08/19/2015. Understanding Medicare Enrollment Periods. Session Objectives. Lesson 1 Medicare Enrollment Overview

Transcription

1 Understanding Medicare Enrollment Periods Information for those who counsel people with Medicare August 2015 Session Objectives This session will help you explain enrollment periods for Medicare Parts A and B Medigap (Medicare Supplement Insurance) policies Medicare Prescription Drug Plans (Part D) Medicare Advantage Plans (Part C) August 2015 Understanding Medicare Enrollment Periods 2 Lesson 1 Medicare Enrollment Overview Medicare Choices Medicare Part A and Part B Enrollment Periods Changes to the Social Security Retirement Age Medicare Enrollment for Immigrants Medicare Enrollment for U.S. Citizens Living Abroad August 2015 Understanding Medicare Enrollment Periods 3 1

2 Medicare Enrollment Overview Health insurance for 3 groups of people 65 and older Under 65 with certain disabilities Any age with End-Stage Renal Disease (ESRD) Medicare enrollment varies By your age If you re receiving Social Security or Railroad Retirement benefits By your employment status August 2015 Understanding Medicare Enrollment Periods 4 The Four Parts of Medicare August 2015 Understanding Medicare Enrollment Periods 5 Your Medicare Coverage Choices Original Medicare Part A Hospital Insurance Medicare Supplement Insurance (Medigap) Policy You can add Part B Medical Insurance Part D Prescription Drug Coverage or Medicare Advantage Plan Part C Combines Part A and Part B May include or you may add Part D Prescription Drug Coverage (Most Part C plans cover prescription drugs. You may be able to add drug coverage to some plan types if not already included.) August 2015 Understanding Medicare Enrollment Periods 6 2

3 Medicare Parts A and B Enrollment for People 65 and Over Initial Enrollment Period (IEP) General Enrollment Period (GEP) Special Enrollment Period (SEP) August 2015 Understanding Medicare Enrollment Periods 7 Change to Social Security Retirement Age Before 1983 the eligibility age for Social Security and Medicare were both 65 Before 1983 Eligibility Age for Medicare Full Social Security Retirement Age August 2015 Understanding Medicare Enrollment Periods 8 Social Security & Medicare Enrollment Ages Since 1983 Eligibility Age for Medicare Full Social Security Retirement Age Enrollment isn't automatic if you re not getting Social Security Some people don t know they need to sign up for Part A, even if they don t want Part B Source: retire2/agereduction.htm August 2015 Understanding Medicare Enrollment Periods 9 3

4 Enrolling in Medicare Automatic Automatic enrollment for those receiving Social Security benefits Railroad Retirement Board benefits Initial Enrollment Period Package Mailed 3 s before 65 or 25th of disability benefits Includes your Medicare card August 2015 Understanding Medicare Enrollment Periods 10 Enrolling in Medicare When It s Not Automatic Apply 3 s before you turn 65 Don t have to be retired If you re not automatically enrolled You need to enroll with Social Security Visit socialsecurity.gov, or Call , or Visit your local Social Security office If retired from a Railroad, enroll with the Railroad Retirement Board Call your local RRB office or August 2015 Understanding Medicare Enrollment Periods 11 Initial Enrollment Period (IEP) Your 7- Initial Enrollment Period Starts 3 s before your 65 th birthday Includes the of your 65 th birthday Ends 3 s after your 65 th birthday If you sign up during your IEP, there is no penalty The age for full Social Security is going up But the age for Medicare is still 65 You need to sign up for Part A at 65, even if you don t want Part B, if you aren t getting Social Security August 2015 Understanding Medicare Enrollment Periods 12 4

