Understanding Medicare Enrollment Periods

Understanding Medicare Enrollment Periods
This presentation explains times that you can enroll in Medicare. It was developed and approved by the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Federally-facilitated Health Insurance Marketplace. The information in this presentation was correct as of August To check for an updated version visit CMS.gov/outreach-and- education/training/cmsnationaltrainingprogram/index.html. The CMS National Training Program provides this as an informational resource for our partners. It’s not a legal document or intended for press purposes. The press can contact the CMS Press Office at Official Medicare program legal guidance is contained in the relevant statutes, regulations, and rulings. 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) This session will help you explain Medicare enrollment periods for Medicare Parts A and B Medigap (Medicare Supplement Insurance) Medicare Prescription Drug (Part D) Medicare Advantage Plans (Part C) August 2015 Understanding Medicare Enrollment Periods

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 Lesson 1—Medicare Enrollment Overview explains 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

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 Medicare is health insurance for 3 groups of people: Those who are 65 and older Anyone under 65 with certain disabilities People of any age who have End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a transplant. Medicare enrollment varies by your age, whether you’re receiving Social Security or Railroad Retirement benefits, and by your employment status. August 2015 Understanding Medicare Enrollment Periods

The Four Parts of Medicare
Medicare covers many types of services, and you have options for how you can get your Medicare coverage. Medicare has 4 parts: Part A (Hospital Insurance) helps pay for inpatient hospital stays, skilled nursing care, home health care, and hospice care. Part B (Medical Insurance) helps cover medically-necessary services like doctor visits and outpatient care. Part B also covers some preventive services including screening tests and shots, diagnostic tests, some therapies, and durable medical equipment like wheelchairs and walkers. Part C (Medicare Advantage) is another way to get your Medicare benefits. It combines Parts A and B, and sometimes Part D (prescription drug coverage). Medicare Advantage Plans are managed by private insurance companies approved by Medicare. These plans must cover medically-necessary services. However, plans can charge different copayments, coinsurance, or deductibles for these services than Original Medicare. Part D (Medicare Prescription Drug Coverage) helps pay for outpatient prescription drugs and may help lower your prescription drug costs and protect against higher costs in the future. August 2015 Understanding Medicare Enrollment Periods

Your Medicare Coverage Choices
Original Medicare Medicare Advantage Plan or Part A Hospital Insurance Part B Medical Insurance Part C Combines Part A and Part B May include or you may add You can 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.) There are 2 main ways to get your Medicare coverage, Original Medicare, or Medicare Advantage (MA) Plans. You can decide which way to get your coverage. Original Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance). You can choose to buy a Medigap policy to help cover some costs not covered by Original Medicare. You can also choose to buy Medicare prescription drug coverage (Part D) from a Medicare Prescription Drug Plan (PDP). MA Plans (Part C), like a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO), cover Part A and Part B services and supplies. They also may include Medicare prescription drug coverage (MA-PD). You can add a Medicare Prescription Drug Plan to a Medicare Private Fee-for-Service Plan or Cost Plan if they don’t provide Part D coverage, and you can add it to a Medicare Medical Savings Account (MSA) Plans. You can’t add a Part D plan to a Medicare HMO or PPO plan without drug coverage. Medigap policies don’t work with these plans. If you join an MA Plan, you can’t use a Medicare Supplement Insurance (Medigap) Policy to pay for out-of-pocket costs you are enrolled in an MA Plan. Medicare Supplement Insurance (Medigap) Policy Part D Prescription Drug Coverage August 2015 Understanding Medicare Enrollment Periods

Medicare Parts A and B Enrollment for People 65 and Over
Initial Enrollment Period (IEP) General Enrollment Period (GEP) Special Enrollment Period (SEP) If you don’t get Medicare Parts A and Part B automatically, there are certain times you may sign up, including: Initial Enrollment Period (IEP) General Enrollment Period (GEP) Special Enrollment Period (SEP) August 2015 Understanding Medicare Enrollment Periods

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 The Medicare eligibility age is 65. The Social Security full retirement age is the age at which a person may first become entitled to full or unreduced retirement benefits. For many years, full retirement age (also called "normal retirement age") for Social Security benefits was also 65. 65 August 2015 Understanding Medicare Enrollment Periods

