist on or before December 7, due to high call volumes or difficulty in accessing CMS’ On-line Enrollment Center (OEC). Sponsors, SHIPs, and other partners must return all calls and obtain completed enrollment requests by midnight local time on Saturday, December 10.”
In a Q&A attached to the memo, CMS clarifies that:
Sponsors, SHIPs and other partners that assist beneficiaries will be allowed to take messages/contact information, through close of business on Wednesday, December 7, from individuals seeking to enroll in a Medicare plan. Beginning on December 8, sponsors, SHIPs, and partners will call back these individuals to complete their enrollment requests. […] 1-800 MEDICARE will also assist callers who are unable to complete their enrollment action by December 7.
Further, CMS points out that any other enrollment or disenrollment requests received after December 7th will not be processed as part of the ACEP.
Note that an individual who wishes to make a change to his or her MA or Part D plan, but misses the ACEP, may have other options, as discussed below.
Part 2: What If I Miss the Annual Coordinated Enrollment Period for Medicare Parts C & D?
Some Medicare beneficiaries who miss the Annual Coordinated Election Period (ACEP) may still have an opportunity to make changes to their coverage for the 2012 plan year, instead of waiting until next year’s ACEP. Whether an individual has a right to change plans outside of the ACEP depends on either certain triggering events or the person’s eligibility status for the Part D Low-Income Subsidy.
The following is a partial list of scenarios in which an individual may make a change to his or her MA or Part D plan outside of the ACEP. Most of these scenarios trigger entitlement to a Special Enrollment Period (SEP).
- I’m enrolled in a Medicare Advantage (MA) plan, but I want to get out of it and return to traditional Medicare.
The Medicare Advantage Disenrollment Period (MADP) is a period that lasts from January 1st through February 14th of each year. During the MADP, a beneficiary can only switch from an MA plan to traditional Medicare. During this period, an individual, using the MADP to disenroll from an MA plan, is also 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 drug benefit.
- My Medicare Advantage or Part D plan is not renewing its contract with Medicare (“non-renewing”) for 2012.
Enrollees of plans that are not renewing their contract with Medicare (or have had such contracts terminated) for the following year are entitled to a Special Enrollment Period (SEP) that begins December 8 and ends on the last day of February of the following year (in other words, for plans that are not renewing for 2012, this SEP lasts from December 8, 2011 through February 29, 2012). During this SEP, an individual can choose a new MA or Part D plan.
- I live in an area that has a Medicare Advantage or Part D plan with a 5-star rating for 2012.
A newly created Special Enrollment Period (SEP) allows Medicare beneficiaries to enroll in MA and Part D plans that receive an overall 5-star rating by CMS’s Plan Performance Rating system. For the 2012 plan year, this SEP starts on December 8, 2011 and ends on November 30, 2012. The 5-Star SEP can only be exercised once per year. Note that there are very few plans in 2012 that have achieved 5-star status.
- I am enrolled in the Part D Low-Income Subsidy (LIS or “Extra Help”).
Certain individuals can change their coverage 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. A SEP also applies if someone loses Medicaid and/or LIS eligibility status.
- I am moving into, living in, or moving out of a long-term care facility.
People who move into, live in, or move out of an institution such as a long-term care facility (NF or SNF), an intermediate care facility for the mentally retarded (ICF-MR), a psychiatric, a rehabilitation hospital or unit, or a long term care hospital, or a “swing-bed” hospital, are entitled to the Open Enrollment Period for Institutionalized Individuals (OEPI). OEPI allows individuals to enroll into, change, or disenroll out of MA or Part D plans. The OEPI lasts as long as the person lives in the institution and for two months following discharge.
- I have recently moved: I am making a permanent move outside of my plan’s service area; I have a new plan choice available to me because I moved to a new service area; I have moved back to the U.S. after living outside the country; or I have been released after a period of incarceration.
A SEP is available to people who make a permanent move outside their plan’s service area; have a new plan choice available to them as a result of their move to a plan’s service area; move back to the U.S. after living outside the country; and to people who were released after a period of incarceration. The SEP lasts for two months from the date the person notifies the plan, returns to the U.S., or is released from incarceration. The SEP begins later if the person does not notify the plan, and the plan learns of the move through CMS or through the Post Office.
- I currently have, have lost, or will leave coverage offered by an employer or union.
