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紅藍卡優質計劃和D部分藥物計劃的特殊公開期

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Medicare Advantage 計劃和 Medicare D 部分藥物計劃的特殊投保期

1 信息來自“Medicare 處方藥手冊:資格、註冊和退出,第 30 節”和“Medicare 管理式護理手冊:Medicare Advantage 註冊和退出,第 30 節”。

2 Medicare Advantage 和 Part D 的資格要求和初始註冊期不同。如果您有 A 部分、B 部分或兩者兼有,並且居住在 Medicare D 部分藥物計劃的服務區,則您有資格參加 Medicare D 部分藥物計劃。 D 部分的初始註冊期通常與 B 部分的初始註冊期相同,即從您符合 B 部分資格前三個月開始到您符合資格月份後三個月結束的七個月期間。如果您同時擁有 A 部分和 B 部分,您就有資格加入 Medicare Advantage 計劃。 如果您患有晚期腎病,通常無法獲得 Medicare Advantage 計劃。 Medicare Advantage 的初始承保選擇期 (ICEP) 在您註冊 A 部分和 B 部分前三個月開始,並在您註冊 A 部分和 B 部分前一個月的最後一天或 B 部分的最後一天結束初始註冊期,以較晚者為準。

您可以加入、更改或退出 Medicare Advantage 計劃(也稱為 Medicare 私人健康計劃)或處方藥計劃(D 部分)的時間和頻率受到限制。

 您可以在首次獲得聯邦醫療保險資格的初始階段加入聯邦醫療保險優惠計劃或 D 部分計劃。 2

 在 Medicare Advantage Open Enrollment Period (MA OEP) 期間,您可以從您的 Medicare Advantage 計劃切換到另一個 MA 計劃,或者切換到有或沒有 D 部分計劃的原始 Medicare。 MA OEP 發生在每年的 1 月 1 日至 3 月 31 日。您只能在擁有 Medicare Advantage 計劃的情況下使用此期間。

 在秋季​​開放註冊期間,您可以更改您的健康保險以及添加、取消或更改您的藥物保險。秋季公開招生每年從 10 月 15 日到 12 月 7 日進行。

在上述三個期間之外,如果您符合特殊投保期 (SEP) 的資格,您只能更改您的健康和/或藥物承保範圍。

特殊註冊期

特殊投保期 (SEP) 的長度和新保險的生效日期取決於觸發您的 SEP 的情況。該計劃以及在某些情況下由 Medicare 和 Medicaid 服務中心 (CMS) 決定您是否有資格獲得 SEP。

下表中的 SEP 可讓您更改您的 Medicare Advantage 計劃、Medicare 藥物計劃或兩者。無論您是參加僅涵蓋藥物的獨立藥物計劃還是同時涵蓋醫療保健和藥物的 Medicare Advantage 計劃,更改 Medicare 藥物計劃的規則都是相同的。

追溯退出
在某些情況下,CMS 可能會讓您追溯退出您的 Medicare Advantage 或藥物計劃。 CMS 決定退出的開始日期。例如,如果您認為自己參加了一項獨立的藥物計劃,但被誤導加入了包括藥物承保的 Medicare Advantage 計劃,您可以要求退出您的計劃,回到您首次加入 Medicare Advantage 的日期計劃。

如果您被授予追溯退出資格,就好像您從未參加過 Medicare Advantage 計劃。該計劃可能會收回它為您的醫療保健和藥物支付的任何款項。在這種情況下,您需要確保您在追溯退出期間擁有健康和藥物保險。您可能有另一種類型的保險,可以從追溯期內支付賬單。或者,您可以要求追溯恢復您在加入您不想要的計劃之前擁有的 Medicare 承保範圍。您在計劃中不想要的護理和藥物賬單必須重新提交到其他計劃。

如果您在計劃中獲得了大量不想要的醫療保健和藥物,請仔細考慮申請追溯退出是否是個好主意。您還可以申請預期退出,這將改變您的承保範圍。在這種情況下,該計劃將不會收回已支付的款項。

如果您想從一個計劃切換到另一個計劃,通常最好只加入您想加入的計劃。您將自動退出舊計劃。最好致電 1-800-MEDICARE 加入新計劃,而不是直接致電該計劃。

延遲加入 D 部分的保費罰款

如果您在首次符合條件時沒有加入 D 部分,並且您沒有可計入的藥物承保範圍,那麼如果您以後加入 D 部分計劃,您可能需要支付保費罰款。

© 2020 醫療保險權利中心

雖然 SEP 允許您在標準註冊期之外註冊 D 部分,但在許多情況下,您仍需支付 D 部分延遲註冊的額外罰款。有兩種例外情況:如果您有資格獲得額外幫助(一項幫助支付 Medicare 藥物福利的大部分費用的聯邦計劃),或者如果您證明您對其他人的可信度的信息不足,您將不會受到處罰。藥物覆蓋。

目錄

下頁中的表格解釋了特殊投保期何時適用於您、每個 SEP 持續多長時間以及您的新保險何時開始。如果您有資格同時獲得不同的 SEP,請選擇最適合您情況的 SEP。

1. 您擁有可信賴的藥物承保或因非您自身的過錯而失去可信賴的承保

2. 您選擇更改雇主/工會保險(通過當前或過去的工作)

3. 你被制度化了

4. 您參加了州藥物援助計劃 (SPAP)

5. 您有額外幫助、醫療補助或醫療保險儲蓄計劃 (MSP)

6. 您獲得、失去或改變您的 Medicaid、MSP 或 Extra Help 資格狀態

7. 您想退出您的第一個 Medicare Advantage 計劃

8. 您加入/退出 PACE(老年人全方位護理計劃)

9. 你搬家(永久改變你的家庭住址)

10. 您有醫療保險資格問題

11. 您有資格參加特殊需要計劃 (SNP) 或失去 SNP 資格

12. 您被動加入 D 部分計劃或雙重資格 SNP (D-SNP)

13. 您遇到違反合同或註冊錯誤的情況

14. 您的計劃不再提供承保

15. 您在 Medicare Advantage 開放註冊期間退出您的 Medicare Advantage 計劃

16. 當您年滿 65 歲時,您就有資格參加新的 D 部分初始註冊期

17. 您想加入五星級 Medicare Advantage 計劃或 Part D 計劃

18. 您一直處於低績效的 Medicare Advantage 或 Part D 計劃中

19. 您的 Medicare Advantage 計劃終止了大量網絡提供者

20. 你遇到了“特殊情況”

特殊投保期

1. 您因自己的過錯而失去可信賴的藥物承保範圍,或者想要保留或加入可信賴的承保範圍。

如果…

您的 SEP 持續…

您的保險開始…

您(並非您自己的過錯)失去了至少與 Medicare 的(可計入的)相同或更好的藥物承保範圍,或者您的藥物承保範圍減少以致不再可計入。 (這不包括因為您不支付或負擔不起您的保費而失去您的藥物承保範圍。)

您加入包含藥物承保的 Medicare Advantage 計劃或獨立的 Medicare D 部分藥物計劃的 SEP 從您被告知您的承保將結束的月份開始並持續

 在您失去承保後 2 個月;或者

 收到通知後 2 個月,以較晚者為準。

提交完整申請後的第一天;或者

如果您提出要求,在您的 SEP 結束後最多兩個月。

您想退出 Medicare 藥物保險以維持或加入另一種類型的可信藥物保險,例如 VA、TRICARE 或提供可信保險的州藥物援助計劃 (SPAP)。

只要您能夠參加另一種類型的可計入保險,您就可以使用此 SEP 退出具有藥物承保範圍的 Medicare Advantage 計劃或獨立的 Medicare D 部分藥物計劃。