Social Security & Medicare Enrollment Ages
Since 1983 Eligibility Age for Medicare 65 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 The 1983 Social Security Amendments included a provision for gradually raising the full Social Security retirement age. Beginning with people born in 1938 or later, the full age gradually increases until it reaches 67 for people born after Congress cited improvements in the health of older people and increases in average life expectancy as primary reasons for increasing the full retirement age. More people are working longer and are waiting to take their Social Security benefits until their full retirement age. Since they’re not receiving Social Security benefits, these people aren’t automatically enrolled in Medicare when they turn 65 and often don’t know they need to apply for Medicare. This can cause confusion for some people. While you can delay taking Social Security, if you delay enrolling in Medicare you may be subject to a late enrollment penalty. No matter what your full Social Security retirement age is, you may start receiving benefits as early as age 62 or as late as age 70. However, if you start Social Security retirement benefits early, your benefits are reduced a fraction of a percent for each month before your full retirement age. Source: retire2/agereduction.htm August 2015 Understanding Medicare Enrollment Periods

Enrolling in Medicare—Automatic
Automatic enrollment for those receiving Social Security benefits Railroad Retirement Board benefits Initial Enrollment Period Package Mailed 3 months before 65 or 25th month of disability benefits Includes your Medicare card If you’re already getting Social Security or Railroad Retirement Board (RRB) benefits (for example, getting early retirement at least 4 months before you turn 65) you’ll automatically be enrolled in Medicare Part A and Part B without an additional application. You’ll get your Initial Enrollment Period Package, which includes your Medicare card and other information, about 3 months before you turn 65 (coverage begins the first day of the month you turn 65), or 3 months before your 25th month of disability benefits (coverage begins your 25th month of disability benefits). If you’re not getting retirement benefits from Social Security or the RRB, you must sign up to get Medicare. We’ll talk about the periods when you can enroll later. August 2015 Understanding Medicare Enrollment Periods

Enrolling in Medicare— When It’s Not Automatic
Apply 3 months 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 1‑877‑772‑5772 If you aren’t getting Social Security or Railroad Retirement Board (RRB) benefits at least 4 months before you turn 65 (for instance, because you’re still working), you’ll need to sign up for Part A (even if you’re eligible to get Part A premium-free) and Part B, if you want the coverage. If you don’t sign up, there could be a late enrollment penalty. You should contact Social Security to apply for Medicare 3 months before you turn 65. If you worked for a railroad, contact the RRB to sign up. You don’t have to be retired to get Medicare. For people born in 1938 or later, their Social Security benefit may be affected by a provision that raises the age at which full Social Security benefits are payable. If you were born from 1943 to 1960, the age at which full retirement benefits are payable increases gradually to age 67. You can calculate your age for collecting full Social Security retirement benefits at ssa.gov/retirement/ageincrease.htm. Those who retired or will retire at 62, get partial benefits. The earliest a person can start receiving reduced Social Security retirement benefits remains 62. For more information visit socialsecurity.gov/pubs/EN pdf. NOTE: Although the age to receive full Social Security benefits is increasing, Medicare benefit eligibility still begins at 65 and you should sign up for Medicare 3 months before your 65th birthday. August 2015 Understanding Medicare Enrollment Periods

Initial Enrollment Period (IEP)
Your 7-month Initial Enrollment Period Starts 3 months before your 65th birthday Includes the month of your 65th birthday Ends 3 months after your 65th 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 If you aren’t automatically enrolled, you can choose to sign up for Part A and Part B during your Initial Enrollment Period (IEP), a 7-month period which begins 3 months before the month you become eligible for Medicare. The age for full Social Security is going up, but the age for Medicare is still 65. Many people don’t know they need to sign up for Part A, even if they don’t want Part B. If you’re not getting Social Security, (for instance, because you’re still working) you don’t get a Welcome to Medicare packet. You can choose whether or not to enroll in Part B. If you enroll, you pay a monthly premium for Medicare Part B. August 2015 Understanding Medicare Enrollment Periods