This SEP applies to people who: 1) wish to leave employer or union coverage, including COBRA; or 2) wish to disenroll from Part D to take employer or union sponsored of any kind. In the first instance, the SEP to join a Part D plan lasts for two full months after employer/union/COBRA coverage ends. In the second instance, the SEP is available during the “open season” of an Employee Group Health Plan (EGHP) or at other times that the employer or union allows.
- I have (or have a right to enroll in) prescription drug coverage that’s at least as good as Medicare Part D (“creditable”), but I lose it involuntarily, or I am given bad information about it.
A SEP exists to enroll in or maintain creditable coverage (such as Veterans’ Administration or TRICARE coverage). In this circumstance, an individual can disenroll from a Part D plan in order to enroll in this other coverage. A SEP also applies if someone involuntarily loses creditable coverage (note that failure to pay premiums does not constitute involuntary loss). This also includes changes to other coverage such that it is no longer creditable. In addition, a SEP applies on a case-by-case basis to people who were misinformed of their existing plan’s creditable coverage status, by an entity required to provide such notice (such as a former employer offering the coverage).
- I enrolled in an MA or Part D plan based on false or misleading information from the plan or an agent.
If a plan enrollee is able to demonstrate to CMS that the plan “substantially violated a material provision of its contract” in relation to the individual, or the plan (or its agent) “materially misrepresented the plan when marketing the plan” such individual may be entitled to disenroll from their current plan and choose a new one.
- I just turned 65 and enrolled in an MA plan during my initial Part B enrollment period.An MA-eligible individual who elects a Medicare Advantage plan (other than an MSA) during the initial enrollment Part B enrollment period surrounding their 65th birthday has a special enrollment period called “SEP65.” SEP65 lasts for 12 months from the effective date of coverage of the MA plan. The individual may disenroll from the MA plan and elect original Medicare during this SEP.
There are other possible SEPs, including SEPs for MA trial period, Medigap trial period, Error by federal employee, Retroactive Medicare entitlement, Retroactive Medicaid entitlement with uncovered months, C-SNPs, SPAP, PACE, and Cost-plans. While we cannot go into detail on all of them, you can find out more at http://www.medicare.gov/Publications/Pubs/pdf/11219.pdf.
Many Medicare beneficiaries were likely caught off guard by the change in the ACEP this year, including the earlier ending date of December 7th. If people miss the December 7th deadline, other options to change plans outside of the ACEP should be explored.
For a more detailed discussion of these enrollment periods, see, e.g., previous Weekly Alerts, including: “Annual Enrollment Starts October 15 and Ends December 7 for Medicare Part D and Part D Plans” (September 22, 2011) available at: http://www.medicareadvocacy.org/2011/09/annual-enrollment-starts-october-15-and-ends-december-7-for-medicare-part-c-part-d-plans/; “Medicare Advantage and Part D Enrollment Updates”(October 6, 2011) available at: http://www.medicareadvocacy.org/2011/10/medicare-advantage-and-part-d-changes-and-enrollment-updates/; “45 Day Disenrollment Period for Medicare Advantage Members”(January 6, 2011), available at: http://www.medicareadvocacy.org/2011/01/45-day-disenrollment-period-for-medicare-advantage-members/; “When a Medicare Advantage Plan Does Not Renew Its Contract” (November 4, 2010 ), available at: http://www.medicareadvocacy.org/InfoByTopic/MedicareAdvantageAndHMOs
/10_11.04.NonRenewal.htm. Also see, e.g., the Center’s website at: http://www.medicareadvocacy.org/medicare-info/medicare-part-d/#enrollment.
 Chapter 2 of the Medicare Managed Care Manual (CMS Pub. 100-16, updated August 19, 2011, revised November 16, 2011):https://www.cms.gov/MedicareMangCareEligEnrol/Downloads/FINALMAEnrollmentandDisenrollmentGuidanceUpdateforCY2012-REV11.16.2011.pdf Chapter 3 of the Medicare Prescription Drug Benefit Manual (CMS Pub. 100-18, updated August 19, 2011, revised November 16, 2011):https://www.cms.gov/MedicarePresDrugEligEnrol/Downloads/FINALPDPEnrollmentandDisenrollmentGuidanceUpdateforCY2012-REV11.16.2011.pdf