您的計劃收到您的退出請求後的第一天。

2. 您加入或放棄雇主/工會健康和/或藥物保險,無論其是否可信。雇主保險可能是當前的或以前的(退休人員計劃)。

如果…

您的 SEP 持續…

您的保險開始…

您選擇:

 加入或退出雇主/工會贊助的 Medicare Advantage 計劃或 D 部分計劃

 退出 Medicare Advantage 計劃或 Part D 計劃以獲取雇主/工會贊助的保險。

 退出雇主/工會-

您的 SEP 加入或退出 Medicare Advantage 計劃或 D 部分計劃,或轉換 Medicare Advantage 計劃或 D 部分計劃,適用於已加入或正在加入雇主計劃的人,並在您的雇主所在月份後兩個月結束或工會保險結束。

在您提交完整的註冊申請的月份後最多三個月。

如果您的雇主/工會延遲提交申請,您的承保範圍可能會追溯至您提交申請的時間。

任何類型的讚助保險(包括 COBRA3)以加入 Medicare Advantage 計劃或 D 部分計劃。

3. 你被制度化了。

如果…

您的 SEP 持續…

您的保險開始…

您搬入、居住或搬出符合條件的機構設施:專業護理設施、療養院、精神病院或單位、智障人士中級護理設施——ICF/ID、康復醫院或單位、長期護理醫院,或搖床醫院 4 或;

您有資格為機構化人員加入特殊需求計劃 (SNP)5

一旦您搬到或居住在合格的機構,您就可以加入或退出 Medicare Advantage 計劃或 D 部分計劃,或者每月更改一次計劃。 (如果您參加的是 Medicare Advantage 計劃,您可以更改為另一個 Medicare Advantage 計劃或更改為 Original Medicare)

此外,在您搬出設施後,您有兩個月的時間加入或退出 Medicare Advantage 計劃或 D 部分計劃,或切換到另一個計劃(如果您參加的是 Medicare Advantage 計劃,則包括原始 Medicare)。

您可以隨時為機構化人員加入或退出 SNP。

在您提交完整的申請後的一個月的第一天,但​​不是在您成為機構化人員或有資格參加針對機構化人員的特殊需求計劃之前。

4. 您已參加合格的州藥物援助計劃 (SPAP) 或失去 SPAP 資格。

如果…

您的 SEP 持續…

您的保險開始…

您已加入合格的 SPAP(無論您成為會員多久)。

您有一個 SEP 可以在一年中的任何時間每年選擇一次首次加入 Medicare Advantage 計劃或 Part D 計劃,或更改為另一個 Medicare Advantage 計劃或 Part D 計劃,包括加入與之合作的計劃你的SPAP。 (如果您的 SPAP 自動加入 D 部分計劃,您將沒有此 SEP。)

您不得使用此 SEP 放棄 D 部分的承保範圍。

提交完成的申請後的第一天。

您將失去 SPAP 資格

您有一個 SEP 可以加入或轉換到另一個有藥物承保的 Medicare D 部分計劃或 Medicare Advantage 計劃。即使您之前沒有 D 部分,這也適用。 SEP 從您失去 SPAP 的月份開始,因為您不再符合資格或收到損失通知(以先到者為準),並在您收到損失通知或失去 SPAP(以較晚者為準)後持續兩個月。

提交完成的申請後的第一天。

5. 您有 Medicaid、Medicare 儲蓄計劃 (MSP) 和/或額外幫助。 (如果您有額外幫助,您將不會受到 D 部分保費罰款。)

如果…

您的 SEP 持續…

您的保險開始…

您自動獲得額外幫助,因為您有 Medicaid、Medicare Savings Program (MSP) 或補充保障

您將在每個日曆中獲得一次加入、退出、6 或轉換 Medicare Advantage 計劃或 D 部分計劃的 SEP

您向 Medicare Advantage 計劃或 D 部分計劃提交完整申請後的第一天。

收入(SSI)。

在今年前九個月的季度。此 SEP 可在以下每個時期使用一次:

 一月到三月

 四月到六月

 而且,七月到九月

您不能在一年的第四個日曆季度(10 月至 12 月)使用此 SEP。在此期間,您應該使用 Fall Open Enrollment 來更改處方藥。

 如果您自己沒有選擇 D 部分計劃,CMS 將在 CMS 確定您的額外幫助狀態後的第二個月的第一天自動為您註冊 D 部分計劃。從您有資格獲得額外幫助的那一個月起,CMS 將通過 Humana 為您註冊 Limited Income NET (LINET) 計劃,直到您的自動註冊計劃開始。

 如果您最近有資格獲得 Extra Help 並選擇您自己的 Medicare D 部分計劃,而不是等待 CMS 自動加入一個計劃,您可以通過 Humana 的 Limited Income NET 計劃獲得任何未覆蓋月份的承保。

 如果您加入沒有藥物承保的 Medicare Advantage 計劃,Medicare 將自動為您加入由同一家公司提供的藥物承保的 Medicare Advantage 計劃。您加入藥物承保的 Medicare Advantage 計劃可能具有追溯效力。

你有額外幫助,因為你申請了它。 (您沒有 Medicaid 或 Medicare 儲蓄計劃。)

在一年的前九個月內,每個日曆季度,您將獲得一份 SEP 以加入、退出或轉換 Medicare Advantage 計劃或 D 部分計劃。此 SEP 可在以下每個時期使用一次:

 一月到三月

 四月到六月

 而且,七月到九月

您向 D 部分計劃提交完整的申請後的第一天。

 如果您自己沒有選擇 D 部分計劃,CMS 將在 CMS 確定您的額外幫助狀態後的第二個月的第一天自動為您註冊 D 部分計劃。 CMS 將讓您參加 Limited Income NET (LINET) 計劃

您不能在一年的第四個日曆季度(10 月至 12 月)使用此 SEP。在此期間,您應該使用 Fall Open Enrollment 來更改處方藥。

從您有資格獲得額外幫助的月份到您的自動註冊計劃開始的月份,通過 Humana。

 如果您最近有資格獲得 Extra Help 並選擇您自己的 Medicare 私人藥物計劃,而不是等待 CMS 自動加入一個計劃,您可以通過 Humana 的 Limited Income NET (LINET) 計劃獲得任何未覆蓋月份的承保。

6. 您的 Medicaid、MSP 或 Extra Help 資格狀態獲得、失去或發生變化。

如果…

您的 SEP 持續…

您的保險開始…

您有資格獲得 Medicaid、任何 MSP 或額外幫助。

在您收到通知後的三個月內,您有一次性 SEP 可以退出或轉換您的 Medicare Advantage 計劃或 D 部分計劃。

提交完成的申請後的第一天。

您失去了享受 Medicaid、MSP 或額外幫助的資格。

在您收到通知後的三個月內,您有一次性 SEP 可以退出或轉換您的 Medicare Advantage 計劃或 D 部分計劃。

提交完成的申請後的第一天。

您獲得的援助水平發生變化(例如,您從全部額外援助變為部分額外援助,或者您停止接受醫療補助但仍有資格獲得額外援助)。

在您收到通知後的三個月內,您有一次性 SEP 可以退出或轉換您的 Medicare Advantage 計劃或 D 部分計劃。

提交完成的申請後的第一天。

7. 您想退出您的 FIRST Medicare Advantage 計劃。

如果…

您的 SEP 持續…

您的保險開始…

當您第一次符合資格時,您選擇了 Medicare Advantage 私人健康計劃

您可以在 12-

視情況而定。

基於年齡的聯邦醫療保險 B 部分(65 歲) 7

在您的健康計劃承保首次開始幾個月後,無論是否加入獨立的聯邦醫療保險 D 部分藥物計劃,都可以返回到原始聯邦醫療保險。

您第一次放棄 Medigap 保單以加入 Medicare Advantage 計劃,並希望在“試用期”期間重新加入 Medigap 保單。8 在您加入 Medicare 私人健康計劃後,試用期持續 12 個月首次。

