MEDICARE ENROLLMENT PERIODS

During the.....
 You CAN..... 
1.  Initial Enrollment Period (IEP)--is available when you first become eligible for Medicare after reaching age 65, or qualifying because of a disability.  IEP is a seven (7) month period that begins three (3) months before, and ends three (3) months after your birth/eligibility month.
  • Select eith Original Medicare or a Medicare Advantage Plan (Part C)
  • Select a Part D plan
  • Special enrollment conditions also exist for Medigap policies
 2.  Annual Election Period (AEP)-- is the general time period each year when you can make changes to your coverage for the upcoming year.  Again in 2014, this period will begin on October 15th and end of December 7th.
  • AEP begins on October 15th and ends of December 7th
  • Coverage becomes effective on January 1st
  • Change from/to Original Medicare to/from a Medicare Advantage Plan (Part C)
  • Change from on Medicare Advantage Plan to another Medicare Advantage Plan (Part C)
  • Change from  one Part D plan to another Part D plan (if on original Medicare)
  • Add or drop a Part D drug plan (penalties may apply if Part D was not selected when first elibible to enroll)
3.  Annual Disenrollment Period (ADP)--This period begins on January 1st and ends on February 14th.  
  • During this period you are only allowed to dis-enroll from a Medicare Advantage Plan and get back into Original Medicare and get Part D drug coverage.
4.  Special Enrollment Period (SEP)--You may also make changes to your Medicare coverage options at any time when certain circumstances apply, such as:
  • Coming off an Employer Group Health plan;
  • Moving out of a plan area;
  • Loss of, or substantial change in, Medicare Advantage Plan (Part C); 
  • Qualified confinement to, and release from, an LTC facility;
  • 1st Time Medicare Advantage plan twelve (12) month "trial" period
  • Loss of, or gaining LIS and/or Medicaid status
 
  • Change from/to Original Medicare to/from a Medicare Advantage Plan (Part C)
  • Change from one Medicare Advantage plan to another Medicare Advantage Plan (Part C)
  • Change from one Part D plan to another Part D plan (if on Original Medicare)
5.  "Five Star" SEP--Beginning on December 8, 2011, you may enroll into a plan that has a Medicare rating of 5 Stars, at any time during the year, if your current plan has a rating of 4.5 stars or less, or from Original Medicare under certain conditions.
  • No 5 Star Plans are available in WV Services area..  As of January 1, 2014.
6.  Medigap Open Enrollment Period--Period lasting six (6) months and begins on the first day of the month in which you are both 65 or older and enrolled in Medicare Part B.
 During this period, an insurance company cannot use medical underwriting.  This means the insurance company cannot do any of the following because of your health problems:
  • Refuse to sell you any Medigap policy it offers
  • Charge you more for a Medigap policy than they charge someone with no health problems
  • Make you wait for coverage to start.  Some companies may make you wait for coverage related to a pre-existing condition, where they will only cover expenses for a pre-existing condition after six (6) months.  After six months the policy would cover.
  • Companies can and will charge tobacco rates to tobacco users during this period Some companies do not apply tobacco rates during this period.  We can review with you if you are a tobacco user

WHEN IS THE BEST TIME TO BUY A MEDICARE SUPPLEMENT POLICY IN WV?

During your Medigap Open Enrollment Period

It’s very important to understand your Medigap Open Enrollment Period. Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, if you apply during your Medigap Open Enrollment Period, you can buy any Medigap policy the company sells, even if you have health problems, for the same price as people with good health. 


If you apply for Medigap coverage after your open enrollment period, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting 

requirements, unless you’re eligible because of one of the limited situations listed here.


It’s also important to understand that your Medigap rights may depend on when you choose to enroll in Medicare Part B (Medical Insurance). If you’re 65 or older, your Medigap Open Enrollment Period begins when you enroll in Part B and it can’t be changed or repeated. In most cases, it makes sense to enroll in Part B and purchase a Medigap policy when you’re first eligible for Medicare, because you might otherwise have to pay a Part B late enrollment penalty and you might miss your Medigap Open Enrollment Period. However, there are exceptions if you have employer coverage.  


NOTE:  Employer Coverage

If you have group health coverage through an employer or union, because either you or your spouse is currently working, you may want to wait to enroll in Part B. This is because benefits based on current employment often provide coverage similar to Part B, and you would be paying for Part B before you need it, and your Medigap Open Enrollment might expire before a Medigap policy would be useful. 


When the employer coverage ends, you’ll get a chance to enroll in Part B without a late enrollment penalty which means your Medigap Open Enrollment Period will start when you’re ready to take advantage of it. If you enrolled in Part B while you still had employer coverage, your Medigap Open Enrollment Period would start, and unless you bought a Medigap policy before you needed it, you would miss your Open Enrollment Period entirely. If you or your spouse is still working and you have coverage through an employer, contact your employer or union benefits administrator to find out how your insurance works with Medicare.

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