5 Initial Enrollment Period If you enroll in Part B 3 s before the you turn 65 No Delay 2 s before the you turn 65 1 before the you turn 65 The you turn 65 Delayed Start 1 after the you turn 65 2 s after the you turn 65 3 s after the you turn 65 Coverage starts First day of your birth day First day of your birth day First day of your birthday The followin g the you enrolled The 2nd following the you enrolled The 3rd following the you enrolled The 3rd following the you enrolled August 2015 Understanding Medicare Enrollment Periods 13 Enrolling During the General Enrollment Period General Enrollment Period (GEP) For people who didn t sign up for Part B (or premium Part A) during their Initial Enrollment Period Occurs January 1 through March 31 annually Coverage starts July 1 May have to pay a lifetime Part B penalty 10% for each 12-s eligible but not enrolled Limited exceptions August 2015 Understanding Medicare Enrollment Periods 14 Enrolling During the Special Enrollment Period There are few Special Enrollment Periods (SEP) for Medicare Parts A and B Most people don't qualify for an SEP Must have group health plan coverage based on active, current employment of you or your spouse Not COBRA, retiree coverage, long-term workers compensation or Veterans Affairs coverage Can enroll Anytime still covered by group health plan, or Within 8 s of the loss of coverage or current employment, whichever happens first August 2015 Understanding Medicare Enrollment Periods 15 5

6 Medicare Enrollment for Immigrants An immigrant may purchase Medicare Part A and/or Part B if he or she meets all of these criteria 65 or older Lawfully admitted for permanent residence Have lived in the U.S. without a break for the 5-year period immediately before the they file for enrollment August 2015 Understanding Medicare Enrollment Periods 16 Medicare Enrollment for U.S. Citizens Living Abroad Medicare enrollment rules apply to citizens living abroad Medicare generally only covers care received in the U.S. You live abroad and Enrollment Considerations You turn 65 and are getting Social Security benefits. You re over 65 and are eligible for Social Security benefits but you re not yet taking them. You re not eligible for Social Security benefits and you ve just turned 65. You are automatically enrolled in Medicare Part A. You must proactively enroll in Medicare Part B. You may file an application for Social Security benefits and Part A. You must live in the U.S. to enroll in Medicare Part B. If you don t take Part B when you are first eligible, you may only apply for Part B during the General Enrollment Period (January 1 through March 31) and you may have to pay higher premiums. You ll have to file for Medicare Part B during the General Enrollment Period (January 1 through March 31) and you may have to pay higher premiums. You re first eligible to enroll in Part B the you return to the U.S. to establish your new residence. You won t have to pay a higher premium if you enroll in Part B within the first 4 s of your return to the U.S. August 2015 Understanding Medicare Enrollment Periods 17 Check Your Knowledge Question 1 For people born in 1960 and later, the full Social Security retirement age is a. 62 years b. 65 years c. 67 years d. 70 years August 2015 Understanding Medicare Enrollment Periods 18 6

7 Check Your Knowledge Question 2 If you enroll in Part B during the General Enrollment Period (January 1 March 31) your coverage will start on a. The first day of the after you enroll b. April 1 c. May 1 d. July 1 August 2015 Understanding Medicare Enrollment Periods 19 Check Your Knowledge Question 3 Which of the following is not a criteria for an immigrant to purchase Medicare Part A and/or Part B? He or she must a. Be 65 or older b. Must have blood relative that s a legal U.S. citizen c. Be lawfully admitted for permanent residence d. Have lived in the U.S. without a break for the 5- year period immediately before the they file for enrollment August 2015 Understanding Medicare Enrollment Periods 20 Lesson 2 Medicare Enrollment Based On a Disability Qualifying for Medicare Based on a Disability Medicare Enrollment for People With a Disability Retroactive Medicare Coverage Medicare & End-Stage Renal Disease (ESRD) Enrollment Considerations Rules for ESRD coverage August 2015 Understanding Medicare Enrollment Periods 21 7