您可以在試用期內的任何時間退出您的 Medicare Advantage 計劃——即您的 Medicare Advantage 承保首次開始後的 12 個月——並在加入或不加入獨立的 Medicare D 部分藥物計劃的情況下返回到 Original Medicare。

視情況而定。

8. 您加入/退出 PACE(老年人全方位護理計劃)。

如果…

您的 SEP 持續…

您的保險開始…

您退出 Medicare Advantage 計劃或 D 部分計劃以加入 PACE。

您可以隨時退出您的 Medicare Advantage 或 Part D 計劃以加入 PACE。

視情況而定。

您退出 PACE 以加入 Medicare Advantage 計劃或 Part D 計劃。

您加入另一個 Medicare Advantage 計劃或 D 部分計劃的 SEP 在您退出 PACE 計劃的生效日期後最多持續兩個月。

視情況而定。

9. 您搬家(永久更改您的家庭住址)。

如果…

您的 SEP 持續…

您的保險開始…

你移動,永久。如果您搬出 Medicare Advantage 計劃或 D 部分計劃的服務區域,或者如果您搬到您的計劃涵蓋的區域但您的新涵蓋區域有更多計劃可供您使用,您將擁有 SEP。

如果您提前通知您的 Medicare Advantage 計劃或 D 部分計劃永久搬遷,您就有一個 SEP 可以轉換到另一個 Medicare Advantage 或 D 部分計劃,最早在您搬家前一個月開始並持續兩個月

您可以選擇在您搬家當月的第一天(只要您提交了完整的申請)到您的 Medicare Advantage 計劃或 D 部分計劃收到完整的申請表三個月後的任何時間開始承保

搬家後。

如果您在搬家後通知您的 Medicare Advantage 或 D 部分計劃永久搬家,則您有 SEP 可以從您告知計劃的月份開始轉換到另一個私人健康或藥物計劃,以及之後的兩個整月。

(注意:如果您搬出 Medicare Advantage Plan 的服務區域,您也可以選擇返回 Original Medicare 並選擇獨立的 Part D 計劃。)

如果您沒有將搬家通知您的私人健康或藥物計劃:

 並且您的 Medicare D 部分計劃從 CMS 或郵局得知您在 12 個月前搬家,該計劃應在您搬家十二個月後取消​​註冊。您轉換到另一個 D 部分計劃的 SEP 從第 12 個月開始,一直持續到您搬家後的第 14 個月末。

 並且您的 Medicare Advantage 計劃從 CMS 或郵局得知您在六個月前搬家,該計劃應在您搬家十二個月後取消​​您的註冊。您的 SEP 轉換到另一個 Medicare Advantage 計劃從第 6 個月開始,一直持續到您搬家後的第 8 個月末。

入學申請。

您有資格參加 D 部分

您有資格獲得 SEP 以參加 D 部分

您可以選擇開始承保任何

計劃或 Medicare Advantage 計劃,因為您有:

 在國外生活後搬回美國

 你被釋放出獄

(如果您居住在美國境外或在監獄中,則您沒有資格參加 D 部分計劃或 Medicare Advantage 計劃。)

計劃或 Medicare Advantage 計劃。您有一份 SEP 可以加入 Medicare Advantage 或 D 部分計劃,該計劃最早在您搬家前一個月開始,並在搬家後最多持續兩個月。

您搬家當月的第一天(只要您提交了完整的申請)到您的 Medicare Advantage 計劃或 D 部分計劃收到完整的註冊申請後最多三個月之間的時間。

10. 您有醫療保險資格問題。

如果…

您的 SEP 持續…

您的保險開始…

您已收到 Medicare 的追溯登記。

您首次加入 Medicare Advantage 或 Part D 計劃的註冊期從您收到您的 Medicare 權利通知的月份開始,並在收到通知的月份後持續兩個月。 9

視情況而定。

您沒有免保費 A 部分,並且您在一般投保期(每年 1 月 1 日至 3 月 31 日)投保 B 部分,您的 B 部分承保範圍從 7 月 1 日開始。

您有 SEP 可以在 4 月 1 日至 6 月 30 日(在您註冊 B 部分之後)加入聯邦醫療保險 D 部分計劃。

當年7月1日。

您失去了 B 部分,但仍然擁有 A 部分,並且非自願退出了您的 Medicare Advantage 計劃。

您有一份 SEP 可以參加 Medicare D 部分藥物計劃,該計劃從您得知您失去 B 部分開始並持續兩個月。

申請月份的次月。

11. 您有資格加入特殊需求計劃 (SNP) 或失去 SNP 資格。

如果…

您的 SEP 持續…

您的保險開始…

您有資格加入 Medicare SNP。

您可以離開您的 Medicare Advantage

提交後當月的第一天

如果您符合條件,可以隨時計劃或 D 部分計劃加入 SNP。

如果您患有慢性病並想加入您有資格參加的慢性病護理 SNP,您可以隨時加入。 SEP 在您加入私人健康或藥物計劃時結束。注意:如果您有另一種慢性病,您會得到另一個 SEP 以加入涵蓋該另一種病的不同 SNP。

一個完整的應用程序。

您將失去繼續通過您的 SNP 獲得保險的資格。 (如果您不符合資格,SNP 必須繼續為您提供至少 1 個月的保障;如果您很可能在 6 個月內重新獲得資格,則 SNP 必須繼續為您提供保障。)

您可以從您不再符合 SNP 資格的月份開始加入另一個 Medicare Advantage 計劃或 D 部分計劃,並在您的持續註冊期結束後三個月或您註冊另一個計劃時結束,以先到者為準。

提交完成的申請後的第一天。

您註冊了慢性病護理 SNP,但您的提供者未能在註冊的第一個月末確認您具有符合資格所需的慢性病。

您有一個 SEP 可以參加 Medicare Advantage 計劃或 D 部分計劃。 SEP 從 SNP 計劃通知您不符合資格的月份開始,並在通知月份或您加入另一個 Medicare Advantage 計劃或 D 部分計劃後整整兩個月結束,以較早者為準。

提交完成的申請後的第一天。

12. 您被動加入 D 部分計劃或雙重資格 SNP (D-SNP)。

如果…

您的 SEP 持續…

您的保險開始…

在確定您的額外幫助狀態後,CMS 會自動為您註冊 D 部分計劃。

您有三個月的時間切換到另一個計劃,從您收到註冊通知後或生效日期後開始,以較晚者為準。

提交完成的申請後的第一天。

在您之前的 D-SNP 結束後,CMS 會自動為您註冊新的 D-SNP。

您有三個月的時間切換到另一個計劃,從您開始

提交完成的申請後的第一天。

通知註冊或在其生效日期之後,以較晚者為準。

13. 您遇到合同違約(例如誤導性營銷)或註冊錯誤。

如果…

您的 SEP 持續…

您的保險開始…

您的 Medicare Advantage 計劃或 D 部分計劃違反了您的合同的重要條款,例如:

 未能及時為您提供該計劃下可用的福利;

 未能按照適用的質量標準提供福利;

 在私人健康或藥物計劃的營銷中提供誤導性信息,以促使您加入該計劃。

一旦區域 CMS 辦公室確定發生了違規行為,您的 SEP 就開始轉換到另一個 Medicare Advantage 計劃或 D 部分計劃。 (如果您參加的是 Medicare Advantage 計劃,則您的 SEP 允許您退出您的計劃並更改為 Original Medicare 或加入另一個 Medicare Advantage 計劃)

您可以在加入當前計劃的最後一個月切換到另一個 Medicare Advantage 計劃或 D 部分計劃。

如果您不立即選擇其他私人健康或藥物計劃,您的 SEP 將從您退出該計劃之日起延長 90 天。

新的 Medicare Advantage 計劃或 D 部分計劃的生效日期將是新的私人健康或藥物計劃收到完整申請後的下個月的第一天,或在收到完整申請後最多三個月。

在某些情況下,CMS 可能會在另一個 Medicare Advantage 或 D 部分計劃中處理追溯退出和/或追溯登記。

聯邦僱員在您加入或退出 Medicare D 部分計劃時犯了錯誤。

您有一個 SEP 可以加入和/或退出 Medicare D 部分計劃,該計劃從 CMS 批准月份開始並持續兩個月。

視情況而定。

CMS 制裁(發現錯誤)Medicare Advantage 計劃或 D 部分計劃,並且您因該制裁退出。

您的 SEP 加入新的 Medicare Advantage 計劃或 D 部分計劃的期限和開始日期取決於具體情況。

視情況而定。

CMS 確定您之前的藥物承保沒有充分通知您失去可計入的承保範圍或您的藥物承保不可計入。

您有一個 SEP 可以加入或退出 Medicare D 部分計劃,該計劃從 CMS 批准月份開始並持續兩個月。 (在這種情況下,CMS 可能會免除您的保費罰款。)

視情況而定。

14. 您的 Medicare Advantage Plan 或 Part D 計劃不再提供 Medicare 承保。

如果…

您的 SEP 持續…

您的保險開始…

您的 Medicare Advantage Plan 或 Part D 計劃不會更新其服務。 (如果明年不提供 Medicare 藥物或健康保險,您的 Medicare Advantage 計劃或 D 部分計劃必須在 10 月 1 日前通知您,並且必須繼續提供承保直至當前日曆年年底。)

您轉換到另一個 Medicare Advantage 計劃或 D 部分計劃的 SEP 持續時間為當年的 12 月 8 日至次年 2 月的最後一天。 (此 SEP 是 10 月 15 日至 12 月 7 日秋季開放註冊期的補充,在此期間您可以轉換 Medicare 健康保險並註冊或退出 D 部分藥物保險。

 10 月 15 日至 12 月 31 日期間的註冊於 1 月 1 日生效。

 在 1 月份進行的註冊於 2 月 1 日生效。

 2 月份的註冊於 3 月 1 日生效。

年中,您的 Medicare Advantage 計劃或 D 部分計劃關閉或更改與 CMS 的合同,因此您將被迫退出該計劃。 (您的 Medicare Advantage 計劃或 D 部分計劃必須在提議的終止或修改日期前 60 天通知您。)

您的 SEP 轉換到另一個 Medicare Advantage 計劃或 D 部分計劃在提議的關閉或更改發生前兩個月開始,並在它們發生後一個月結束。

您可以要求您的新 Medicare Advantage 計劃或 D 部分計劃承保範圍在您收到通知後的一個月開始,並且在您舊的 Medicare Advantage 計劃或 D 部分計劃承保範圍結束後最多兩個月內開始。

由於不當行為或其他問題,CMS 終止您的 Medicare Advantage 計劃或 D 部分計劃的合同。 (您的計劃必須在終止日期前 30 天通知您。)

您轉換到另一個 Medicare Advantage Plan 或 Part D 計劃的 SEP 在終止發生前一個月開始,並在終止後持續兩個月。

您可以選擇讓您的新 Medicare Advantage Plan 或 Part D 計劃承保在您的舊承保結束後三個月內開始。

CMS 決定立即終止與您的 Medicare Advantage 計劃或 D 部分計劃的合同。

CMS 將通知您終止和您的 SEP。終止可能是月中。

視情況而定。

15. 您在 Medicare Advantage 開放註冊期 (MA OEP) 期間退出您的 Medicare Advantage 計劃。

如果…

您的 SEP 持續…

您的保險開始…

您在 Medicare Advantage 開放註冊期(每年 1 月 1 日至 3 月 31 日)退出您的 Medicare Advantage 計劃。

當您退出您的 Medicare Advantage 計劃時,您有一份 SEP 可以參加 Medicare 獨立的 D 部分藥物計劃。您可以通過提交退出請求或簡單地加入獨立的 D 部分藥物計劃來退出您的 Medicare Advantage 計劃。

如果您在 MA OEP 期間退出您的 Medicare Advantage 計劃,您可以通過獨立的 D 部分計劃加入原始 Medicare,或轉換您的 Medicare Advantage 計劃。

您向新計劃提交註冊請求的次月。

16. 當您年滿 65 歲時,您就有資格參加新的 D 部分初始註冊期。

如果…

您的 SEP 持續…

您的保險開始…

您有資格參加新的 D 部分初始投保期以加入獨立的聯邦醫療保險 D 部分藥物計劃,因為您是年滿 65 歲的殘障人士。(注意:如果您已經投保了聯邦醫療保險 D 部分計劃並且正在支付延遲保費罰款,罰款將在註冊期開始時結束。)

您有一份 SEP 可以退出 Medicare Advantage 計劃(包括或不包括藥物承保)以加入 Original Medicare 或加入不包括藥物承保的 Medicare Advantage 計劃。您也可以使用額外的 IEP 加入獨立的 D 部分藥物計劃。 SEP 以加入聯邦醫療保險 D 部分計劃的額外 D 部分 IEP 開始和結束——通常是七個月的時間段,包括您年滿 65 歲之前的三個月、您年滿 65 歲的月份以及您年滿 65 歲之後的三個月。

如果您尚未加入 D 部分計劃,您的承保範圍通常會在您向新計劃提交加入申請的次月開始。

17. 您想參加五星級的 Medicare Advantage 計劃或 Part D 計劃。

如果…

您的 SEP 持續…

您的保險開始…

您想參加總體計劃績效評級為 5 的 Medicare Advantage 或 Part D 計劃

計劃績效評級每年秋季發布,適用於下一個日曆年。您的 SEP 加入五星級

 12 月 8 日至 12 月 31 日的註冊於 1 月 1 日生效。

星,否則您就有資格參加該計劃。 (例如,您住在計劃的服務區。)

Medicare Advantage 或 Part D 計劃從該計劃被視為五星級計劃前一年的 12 月 8 日開始。它持續到當年的 11 月 30 日,該計劃被認為是五星級計劃。您可以使用此 SEP 每年更改一次計劃。

