Re-Learning Life after AEP
Getting back to non-AEP activities after the season has ended is like trying to tie your shoe after 30 years of wearing Velcro sneakers. It can be hard. Our schedules have changed, we are distracted by the holiday’s. Your immediate families, who became your “long lost” families during AEP are excited to have you back. And through all that you’re on a roll and ready to keep up the phenomenal sales year.
So what election periods for Medicare Advantage plans do I use now?
Services Area Reduction (SAR) Election Period
When: December 8th – February 28th with the new 2018 plan coverage beginning on the first day of the month following enrollment.
Beneficiaries who’s Medicare plan is not being offered next year qualify to use the Service Area Reduction SEP.
The new Medicare plan enrollment becomes effective the first day of the month after enrollment (for example, if you enroll in December, you still will have Medicare plan coverage starting January 1st of the next year. But if you enroll into a new Medicare plan during February, your coverage begins on March 1st. Remember that clients enrolling in January or February will be without Medicare plan coverage for January and/or February.
And what are the Medicare Supplement guarantee issue rights due to SAR?
If your client was in a Medicare Advantage Plan, and that plan is leaving Medicare, stops giving care in the area, or your client moves out of the plan’s service area.
- Your client has the right to buy a Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.
- Your client only has this right if they switch to Original Medicare rather than joining another Medicare Advantage Plan.
- Your client can/must apply for a Medigap policy as early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends.
- Your clients Medigap coverage cannot start until their Medicare Advantage Plan coverage ends.
Note: When completing Medicare Advantage applications, you cannot use the SEP for SAR’s until that enrollment period opens. If an individual losing their plan wants to apply for a new plan during AEP, use the election period code AEP. You cannot use the SEP for service area reductions prior to December 8th.
Medicare Advantage Disenrollment Period (MADP) Election Period
When: January 1st – February 14th with the new 2018 plan coverage beginning on the first day of the month following enrollment.
During the MADP, a beneficiary can switch from an MA plan to traditional Medicare. Beneficiaries also have an opportunity to enroll in a Part D drug plan if they have not already done so.
- When disenrolling from an MA plan during the MADP, the effective date of disenrollment 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.
- During the MADP, 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 drug benefit.
- Beneficiaries are advised to enroll in a PDP as close to the time of disenrollment from the MA plan as possible in order to avoid having a gap in drug coverage. For example, a beneficiary who disenrolls from an MA plan on January 31 and enrolls in a prescription drug plan (PDP) on February 1 would return to traditional Medicare on February 1, but would not have drug coverage until March 1.
And what are the Medicare Supplement guarantee issue rights due to MADP?
There is no federal guaranteed issue right to buy a Medigap policy that is associated with the MADP. This means that your clients do not have protections against medical underwriting or premium cost differences when they shop for a Medigap policy, except to the extent that your state may have laws protecting them. For example, your clients may be able to buy a Medigap policy but may pay a higher premium or a waiting period may apply before the policy will pay. Some states expand guaranteed issue rights beyond the federal guidelines. Call us for questions specific to your state.
Special Election Periods
In addition to AEP, SAR, and MADP there are around 25 other election periods your clients could qualify for the entire rest of the year. Some of the more frequent situations that qualify beneficiaries for a Special Election Period include, but aren’t limited to:
- Dual Eligible or Low Income Subsidy
- Moving out of a plan’s service area
- Enrolling in Part B after delaying enrollment
- Losing group coverage
For help in deciding which election period your clients may qualify for check out our handy Election Period Tool or give us a call today.