8 Qualifying for Medicare Based on Disability Medicare usually begins after getting Social Security Disability Insurance (SSDI) for 24 s Unless you have Amyotrophic Lateral Sclerosis Medicare begins first entitled to SSDI Generally, this means you get Medicare in the 30th after you become disabled 5- waiting period for SSDI benefits Followed by 24- waiting period for Medicare August 2015 Understanding Medicare Enrollment Periods 22 Medicare Enrollment for People with Disabilities You re automatically enrolled in Medicare if you qualify based on disability You ll get an Initial Enrollment Period package 3 s before 25th of disability benefits If you have Amyotrophic Lateral Sclerosis about 4 weeks after Medicare entitlement You need to decide whether to Keep Part B Enroll in Part D August 2015 Understanding Medicare Enrollment Periods 23 Retroactive Entitlement to Medicare In some cases, your entitlement to Medicare may be retroactive If your disability benefits are retroactive Your Medicare card will show effective date If you ve received Medicare-covered services prior You may request that your provider submit those claims to Medicare Services must have been received after the effective date on your Medicare card August 2015 Understanding Medicare Enrollment Periods 24 8

9 Information Received with Retroactive Determination You ll get this information with your determination: Your effective date of Part A coverage (the 25th of disability benefit entitlement) Your effective date of Part B coverage (the of processing), and the option to elect Part B coverage starting with the 25th of disability benefit entitlement To exercise your option for retroactive Part B coverage you must submit a written request and agree to pay all retroactive premiums due August 2015 Understanding Medicare Enrollment Periods 25 How Long Are You Entitled to Medicare? As long you meet the Social Security definition of disability Social Security has work incentives if you go back to work Medicare continues if you re working but still disabled You can get premium-free Part A for 8½ years after you return to work You may purchase Part A coverage afterward The reason for your Medicare entitlement changes at 65 Any penalty you may have had for late enrollment is removed at that time August 2015 Understanding Medicare Enrollment Periods 26 Applying for Disability Benefits To apply for disability benefits, you ll need your Social Security number Proof of age Health care provider information Medical records, including lab/test results and medications Work history Most recent W-2 or self-employment tax return Don t wait to apply Even if you re still gathering information August 2015 Understanding Medicare Enrollment Periods 27 9

10 Medicare Enrollment Based on End-Stage Renal Disease Eligibility requirements Any age Kidneys no longer function, and Must have worked the required amount of time or Getting or be eligible for Social Security, Railroad Retirement, or federal retirement benefits or An eligible child or An eligible spouse (including through same-sex marriage) August 2015 Understanding Medicare Enrollment Periods 28 Medicare Part B (Medical Insurance) Eligibility You can enroll in Part B if entitled to Part A based on ESRD You pay the ly Part B premium You may pay a penalty if you delay taking Part B You need both Part A and Part B for complete coverage For more information Call Social Security at TTY users should call Railroad retirees call the Railroad Retirement Board at TTY users should call August 2015 Understanding Medicare Enrollment Periods 29 Enrolling in Medicare Part B Enrollment based on ESRD may eliminate your Part B penalty if you already had Medicare due to age or disability If you didn t enroll when you were first eligible If you have Medicare due to ESRD and reach 65 You have continuous coverage Those not enrolled in Part B will be enrolled You can decide whether or not to keep it August 2015 Understanding Medicare Enrollment Periods 30 10