 1 月 1 日至 11 月 30 日的註冊在您提交註冊請求的次月生效。

18. 您一直處於低績效的 Medicare Advantage 或 Part D 計劃中。

如果…

您的 SEP 持續…

您的保險開始…

您一直處於低績效計劃中,這意味著該計劃連續三年獲得的整體 Medicare 星級評分低於三顆星。

您有一個 SEP 可以全年參加更高質量的計劃。您應該會在 10 月下旬收到 CMS 的通知,說您的計劃表現不佳。您可以在那一年的剩餘時間以及下一年切換到 3 星或以上評級的計劃。要使用此 SEP,您必須直接致電 1-800-MEDICARE。注意:這與上面列出的五星級 SEP 是分開的。

您向新計劃提交註冊請求的次月。

19. 您的 Medicare Advantage 停止與其許多提供者簽訂合同。

如果…

您的 SEP 持續…

您的保險開始…

您的 Medicare Advantage 計劃在日曆年期間停止與其網絡中的許多提供者簽訂合同,並且 CMS 確定這些終止是實質性的。如果終止足夠重要,您將有一次性 SEP 以加入不同的 Medicare Advantage 計劃(有或沒有 D 部分承保)或切換到原始 Medicare,有或沒有獨立的 D 部分計劃。如果 CMS 確定終止是實質性的,您的計劃將向您郵寄通知。

從您收到網絡更改通知的那一個月起,再過兩個月。您應該在網絡終止前至少 30 天收到郵件通知,並且您的 SEP 會切換到新的聯邦醫療保險優勢計劃,或加入具有 D 部分計劃的原始聯邦醫療保險。

您沒有通過此 SEP 購買 Medigap 的保證權利。

您向新計劃提交註冊請求的次月。

20. 你遇到了“特殊情況”。

如果…

您的 SEP 持續…

您的保險開始…

如果您的情況不屬於任何其他 SEP 類別,您有權要求 CMS 根據您的特定特殊情況授予您 SEP。 10

取決於 SEP。

視情況而定。

點擊此處或查閱以下原文英文版本:

© 2020 Medicare Rights Center

Last updated: January 2020

Special Enrollment Periods for Medicare Advantage Plans and Medicare Part D Drug Plans 1

1 The information in this chart comes from the “Medicare Prescription Drug Manual: Eligibility, Enrollment and Disenrollment, Section 30” and the “Medicare Managed Care Manual: Medicare Advantage Enrollment and Disenrollment, Section 30.”

2 Eligibility requirements and initial enrollment periods for Medicare Advantage and Part D are different. You are eligible to enroll in a Medicare Part D drug plan if you have Part A, Part B or both and live in the service area of a Medicare Part D drug plan. The Part D Initial Enrollment Period is usually the same as the Initial Enrollment Period for Part B, which is the seven-month period that begins three months before you qualify for Part B and ends three months after the month you qualify. You’re eligible to enroll in a Medicare Advantage Plan if you have both Parts A and B. You usually can’t get a Medicare Advantage Plan if you have End-Stage Renal Disease. The Initial Coverage Election Period (ICEP) for Medicare Advantage begins three months before you are enrolled in both Parts A and B and ends either the last day of the month before you enrolled in both Parts A and B or the last day of your Part B initial enrollment period, whichever is later.

You are limited in when and how often you can join, change or leave a Medicare Advantage Plan (also known as a Medicare private health plan) or prescription drug plan (Part D).

 You can enroll in a Medicare Advantage or Part D plan during the initial period when you first qualify for Medicare.2

 You can switch from your Medicare Advantage Plan to another MA Plan, or to Original Medicare with or without a Part D plan, during the Medicare Advantage Open Enrollment Period (MA OEP). The MA OEP occurs each year from January 1 through March 31. You can only use this period if you have a Medicare Advantage Plan.

 You can change your health coverage and add, drop, or change your drug coverage during Fall Open Enrollment. Fall Open Enrollment occurs each year from October 15 through December 7.

Outside of the above three periods, you can only change your health and/or drug coverage if you qualify for a Special Enrollment Period (SEP).

© 2020 Medicare Rights Center

Special Enrollment Periods

The length of the Special Enrollment Period (SEP) and the effective date of your new coverage vary depending on the circumstances that trigger your SEP. The plan and, in some cases, the Centers for Medicare & Medicaid Services (CMS), determine whether you qualify for an SEP.

The SEPs in the tables below let you change your Medicare Advantage Plan, Medicare drug plan or both. The rules for changing Medicare drug plans are the same whether you are in a stand-alone drug plan that only covers drugs or a Medicare Advantage Plan that covers both health care and drugs.

Retroactive Disenrollment

In some cases, CMS may let you retroactively disenroll from your Medicare Advantage or drug plan. CMS decides the date the disenrollment starts. For example, if you thought you were enrolling in a stand-alone drug plan but instead were misled into joining a Medicare Advantage Plan that includes drug coverage, you can request for your plan disenrollment to go back to the date you first joined the Medicare Advantage Plan.

If you are granted retroactive disenrollment, it would be as if you never enrolled in the Medicare Advantage Plan. The plan will likely take back any payments it made for your health care and drugs. In this case, you will want to make sure you have health and drug coverage for the period for which you were retroactively disenrolled. You may have another type of insurance that will pay bills from the retroactive period. Or you may request retroactive reinstatement into the Medicare coverage you had before enrolling in the plan you did not want. Bills for care and drugs you got while in the plan you did not want would have to be resubmitted to that other plan.

If you got a lot of health care and drugs while in the plan you did not want, think carefully about whether it is a good idea to request retroactive disenrollment. You can also request prospective disenrollment, which will change your coverage going forward. In this case, the plan will not recoup payments it has already made.

If you want to switch from one plan to another, it is usually better to just enroll in the plan you want to enroll in. You will be automatically disenrolled from your old plan. It’s best to call 1-800-MEDICARE to enroll in a new plan rather than calling the plan directly.

Premium Penalty for Late Enrollment into Part D

If you do not enroll in Part D when you are first eligible, and you do not have creditable drug coverage, you will likely have to pay a premium penalty if you later enroll in a Part D plan.

© 2020 Medicare Rights Center

While SEPs let you enroll in Part D outside of a standard enrollment period, you will still owe a premium penalty for late Part D enrollment in many cases. There are two exceptions: You will not have a penalty if you qualify for Extra Help—a federal program that helps pay for most of the costs of the Medicare drug benefit—or if you show that you got inadequate information about the creditability of your other drug coverage.

Table of Contents

The table in the following pages explains when a Special Enrollment Period may apply to you, how long each SEP lasts, and when your new coverage will begin. If you qualify for different SEPs at the same time, pick the one that is most convenient for your circumstances.