Initial Enrollment Period
No Delay Delayed Start If you enroll in Part B 3 months before the month you turn 65 2 months before the month you turn 65 1 month before the month you turn 65 Coverage starts First day of your birth day month First day of your birthday month The month you turn 65 1 month after the month you turn 65 2 months after the month you turn 65 3 months after the month you turn 65 The month following the month you enrolled The 2nd month following the month you enrolled The 3rd month following the month you enrolled Generally, the first time you can enroll in Medicare is at the beginning of your Initial Enrollment Period (IEP). If you’re not automatically enrolled, you can choose to sign up for Medicare Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you sign up for Part A and/or Part B during the first 3 months of your IEP, your coverage start date will depend on your birthday: If your birthday isn’t on the first day of the month, your Part B coverage starts the first day of your birthday month. For example, Mr. Green’s 65th birthday is July 20, If he enrolls in April, May, or June, his coverage starts on July 1, 2015. If your birthday is on the first day of the month, your coverage will start the first day of the prior month. For example, Mr. Kim’s 65th birthday is July 1, If he enrolls in March, April, or May, his coverage starts on June 1, To read the chart above correctly, use the month before your birthday as “the month you turn 65.” If you enroll in Part A and/or Part B the month you turn 65 or during the last 3 months of your IEP, your start date will be delayed. Coverage begins on the first day of The month following the month of enrollment if enrollment occurs during the 4th month of the IEP (the month you turn 65), The 2nd month following the month of enrollment if enrollment occurs during the 5th month of the IEP, or The 3rd month following the month of enrollment if enrollment occurs during the 6th or 7th month of the IEP. You can choose whether or not to enroll in Part B. If you enroll, you pay a monthly premium for Medicare Part B. You can only enroll in Part B during your IEP, the annual General Enrollment Period, or in limited situations, a Special Enrollment Period . If you don't enroll in Part B (or premium Part A) during your IEP, you may have to pay a penalty. For Part B, it's a lifetime penalty. August 2015 Understanding Medicare Enrollment Periods

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-months eligible but not enrolled Limited exceptions If you didn’t sign up for Part B (or premium Part A) during your Initial Enrollment Period (IEP), you can enroll during the General Enrollment Period (GEP). For most people who don’t enroll during their IEP, this is their only chance to enroll. The GEP occurs each year. It begins January 1 and ends March 31. If you enroll in the GEP, your coverage will start on July 1. This is required by law. In addition, if more than 12 months passed since you turned 65, you'll likely have to pay a penalty that is added to your monthly Part B premium. In most cases, you’ll have to pay this penalty for as long as you have Part B. If you aren't eligible for premium-free Part A, and you don't buy it when you're first eligible, your monthly premium may go up 10%. You'll have to pay the higher premium for twice the number of years you could have had Part A, but didn't sign up. This means that your monthly premiums will be higher than if you signed up during your IEP. The longer you go without the coverage, the higher the penalty. August 2015 Understanding Medicare Enrollment Periods

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 months of the loss of coverage or current employment, whichever happens first There are very few Special Enrollment Periods (SEPs) for Part B and premium Part A enrollment allowed by law. Most people don't qualify for an SEP. However, if you or your spouse is still working, you may be eligible. If you didn’t sign up for Part B (or premium Part A) during your Initial Enrollment Period (IEP), you may be able to enroll during the SEP. The SEP allows you to enroll after your IEP and not wait for the General Enrollment Period. If eligible, you won’t have to pay a penalty, but this SEP is limited. To be eligible, you must have group health plan coverage based on active, current employment. If you're 65 or older, you must get this employer-sponsored coverage based on your or your spouse’s current employment. If you have Medicare based on disability, you can also have employer-sponsored coverage based on a member’s current employment. It's important to note that COBRA, retiree coverage, long-term workers’ compensation, or Veterans Affairs coverage isn't considered active, current employment. To qualify for the SEP, you must have group health plan coverage for all the months you were eligible to enroll in Part B, but didn’t. For most people, this means you had group health plan coverage since you turned 65. You can enroll using the SEP at any time while you have group health plan coverage based on active, current employment. If you lose either the group health plan coverage or the current employment, you have 8 months to enroll. If you don’t enroll within the 8 months, you'll have to wait until the next GEP to enroll, you'll have a gap in your coverage, and you may have to pay a penalty. August 2015 Understanding Medicare Enrollment Periods