11 Delaying Medicare Part B If you enroll in Part A and delay enrolling in Part B You must wait for a General Enrollment Period January 1 to March 31 each year, coverage effective July 1 of the same year You may have to pay a higher premium for as long as you have Part B 10% for each 12- period, you were eligible but not enrolled No Special Enrollment Period for those with End-Stage Renal Disease August 2015 Understanding Medicare Enrollment Periods 31 Medicare and Group Health Plan (GHP) Coverage (30-Month Coordination Period) If enrollment is based solely on ESRD GHP/employer is the only payer during first 3 s Medicare is the secondary payer during the 30- coordination period Begins when first eligible for Medicare even if not enrolled Separate coordination period each time enrolled based on ESRD No 3- waiting period New 30- coordination period if you have GHP coverage August 2015 Understanding Medicare Enrollment Periods 32 Enrollment Considerations Immunosuppressive Drugs If You Are entitled to Part A at time of transplant and Medicare paid for your transplant and the transplant took place in a Medicare-approved facility or Medicare was secondary payer but made no payment Didn t meet the transplant conditions above Your Immunosuppressive Drugs Are covered by Part B Medicare pays 80% You pay 20% Coinsurance costs don t count toward catastrophic coverage under Part D May be covered by Part D (unless you would be covered by Part B, but you haven't enrolled in Part B) Costs vary by plan Helps cover drugs needed for other conditions August 2015 Understanding Medicare Enrollment Periods 33 11

12 Enrollment Considerations 30-Month Coordination Period You might want Medicare during the coordination period To pay the group health plan deductible/coinsurance If you're getting a transplant soon Affects coverage for immunosuppressive drugs Coverage for living donor Delaying Part B or Part D could mean Waiting for applicable enrollment period to enroll Possible penalty for late enrollment August 2015 Understanding Medicare Enrollment Periods 34 How to Enroll in Medicare Part A and Part B Based on ESRD Enroll at your local Social Security office Get doctor/dialysis facility to fill out Form CMS-2728 If Social Security gets the form before you enroll, they may contact you to see if you want to enroll If you have a group health plan, you may want to delay enrolling Near the end of the 30- coordination period Won t have to pay Part B premium until you need it Get facts before deciding to delay Especially if transplant is planned August 2015 Understanding Medicare Enrollment Periods 35 When Medicare Coverage Based on ESRD Starts Your Coverage Starts Under the Following Circumstances 1 st day of the 4 th You get a regular course of dialysis in a facility 1 st day of the of the 1 st You participate in a home dialysis training program during the first 3 s of your regular course of dialysis (with expectation of completion) 1 st day of the You get a kidney transplant 1 st day of the You re admitted to a Medicare-approved transplant facility for a kidney transplant or procedures preliminary to a kidney transplant if transplant takes place in the same or within the following 2 s 2 s before the of your transplant Your transplant is delayed more than 2 s after you re admitted to the hospital for the transplant or for health care services you need for the transplant August 2015 Understanding Medicare Enrollment Periods 36 12

13 When Coverage Ends Entitlement based solely on ESRD Coverage ends 12 s after the you no longer require a regular course of dialysis or Thirty-six s after the of your kidney transplant When Coverage for ESRD Ends, Continues or Resumes When Coverage Continues No interruption in coverage if you start a regular course of dialysis again within 12 s after regular dialysis stopped or You have a kidney transplant or Regular course of dialysis starts within 36 s after transplant or you received another kidney transplant within 36 s after transplant When Coverage Resumes Must file new application and there's no waiting period if You start a regular course of dialysis again or get a kidney transplant more than 12 s after you stopped getting a regular course of dialysis You have another kidney transplant > 36 s later August 2015 Understanding Medicare Enrollment Periods 37 Check Your Knowledge Question 4 Kevin has an endocrine disorder and started receiving Social Security Disability Insurance this. How long will Kevin have to wait until he can get Medicare? a. 24 s b. 36 s c. 48 s d. There is no waiting period. He can get Medicare immediately. August 2015 Understanding Medicare Enrollment Periods 38 Lesson 3 Medigap (Medicare Supplement Insurance Policy) Enrollment Period Medigap Open Enrollment Switching Medigap Policies August 2015 Understanding Medicare Enrollment Periods 39 13