1. You have creditable drug coverage or lose creditable coverage through no fault of your own

2. You choose to change employer/union coverage (through either current or past employment)

3. You are institutionalized

4. You are enrolled in a State Pharmaceutical Assistance Program (SPAP)

5. You have Extra Help, Medicaid, or a Medicare Savings Program (MSP)

6. You gain, lose, or have a change in your Medicaid, MSP, or Extra Help eligibility status

7. You want to disenroll from your first Medicare Advantage Plan

8. You enroll in/disenroll from PACE (Program of All-Inclusive Care for the Elderly)

9. You move (permanently change your home address)

10. You have had Medicare eligibility issues

11. You are eligible for a Special Needs Plan (SNP) or lose eligibility for your SNP

12. You are passively enrolled into a Part D plan or Dual-eligible SNP (D-SNP)

13. You experience contract violations or enrollment errors

14. Your plan no longer offers coverage

15. You disenroll from your Medicare Advantage Plan during the Medicare Advantage Open Enrollment Period

16. You qualify for a new Part D Initial Enrollment Period when you turn 65

17. You want to enroll in a five-star Medicare Advantage Plan or Part D plan

18. You have been in a consistently low-performing Medicare Advantage or Part D plan

19. Your Medicare Advantage Plan terminates a significant amount of its network providers

20. You experience an “exceptional circumstance”

© 2020 Medicare Rights Center

Special Enrollment Periods 1. You lose creditable drug coverage through no fault of your own or want to keep or enroll in creditable coverage.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You, through no fault of your own, lose drug coverage that is at least as good as or better than Medicare’s (creditable) or your drug coverage is reduced so that it is no longer creditable. (This does not include losing your drug coverage because you do not pay, or cannot afford, your premiums.)

Your SEP to join a Medicare Advantage Plan with drug coverage or a stand-alone Medicare Part D drug plan begins the month you are told your coverage will end and lasts for

 2 months after you lose your coverage; or

 2 months after you receive notice, whichever is later.

The first day of the month after you submit a completed application; or

Up to two months after your SEP ends, if you request it.

You want to disenroll from Medicare drug coverage to maintain or enroll in another type of creditable drug coverage such as VA, TRICARE, or a state pharmaceutical assistance program (SPAP) that offers creditable coverage.

You can use this SEP to disenroll from a Medicare Advantage Plan with drug coverage or a stand-alone Medicare Part D drug plan whenever you are able to enroll in another type of creditable coverage.

The first day of the month after your plan receives your disenrollment request.

2. You join or drop employer/union health and/or drug coverage regardless of whether it is creditable. Employer coverage may be current or former (retiree plan).

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You choose to:

enroll in or disenroll from a employer/union-sponsored Medicare Advantage Plan or Part D plan

disenroll from a Medicare Advantage Plan or Part D plan to take employer/union-sponsored coverage.

disenroll from employer/union-

Your SEP to join or disenroll from a Medicare Advantage Plan or Part D plan, or to switch Medicare Advantage Plans or Part D plans is available to persons who have or are enrolling in an employer plan and ends two months after the month in which your employer or union coverage ends.

Up to three months after the month in which you submit a completed enrollment application.

If your employer/union was late sending in the application, your coverage may begin retroactive to when you submitted the application.

 

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sponsored coverage of any kind (including COBRA3) to enroll in a Medicare Advantage Plan or Part D plan.

3. You are institutionalized.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You move into, reside in, or move out of a qualified institutional facility: a skilled nursing facility, nursing home, psychiatric hospital or unit, Intermediate Care Facility for Individuals with Intellectual Disabilities—ICF/ID, rehabilitation hospital or unit, long-term care hospital, or swing-bed hospital4 or;

You qualify to enroll in a Special Needs Plan (SNP) for institutionalized people5

Once you move to or reside in a qualified institution, you can enroll in or disenroll from a Medicare Advantage Plan or Part D plan or change your plan once a month. (If you are in an Medicare Advantage Plan, you may change to another Medicare Advantage Plan or change to Original Medicare)

In addition, after you move out of the facility, you have two months to enroll in or disenroll from a Medicare Advantage Plan or Part D plan, or to switch to another plan (including Original Medicare if you are in a Medicare Advantage Plan).

You can enroll in or disenroll from the SNP for institutionalized people at any time.

The first day of the month after you submit a completed application, but not before you become institutionalized or qualify to enroll in a Special Needs Plan for institutionalized people.

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4. You are enrolled in a qualified State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You’re enrolled in a qualified SPAP (no matter how long you have been a member).

You have an SEP to choose once per year, at any time during the year, to join a Medicare Advantage Plan or Part D plan for the first time or to change to another Medicare Advantage Plan or Part D plan, including joining one that works with your SPAP. (If you are automatically enrolled in a Part D plan by your SPAP, you will not have this SEP.)

You may not drop Part D coverage using this SEP.

The first day of the month after you submit a completed application.

You lose SPAP eligibility

You have an SEP to join or switch to another Medicare Part D plan or Medicare Advantage Plan with drug coverage. This applies even if you didn’t have Part D before. The SEP starts the month you lose the SPAP because you’re no longer eligible or are notified of the loss (whichever comes first) and continuing for two months after you’re notified of the loss or lose the SPAP (whichever comes later).

The first day of the month after you submit a completed application.

5. You have Medicaid, a Medicare Savings Program (MSP) and/or Extra Help. (You will have no Part D premium penalty if you have Extra Help.)

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You get Extra help automatically because you have Medicaid, a Medicare Savings Program (MSP), or Supplemental Security

You will get an SEP to join, disenroll from,6 or switch Medicare Advantage Plans or Part D plans once per calendar

The first day of the month after you submit a completed application to the Medicare Advantage Plan or Part D plan.

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Income (SSI).

quarter during the first nine months of the year. This SEP can be used once during each of the following periods:

 January through March

 April through June

 And, July through September

You cannot use this SEP during the fourth calendar quarter of the year (October through December). You should use Fall Open Enrollment during this time to make prescription drug changes.

 If you do not select a Part D plan yourself, CMS will auto-enroll you in a Part D plan effective the first day of the second month after CMS identifies your Extra Help status. CMS will enroll you in the Limited Income NET (LINET) program through Humana from the month you qualified for Extra Help until the month your auto-enrolled plan starts.

 If you recently qualified for Extra Help and choose your own Medicare Part D plan instead of waiting to be auto-enrolled in one by CMS, you may receive coverage of any uncovered months through the Limited Income NET program through Humana.

 If you enroll in a Medicare Advantage Plan without drug coverage, Medicare will automatically enroll you in a Medicare Advantage Plan with drug coverage offered by that same company. Your Medicare Advantage Plan with drug coverage enrollment could be retroactive.

You have Extra Help because you applied for it. (You do not have Medicaid or a Medicare Savings Program.)

You will get an SEP to join, disenroll from, or switch Medicare Advantage Plans or Part D plans once per calendar quarter during the first nine months of the year. This SEP can be used once during each of the following periods:

 January through March

 April through June

 And, July through September

The first day of the month after you submit a completed application to the Part D plan.

 If you do not select a Part D plan yourself, CMS will auto-enroll you in a Part D plan effective the first day of the second month after CMS identifies your Extra Help status. CMS will enroll you in the Limited Income NET (LINET) program

© 2020 Medicare Rights Center

You cannot use this SEP during the fourth calendar quarter of the year (October through December). You should use Fall Open Enrollment during this time to make prescription drug changes.

through Humana from the month you qualified for Extra Help until the month your auto-enrolled plan starts.

 If you recently qualified for Extra Help and choose your own Medicare private drug plan instead of waiting to be auto-enrolled in one by CMS, you may receive coverage of any uncovered months through the Limited Income NET (LINET) program through Humana.

6. You gain, lose, or have a change in your Medicaid, MSP, or Extra Help eligibility status.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You become eligible for Medicaid, any MSP, or Extra Help.

You have a one-time SEP to disenroll from or switch your Medicare Advantage Plan or Part D plan for three months after you are notified.

The first day of the month after you submit a completed application.

You lose eligibility for Medicaid, an MSP, or Extra Help.