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 month they file for enrollment If you are 65 or older and an immigrant lawfully admitted for permanent residence, have lived in the U.S. without a break for the 5-year period immediately before the month you file for enrollment in Part B, you can purchase Medicare Part A and /or Part B. August 2015 Understanding Medicare Enrollment Periods

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 are automatically enrolled in Medicare Part A. You must proactively 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’re over 65 and are eligible for Social Security benefits but you’re not yet taking them. You may file an application for Social Security benefits and Part A. 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 not eligible for Social Security benefits and you’ve just turned 65. You must live in the U.S. to enroll in Medicare Part B. You’re first eligible to enroll in Part B the month 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 months of your return to the U.S. Medicare enrollment rules for U.S. citizens that live abroad are the same as for citizens living in the U.S. People who live in the U.S. and turn 65 and are getting Social Security benefits are automatically enrolled in Medicare Parts A and B. If you live abroad and you turn 65 and you are getting Social Security benefits, you are automatically enrolled in Medicare Part A. If you want Medicare Part B you have to proactively apply for Part B benefits. If you don’t take Part B when you are first eligible, you may only apply for Part B during the General Enrollment Period. This period runs from January 1 through March 31 and you may have to pay higher premiums. If you live outside of the U.S., you’re over 65, and are eligible for Social Security benefits but not yet taking them, you may file an application for monthly benefits and Part A. You’ll have to enroll in Part B during the General Enrollment Period. If you’re a U. S. citizen, NOT eligible for Social Security benefits, and lived in a foreign country when you turned 65, you must live in the U. S. to file for Part B. You’re first eligible to enroll in Part B the month 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 months of your return to the U. S. Although you may be able to enroll, in most cases, you won’t be able to get Medicare-covered services while living outside the U. S. Medicare generally can’t pay for any of your hospital or medical bills unless you get your medical care in the U.S. (including Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa). Under certain limited circumstances, medical services provided in Canada or Mexico also may be covered by Medicare, but only if you are living in the U.S. If you live in Puerto Rico and get benefits from Social Security or the Railroad Retirement Board you’ll automatically get Medicare Part A. If you want Part B you need to sign up for it. August 2015 Understanding Medicare Enrollment Periods

Check Your Knowledge—Question 1
For people born in and later, the full Social Security retirement age is 62 years 65 years 67 years 70 years Check Your Knowledge—Question 1 For people born in 1960 and later, the full Social Security retirement age is 62 years 65 years 67 years 70 years Answer: c. 67 years The 1983 Social Security Amendments included a provision for gradually raising the full Social Security retirement age. The full age gradually increased until it reached 67 for people born in 1960 and later. No matter what your full Social Security retirement age is, you may start receiving benefits as early as age 62 or as late as age 70. However, if you start Social Security retirement benefits early, your benefits are reduced a fraction of a percent for each month before your full retirement age. August 2015 Understanding Medicare Enrollment Periods

If you enroll in Part B during the General Enrollment Period (January 1 – March 31) your coverage will start on The first day of the month after you enroll April 1 May 1 July 1 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 The first day of the month after you enroll April 1 May 1 July 1 Answer: d. July 1. If you enroll during the GEP, your coverage will start on July 1. This is required by law. August 2015 Understanding Medicare Enrollment Periods

Which of the following is not a criteria for an immigrant to purchase Medicare Part A and/or Part B? He or she must Be 65 or older Must have blood relative that’s a legal U.S. citizen Be lawfully admitted for permanent residence Have lived in the U.S. without a break for the 5- year period immediately before the month they file for enrollment 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 Be 65 or older Have a legal U.S. blood relative Be lawfully admitted for permanent residence Have lived in the U.S. without a break for the 5-year period immediately before the month they file for enrollment Answer: b. Must have a blood relative that’s a legal U.S. citizen August 2015 Understanding Medicare Enrollment Periods

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 Lesson 2—Medicare enrollment based on a disability covers the following 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