14 Medigap Open Enrollment Period Your Medigap Open Enrollment Period (OEP) 6 s when insurance company must sell Guaranteed issue period without medical underwriting Your one OEP begins when you re 65 or older and enrolled in Part B Can t be changed or repeated Some states have more generous rules May buy a Medigap policy any time an insurance company will sell you one August 2015 Understanding Medicare Enrollment Periods 40 Pre-existing Conditions and Medigap Health problem you had before the new insurance policy starts Treated or diagnosed 6 s before coverage start date Pre-existing Condition Waiting Period Insurance companies can refuse to cover out-of-pocket costs for excluded condition for up to 6 s ( lookback period ) Without 6 s of prior creditable coverage and no break in coverage more than 63 days The Affordable Care Act doesn t impact the pre-existing condition waiting period for Medigap coverage. August 2015 Understanding Medicare Enrollment Periods 41 Guaranteed Issue Rights Federal protections in certain situations Companies must sell you a Medigap policy All pre-existing conditions must be covered Can t be charged more Must apply within 63 days of date other coverage ends See Appendix A for all situations August 2015 Understanding Medicare Enrollment Periods 42 14

15 Medigap for People With a Disability or End-Stage Renal Disease (ESRD) People with a disability or ESRD may not be able to buy a policy until they turn 65 Some states require insurers to sell Medigap policies to people with a disability or ESRD Companies may voluntarily sell Medigap policies May cost more than policies sold to people over 65 Can use medical underwriting Get a Medigap Open Enrollment Period at 65 August 2015 Understanding Medicare Enrollment Periods 43 Check Your Knowledge Question 5 Sarah turns 65 next, and has enrolled in Medicare Parts A and B. How many Medigap Open Enrollment Periods will she get? a. None you can sign up for a Medigap plan anytime b. One c. One each year d. Two each year, if you count Special Enrollment periods August 2015 Understanding Medicare Enrollment Periods 44 Lesson 4 Enrollment Periods for Medicare Prescription Drug Coverage (Part D) Initial Enrollment Period Open Enrollment Period Special Enrollment Periods August 2015 Understanding Medicare Enrollment Periods 45 15

16 Part D Initial Enrollment Period (IEP) When you first become eligible to get Medicare 7- IEP for Part D If You Join During the 3 s before you turn 65 During the you turn 65 During the 3 s after you turn 65 Coverage Begins Date eligible for Medicare First day of the following First day of the after you apply August 2015 Understanding Medicare Enrollment Periods 46 When You Can Join or Switch Plans Part D Plans Medicare s Open Enrollment Period is October 15 December 7 each year, coverage starts January 1 You can leave a Medicare Advantage Plan and switch to Original Medicare from January 1 February 14 each year You have until February 14 to also join a Part D plan If you don t have Medicare Part A coverage, and enroll in Part B during the General Enrollment Period (January 1 March 31), you can sign up for a Medicare Prescription Drug Plan from April 1 June 30 each year August 2015 Understanding Medicare Enrollment Periods 47 Part D Special Enrollment Period (SEP) Life events that allow an SEP include You permanently move out of your plan s service area You lose other creditable prescription coverage You weren t properly told that your other coverage wasn t creditable, or your other coverage was reduced and is no longer creditable You enter, live at, or leave a long-term care facility You have a continuous SEP if you qualify for Extra Help You belong to a State Pharmaceutical Assistance Program Other exceptional circumstances August 2015 Understanding Medicare Enrollment Periods 48 16

17 5-Star Special Enrollment Period (SEP) Use Medicare Plan Finder tool at Medicare.gov to see quality and performance ratings Star ratings are given once a year, assigned in October of the past year Use 5-star SEP to switch to any 5-star plan one time December 8 November 30 of following year Coverage starts first day of after enrolled Be careful not to switch from a Medicare Advantage (MA) Plan with drug coverage to an MA Plan with no Part D coverage August 2015 Understanding Medicare Enrollment Periods 49 Low Performing Plan Low performing star rating status You may have a one-time option to switch to another Medicare drug plan with a rating of 3, 4, or 5 stars if your plan s summary rating was less than 3 stars for 3 years Low Performance Icon (LPI) appears on Plan Finder Plans may not attempt to discredit their LPI status by showcasing a separate higher rating August 2015 Understanding Medicare Enrollment Periods 50 Check Your Knowledge Question 6 You can add or switch a Medicare Part D plan during Medicare s Open Enrollment Period (October 15 December 7) each year. a. True b. False August 2015 Understanding Medicare Enrollment Periods 51 17