You have a one-time SEP to disenroll from or switch your Medicare Advantage Plan or Part D plan for three months after you are notified.

The first day of the month after you submit a completed application.

The level of assistance you receive changes (for example, you move from full to partial Extra Help, or you stop receiving Medicaid but still qualify for Extra Help).

You have a one-time SEP to disenroll from or switch your Medicare Advantage Plan or Part D plan for three months after you are notified.

The first day of the month after you submit a completed application.

7. You want to disenroll from your FIRST Medicare Advantage Plan.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You select a Medicare Advantage private health plan when you first qualify for

You can disenroll from your Medicare Advantage Plan at any time during the 12-

Depends upon the situation.

© 2020 Medicare Rights Center

Medicare Part B based on age (65 years old) 7

months after your health plan coverage first started and go back to Original Medicare with or without joining a stand-alone Medicare Part D drug plan.

You dropped your Medigap policy to enroll in a Medicare Advantage Plan for the first time and want to re-enroll in a Medigap policy during your “trial period.”8 The trial period lasts for 12 months after you enroll in a Medicare private health plan for the first time.

You can disenroll from your Medicare Advantage Plan at any time during the trial period – the 12-months after your Medicare Advantage coverage first started– and go back to Original Medicare with or without joining a stand-alone Medicare Part D drug plan.

Depends upon the situation.

8. You enroll in/disenroll from PACE (Program of All-Inclusive Care for Elderly).

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You disenroll from a Medicare Advantage Plan or Part D plan to enroll in PACE.

You can disenroll from your Medicare Advantage or Part D plan at any time to enroll in PACE.

Depends upon the situation.

You disenroll from PACE to join a Medicare Advantage Plan or Part D plan.

Your SEP to join another Medicare Advantage Plan or Part D plan lasts up to two months after the effective date of your disenrollment from the PACE program.

Depends upon the situation.

9. You move (permanently change your home address).

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You move, permanently. You will have an SEP if you move out of your Medicare Advantage Plan’s or Part D plan’s service area or if you move to an area covered by your plan but more plans are available to you in your new coverage area.

If you notify your Medicare Advantage Plan or Part D plan of a permanent move in advance, you have an SEP to switch to another Medicare Advantage or Part D plan beginning as early as the month before your move and lasting up to two months

You may choose to begin coverage any time between the first day of the month you moved (as long as you have submitted a completed application), and up to three months after your Medicare Advantage Plan or Part D plan receives the completed

© 2020 Medicare Rights Center

after the move.

If you notify your Medicare Advantage or Part D plan of a permanent move after you move, you have an SEP to switch to another private health or drug plan, beginning the month you tell your plan, plus two more full months thereafter.

(Note: You can also choose to return to Original Medicare and select a stand-alone Part D plan if you move out of your Medicare Advantage Plan’s service area.)

If you did not notify your private health or drug plan about a move:

 and your Medicare Part D plan learns from CMS or the post office that you moved over twelve months ago, the plan should disenroll you twelve months after your move. Your SEP to switch to another Part D plan begins at the beginning of the twelfth month and continues through the end of the fourteenth month after your move.

 and your Medicare Advantage Plan learns from CMS or the post office that you moved over six months ago, the plan should disenroll you twelve months after your move. Your SEP to switch to another Medicare Advantage Plan begins at the beginning of the sixth month and continues through the end of the eighth month after your move.

enrollment application.

You become eligible to enroll in a Part D

You qualify for an SEP to enroll in a Part D

You may choose to begin coverage any

© 2020 Medicare Rights Center

plan or a Medicare Advantage Plan because you have:

 Moved back to the U.S. after living abroad

 You were released from prison

(You aren’t eligible to enroll in Part D plans or Medicare Advantage Plans if you live outside the U.S. or are in prison.)

plan or a Medicare Advantage Plan. You have an SEP to join a Medicare Advantage or Part D plan beginning as early as the month before your move and lasting up to two months after the move.

time between the first day of the month you moved (as long as you have submitted a completed application), and up to three months after your Medicare Advantage Plan or Part D plan receives the completed enrollment application.

10. You have had Medicare eligibility issues.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You have received retroactive enrollment into Medicare.

Your enrollment period to join a Medicare Advantage or Part D plan for the first time begins the month that you receive notice of your Medicare entitlement and continues for an additional two months after the month the notice is received.9

Depends on the situation.

You do not have premium-free Part A and you enroll in Part B during the General Enrollment Period (January 1 to March 31 of each year) with your Part B coverage beginning July 1.

You have an SEP to join a Medicare Part D plan from April 1-June 30 (after you have enrolled in Part B).

July 1 of that year.

You lost Part B but still have Part A and are involuntarily disenrolled from your Medicare Advantage Plan.

You have an SEP to enroll in a Medicare Part D drug plan that begins when you learn you lost Part B and continues for two additional months.

The month following the month you applied.

11. You are eligible to join a Special Needs Plan (SNP) or you lose SNP eligibility.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You’re eligible to enroll in a Medicare SNP.

You can leave your Medicare Advantage

The first day of the month after you submit

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Plan or Part D plan at any time to enroll in a SNP if you are eligible.

If you have a chronic condition and want to join a chronic care SNP for which you are eligible, you can do so at any time. The SEP ends when you join the private health or drug plan. Note: If you have another chronic condition, you get another SEP to join a different SNP that covers this other condition.

a completed application.

You lose eligibility to continue getting coverage through your SNP. (SNPs must continue to cover you for at least one month if you become ineligible and for up to six months if it’s likely that you will re-qualify within six months.)

You can join another Medicare Advantage Plan or Part D plan beginning the month you no longer qualify for the SNP and ending either three months after your continued period of enrollment ends or when you enroll in another plan, whichever comes first.

The first day of the month after you submit a completed application.

You’re enrolled in a chronic care SNP, but your provider fails to confirm that you have the chronic condition required for eligibility by the end of the first month of enrollment.

You have an SEP to enroll in a Medicare Advantage Plan or a Part D plan. The SEP begins the month the SNP plan notifies you that you don’t qualify and ends two full months after the month of notification or when you enroll in another Medicare Advantage Plan or Part D plan, whichever is earlier.

The first day of the month after you submit a completed application.

12. You are passively enrolled into a Part D plan or Dual-eligible SNP (D-SNP).

You have an SEP if…

Your SEP lasts…

Your coverage begins…

CMS auto-enrolls you in a Part D plan after identifying your Extra Help status.

You have three months to switch to another plan, beginning after you are notified of the enrollment or after its effective date, whichever is later.

The first day of the month after you submit a completed application.

CMS auto-enrolls you in a new D-SNP after your previous D-SNP ends.

You have three months to switch to another plan, beginning after you are

The first day of the month after you submit a completed application.

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notified of the enrollment or after its effective date, whichever is later.

13. You experience contract violations (such as misleading marketing) or enrollment errors.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

Your Medicare Advantage Plan or Part D plan violated a material provision of your contract such as:

 Failing to provide you on a timely basis with benefits available under the plan;

 Failing to provide benefits in accordance with applicable quality standards;

 Giving misleading information in the private health or drug plan’s marketing to get you to enroll in the plan.

Your SEP to switch to another Medicare Advantage Plan or Part D plan begins once the regional CMS office has determined that a violation has occurred. (If you are in an Medicare Advantage Plan, your SEP allows you to disenroll from your plan and either change to Original Medicare or join another Medicare Advantage Plan)

You can switch to another Medicare Advantage Plan or Part D plan during the last month of enrollment in your current plan.