18 Lesson 5 Enrollment Periods for Medicare Advantage Plans (Part C) Initial Enrollment Period Open Enrollment Period Special Enrollment Periods 5-Star Special Enrollment Period August 2015 Understanding Medicare Enrollment Periods 52 Initial Enrollment Period Medicare Advantage Initial Enrollment Medicare Open Enrollment Period Medicare due to a Disability When You Can Join or Switch Medicare Advantage Plans 7- period begins 3 s before the you turn 65 Includes the you turn 65 Ends 3 s after the you turn 65 You must have both Medicare Part A and Part B to enroll in a Medicare Advantage (MA) Plan. If you didn t enroll in Part B when you were first eligible, your MA enrollment period: Begins 3 s immediately before your first entitlement to both Medicare Parts A and B ends, and the later of The last day of the preceding entitlement to both Part A and Part B or The last day of the individual s Part B initial enrollment period October 15 December 7 Coverage begins January 1 7- period begins 3 s before the 25 th of disability. Ends 3 s after the 25 th of disability. Special Enrollment Periods (SEP) When You Can Join or Switch Plans Move out of your plan s service area Plan leaves Medicare program or reduces its service area Leaving or losing employer or union coverage You enter, live at, or leave a long-term care facility You have a continuous SEP if you qualify for Extra Help Losing your Extra Help status You join or switch to a plan that has a 5-star rating Retroactive notice of Medicare entitlement Other exceptional circumstances August 2015 Understanding Medicare Enrollment Periods 54 18

19 When You Can Join or Switch MA Plans 5-Star Special Enrollment Period (SEP) Can enroll in 5-star Medicare Advantage (MA), Prescription Drug Plan (PDP), Medicare Advantage Plan with prescription drug coverage (MA-PD), or Cost Plan Enroll once per year from December 8, 2014 November 30, 2015 New plan starts first day of after enrolled Star ratings given once per year Ratings assigned in October and effective January 1st Use Medicare Plan Finder to see star ratings Look at Overall Plan Rating to find eligible plans August 2015 Understanding Medicare Enrollment Periods 55 Medicare Advantage Plan Disenrollment Between January 1 February 14 You can leave a Medicare Advantage Plan and switch to Original Medicare If you make this change, you may also join a Medicare Prescription Drug Plan to add drug coverage Coverage begins the first of the after the plan gets enrollment form Check whether you could get a Medigap policy August 2015 Understanding Medicare Enrollment Periods 56 Check Your Knowledge Question 7 Which of these is not a reason to qualify for a Medicare Advantage Plan Special Enrollment Period? a. You move out of the plan s serving area b. Your doctor leaves the Medicare Advantage Plan c. You have a chance to enroll in other coverage offered by your employer or union d. You re released from jail August 2015 Understanding Medicare Enrollment Periods 57 19

20 National Training Program Contact Information To view all available NTP training materials, or to subscribe to our list, visit CMS.gov/Outreach-and-Education/Training/ CMSNationalTrainingProgram/index.html For questions about training products Appendix A page 1 This chart describes the situations, under federal law, that give you a right to buy a policy, the kind of policy you can buy, and when you can or must apply for it. States may provide additional Medigap guaranteed issued rights. August 2015 Understanding Medicare Enrollment Periods 59 Appendix A page 2 This chart describes the situations, under federal law, that give you a right to buy a policy, the kind of policy you can buy, and when you can or must apply for it. States may provide additional Medigap guaranteed issued rights. (Continued) August 2015 Understanding Medicare Enrollment Periods 60 20

21 Special Enrollment Periods (SEPs) for Part C and Part D page 1 Changes in where you live If this describes you You can At this time You move to a new address that isn t in your plan s service area. You move to a new address that s still in your plan s service area, but you have new plan options in your new location. You move back to the U.S. after living outside the country. Switch to a new Medicare Advantage or Medicare Prescription Drug Plan. Join a Medicare Advantage or Medicare Prescription Drug Plan. If you tell your plan before you move, your chance to switch plans begins the before the you move and continues for 2 full s after you move. If you tell your plan after you move, your chance to switch plans begins the you tell your plan, plus 2 more full s. Your chance to join lasts for 2 full s after the you move back to the U.S. August 2015 Understanding Medicare Enrollment Periods 61 Special Enrollment Periods (SEPs) for Part C and Part D page 2 Changes in where you live If this describes you You can At this time You just moved into, currently live in, or just moved out of an institution (like a skilled nursing facility or longterm care hospital). You re released from jail. Join a Medicare Advantage or Medicare Prescription Drug Plan. Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan. Drop your Medicare Advantage Plan and return to Original Medicare. Drop your Medicare prescription drug coverage. Join a Medicare Advantage or Medicare Prescription Drug Plan. Your chance to join, switch, or drop coverage lasts as long as you live in the institution and for 2 full s after the you move out of the institution. Your chance to join lasts for 2 full s after the you re released from jail. August 2015 Understanding Medicare Enrollment Periods 62 Special Enrollment Periods (SEPs) for Part C and Part D page 3 Changes that cause you to lose your current coverage If this describes you You can At this time You re no longer eligible for Medicaid. You leave coverage from your employer or union. Join a Medicare Advantage or Medicare Prescription Drug Plan. Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan. Drop your Medicare Advantage Plan and return to Original Medicare. Drop your Medicare prescription drug coverage. Join a Medicare Advantage or Medicare Prescription Drug Plan. Your chance to change lasts for 2 full s after the you find out you re no longer eligible for Medicaid. Your chance to join lasts for 2 full s after the your coverage ends. August 2015 Understanding Medicare Enrollment Periods 63 21

22 Special Enrollment Periods (SEPs) for Part C and Part D page 4 Changes that cause you to lose your current coverage If this describes you You can At this time You involuntarily lose other drug coverage that s as good as Medicare drug coverage (creditable coverage), or your other coverage changes and is no longer creditable. You have drug coverage through a Medicare Cost Plan and you leave the plan. Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan. Join a Medicare Prescription Drug Plan. Your chance to join lasts for 2 full s after the you lose your creditable coverage or are notified of the loss of creditable coverage, whichever is later. Your chance to join lasts for 2 full s after the you drop your Medicare Cost Plan. August 2015 Understanding Medicare Enrollment Periods 64 Special Enrollment Periods (SEPs) for Part C and Part D page 5 Changes that cause you to lose your current coverage If this describes you You can At this time You drop your coverage in a Program of Allinclusive Care for the Elderly (PACE) plan. You find out that you won t be eligible for Extra Help for the following year. Join a Medicare Advantage or Medicare Prescription Drug Plan. Join a Medicare Advantage or Medicare Prescription Drug Plan. Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan. Drop your Medicare Advantage Plan and return to Original Medicare. Drop your Medicare prescription drug coverage. Your chance to join lasts for 2 full s after the you drop your PACE plan. Your chance to change is between January 1 March 31. August 2015 Understanding Medicare Enrollment Periods 65 Special Enrollment Periods (SEPs) for Part C and Part D page 6 You have a chance to get other coverage If this describes you You can At this time You have a chance to enroll in other coverage offered by your employer or union. You have or are enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage). Drop your current Medicare Advantage or Medicare Prescription Drug Plan to enroll in the private plan offered by your employer or union. Drop your current Medicare Advantage Plan with drug coverage or your Medicare Prescription Drug Plan. Whenever your employer or union allows you to make changes in your plan. Anytime. August 2015 Understanding Medicare Enrollment Periods 66 22