If you do not choose another private health or drug plan immediately, your SEP is extended for 90 days from the time of your disenrollment in the plan.

The effective date of the new Medicare Advantage Plan or Part D plan will be the first of the month following the month the new private health or drug plan receives the completed application or up to three months after it receives the completed application.

In some cases, CMS may process a retroactive disenrollment and/or retroactive enrollment in another Medicare Advantage or Part D plan.

A federal employee made a mistake in your enrollment or disenrollment in a Medicare Part D plan.

You have one SEP to enroll in and/or disenroll from a Medicare Part D plan that begins the month of CMS approval and lasts two additional months.

Depends on the situation.

CMS sanctions (finds fault with) a Medicare Advantage Plan or Part D plan and you disenroll in connection with that sanction.

The length and start date of your SEP to join a new Medicare Advantage Plan or Part D plan depends on the situation.

Depends on the situation.

CMS determines that your previous drug coverage did not adequately inform you of a loss of creditable coverage or that your drug coverage was not creditable.

You have one SEP to enroll in or disenroll from a Medicare Part D plan that begins the month of CMS approval and lasts two additional months. (In this case, CMS may waive your premium penalties.)

Depends on the situation.

© 2020 Medicare Rights Center

14. Your Medicare Advantage Plan or Part D plan no longer offers Medicare coverage.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

Your Medicare Advantage Plan or Part D plan doesn’t renew its service. (Your Medicare Advantage Plan or Part D plan must notify you by October 1 if it won’t offer Medicare drug or health coverage next year, and it must continue to provide coverage through the end of the current calendar year.)

Your SEP to switch to another Medicare Advantage Plan or Part D plan lasts from December 8 of that year through the last day of February of the next year. (This SEP is in addition to the Fall Open Enrollment period from October 15 through December 7, when you can switch Medicare health coverage and enroll or disenroll from Part D drug coverage.

 Enrollments made from October 15 through December 31 are effective January 1.

 Enrollments made during January are effective February 1.

 Enrollments made in February are effective March 1.

Mid-year, your Medicare Advantage Plan or Part D plan closes or changes its contract with CMS so that you will be forced to disenroll from the plan. (Your Medicare Advantage Plan or Part D plan must notify you 60 days before the proposed date of termination or modification.)

Your SEP to switch to another Medicare Advantage Plan or Part D plan begins two months before the proposed closing or changes take place and ends one month after they occur.

You can ask that your new Medicare Advantage Plan or Part D plan coverage start the month after you get notice and up to two months after your old Medicare Advantage Plan or Part D plan coverage ends.

CMS terminates your Medicare Advantage Plan’s or Part D plan’s contract because of misconduct or other problems. (Your plan must give you 30 days notice before the termination date.)

Your SEP to switch to another Medicare Advantage Plan or Part D plan begins one month before the termination occurs and lasts for two months afterward.

You can choose to have your new Medicare Advantage Plan or Part D plan coverage begin up to three months after the month your old coverage ended.

CMS decides to immediately terminate its contract with your Medicare Advantage Plan or Part D plan.

CMS will notify you of the termination and your SEP. The termination may be mid-month.

Depends on the situation.

15. You disenroll from your Medicare Advantage Plan during the Medicare Advantage Open Enrollment Period (MA OEP).

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You have an SEP if…

Your SEP lasts…

Your coverage begins…

You disenroll from your Medicare Advantage Plan during the Medicare Advantage Open Enrollment Period (January 1 – March 31 of each year).

You have an SEP to enroll in a Medicare stand-alone Part D drug plan when you disenroll from your Medicare Advantage Plan. You can disenroll from your Medicare Advantage Plan by submitting a disenrollment request or by simply enrolling in a stand-alone Part D drug plan.

If you disenroll from your Medicare Advantage Plan during the MA OEP, you can either enroll in Original Medicare with a stand-alone Part D plan or switch your Medicare Advantage Plan.

The month following the month you submit an enrollment request to a new plan.

16. You qualify for new Part D initial enrollment period when you turn 65.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You qualify for new Part D initial enrollment period to join a stand-alone Medicare Part D drug plan because you are a person with a disability who is turning 65. (Note: If you are already enrolled in a Medicare Part D plan and are paying a late premium penalty, the penalty will end when the enrollment period starts.)

You have an SEP to disenroll from a Medicare Advantage Plan (that does or does not include drug coverage) to join Original Medicare or to enroll in a Medicare Advantage Plan that does not include drug coverage. You may also use your additional IEP to join a stand-alone Part D drug plan. The SEP begins and ends with the additional Part D IEP to join a Medicare Part D plan—usually the seven-month period including three months before you turn 65, the month you turn 65, and the three months after you turn 65.

If you are not already enrolled in a Part D plan, your coverage will usually start the month following the month you submit an enrollment request to a new plan.

17. You want to enroll in a five-star Medicare Advantage Plan or Part D plan.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You want to enroll in a Medicare Advantage or Part D plan that has an overall Plan Performance Rating of five

Plan Performance Ratings are released every fall and apply to the following calendar year. Your SEP to join a five-star

 Enrollments December 8 through December 31 are effective January 1.

© 2020 Medicare Rights Center

stars and you’re otherwise eligible to enroll in the plan. (For example, you live in the plan’s service area.)

Medicare Advantage or Part D plan starts December 8 of the year before the plan is considered a five-star plan. It lasts through November 30 of the year the plan is considered a five-star plan. You can use this SEP to change plans one time per year.

 Enrollments January 1 through November 30 are effective the month following the month you submit an enrollment request.

18. You have been in a consistently low-performing Medicare Advantage or Part D plan.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

You have been in a consistently low-performing plan, meaning that the plan has received an overall Medicare star rating of less than three stars for three consecutive years.

You have an SEP to enroll into a higher quality plan throughout the year. You should receive a notice from CMS in late October, saying that you are in a low-performing plan. You have the remainder of that year, as well as the following year, to switch to a plan rated 3 stars or more. To use this SEP, you must call 1-800-MEDICARE directly. Note: This is separate from the five-star SEP listed above.

The month following the month you submit an enrollment request to a new plan.

19. Your Medicare Advantage stops contracting with many of its providers.

You have an SEP if…

Your SEP lasts…

Your coverage begins…

Your Medicare Advantage Plan stops contracting with many providers in its network during the course of the calendar year and CMS determines these terminations are substantial. If the terminations are significant enough, you will have a one-time SEP to enroll in a different Medicare Advantage Plan (with or without Part D coverage) or switch to Original Medicare with or without a stand-alone Part D plan. Your plan will mail you a notice if CMS determines the terminations are substantial.

From the month you get notified of the network change and two additional months after that. You should be notified via mail at least 30 days in advance of the network terminations and of your SEP to switch to a new Medicare Advantage Plan, or to join Original Medicare with a Part D plan.

You do not have a guaranteed right to purchase a Medigap via this SEP.

The month following the month you submit an enrollment request to a new plan.

© 2020 Medicare Rights Center

20. You experience an “exceptional circumstance.”

You have an SEP if…

Your SEP lasts…

Your coverage begins…

If your circumstances do not fit into any of the other SEP categories, you have the right to ask CMS to grant you an SEP based on your particular exceptional circumstances.10

Depends on the SEP.

Depends upon the circumstances.

 

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