23 Special Enrollment Periods (SEPs) for Part C and Part D page 7 You have a chance to get other coverage If this describes you You can At this time You enroll in a Program of All-inclusive Care for the Elderly (PACE) plan Drop your current Medicare Advantage or Medicare Prescription Drug Plan Anytime You live in the service area of one or more Medicare Advantage or Medicare Prescription Drug Plans with an overall quality rating of 5 stars Join a Medicare Advantage, Medicare Cost, or Medicare Prescription Drug plan with an overall quality rating of 5 stars One time between December 8, 2012 November 30 each year August 2015 Understanding Medicare Enrollment Periods 67 Special Enrollment Periods (SEPs) for Part C and Part D page 8 Changes in your plan s contract with Medicare If this describes you You can At this time Medicare takes an official action Switch from your (called a sanction ) because of a Medicare Advantage or problem with the plan that Medicare Prescription affects you Drug Plan to another plan Your plan s contract ends (terminates) during the contract year Your Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan s contract with Medicare isn t renewed for the next contract year Switch from your Medicare Advantage or Medicare Prescription Drug Plan to another plan Join another Medicare Advantage or Medicare Prescription Drug Plan Your chance to switch is determined by Medicare on a case-by-case basis Your chance to switch starts 1 s before and ends 2 full after the contract ends Between October 15 and the last day in February August 2015 Understanding Medicare Enrollment Periods 68 Special Enrollment Periods (SEPs) for Part C and Part D page 9 Changes due to other special situations If this describes you You can At this time You re eligible for both Medicare and Medicaid Join, switch, or drop a Medicare Advantage Plan or Medicare prescription drug coverage Anytime You qualify for Extra Help paying for Medicare prescription drug coverage You re enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility Join, switch, or drop Medicare prescription drug coverage Join either a Medicare Prescription Drug Plan or a Medicare Advantage Plan with prescription drug coverage Anytime Once during the calendar year August 2015 Understanding Medicare Enrollment Periods 69 23

24 Special Enrollment Periods (SEPs) for Part C and Part D page 10 Changes due to other special situations If this describes you You can At this time You dropped a Medicare Supplemental Insurance (Medigap) policy the first time you joined a Medicare Advantage Plan Drop your Medicare Advantage Plan and enroll in Original Medicare. You ll have special rights to buy a Medigap policy Your chance to drop your Medicare Advantage Plan lasts for 12 s after you join the Medicare Advantage Plan for the first time You have a severe or disabling condition, and there s a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with your condition Join a Medicare Chronic Care Special Needs Plan (SNP) that serves people with your condition You can join anytime, but once you join, your chance to make changes using this SEP ends August 2015 Understanding Medicare Enrollment Periods 70 Special Enrollment Periods (SEPs) for Part C and Part D page 11 Changes due to other special situations If this describes you You can At this time You weren t properly told that your other private drug coverage wasn t as good as Medicare drug coverage (creditable coverage) You weren t properly told that you were losing private drug coverage that was as good as Medicare drug coverage (creditable coverage) Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan Your chance to join lasts for 2 full s after the you get a notice of the error from Medicare Your chance to join lasts for 2 full s after the you get a notice of the error from Medicare August 2015 Understanding Medicare Enrollment Periods 71 Special Enrollment Periods (SEPs) for Part C and Part D page 12 Changes due to other special situations If this describes you You can At this time You joined a plan, or chose not to join a plan, due to an error by a federal employee Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan Switch from your current plan to another Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan Drop your Medicare Advantage Plan with drug coverage and return to Original Medicare Drop your Medicare prescription drug coverage Your chance to change coverage lasts for 2 full s after the you get a notice of the error from Medicare August 2015 Understanding Medicare Enrollment Periods 72 24