Qualifying for Medicare Based on Disability
Medicare usually begins after getting Social Security Disability Insurance (SSDI) for 24 months Unless you have Amyotrophic Lateral Sclerosis Medicare begins first month entitled to SSDI Generally, this means you get Medicare in the 30th month after you become disabled 5-month waiting period for SSDI benefits Followed by 24-month waiting period for Medicare Medicare also covers 2 additional groups: People under 65 with a disability who have been entitled to Social Security (SSA) benefits for 24 months. People with End-Stage Renal Disease (ESRD) who meet special SSA earnings requirements. People with ESRD don’t need to be entitled to Social Security benefits to qualify for Medicare. However, if they’re also entitled to disability benefits, they may qualify under both programs. In most cases, you must be entitled to disability benefits for 24 months before Medicare can begin. Since there is a 5-month waiting period for Social Security Disability Insurance, the earliest that Medicare can start is usually the 30th month after you become disabled. However, there are 2 exceptions: The 5-month waiting period for cash benefits doesn’t apply to people who get childhood disability benefits or to some people who were previously entitled to disability benefits (in the past 5 years). The 24-month Medicare waiting period doesn’t apply to people disabled by Amyotrophic Lateral Sclerosis (ALS, known as Lou Gehrig’s Disease). People with ALS get Medicare the first month they’re entitled to disability benefits. August 2015 Understanding Medicare Enrollment Periods

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 months before 25th month 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 You’ll automatically get Part A and Part B after you get disability benefits from Social Security (SSA), or certain disability benefits from the Railroad Retirement Board, for 24 months. If you have Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s Disease), you’ll automatically get Part A and Part B the month your disability benefits begin. You’ll get your red, white, and blue Medicare card in the mail 3 months before your 25th month of disability. If you don’t want Part B, follow the instructions that come with the card, and send the card back. If you keep the card, you keep Part B and will pay Part B premiums. Call SSA at if your card doesn’t arrive. Having employer or union coverage while you or your spouse (or family member, if you’re disabled) is still working can affect your Part B enrollment rights. You should contact your employer or union benefits administrator to find out how your insurance works with Medicare and if it would be to your advantage to delay Part B enrollment. Sometimes you must have Part B if You want to buy a Medigap (Medicare Supplement Insurance) policy You want to join a Medicare Advantage Plan You're eligible for TRICARE Your employer coverage requires you or your spouse or family member to have it (talk to your employer’s or union benefits administrator) Even if you don’t take many prescriptions now, you should consider joining a Medicare drug plan (Part D). If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. August 2015 Understanding Medicare Enrollment Periods

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 In some cases, a disability determination may be made based on an appeal, giving you an earlier date of entitlement to disability benefits. In other cases, if your application isn’t processed in a timely manner, you may be entitled to retroactive Medicare Part A coverage. 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

Information Received with Retroactive Determination
You’ll get this information with your determination: Your effective date of Part A coverage (the 25th month of disability benefit entitlement) Your effective date of Part B coverage (the month of processing), and the option to elect Part B coverage starting with the 25th month 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 You’ll get this information with your determination: Your effective date of Part A coverage (the twenty-fifth month of disability benefit entitlement) Your effective date of Part B coverage (the month of processing), and the option to elect Part B coverage starting with the twenty-fifth month 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. If you elect retroactive Part B coverage, you’ll get a second letter stating that you have retroactive Part B coverage. The letter also gives instructions for the provider to file Part B claims outside the timely filing limit. Regardless of the situation, your Part A start date will always be the twenty-fifth month after your disability benefit is approved. Your Part B start date will be the twenty-fifth month after your disability benefit is approved, if, at the time the disability application is processed, you owe less than 6 months of previous Part B premiums. If you owe 6 or more months of premiums, Part B becomes effective the month your disability application is processed. NOTE: Because there’s uncertainty in determining the Initial Enrollment Period (IEP) for an individual filing for re-entitlement to disability benefits, the Part B enrollment request is deemed to have been filed in the third month of the IEP. This ensures that you have the opportunity for coverage at the earliest possible date. August 2015 Understanding Medicare Enrollment Periods

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 You’re entitled to Medicare as long as you continue to meet the requirements for Social Security disability benefits. If Social Security (SSA) determines that your disability benefits should be stopped because your condition has improved and you’re no longer considered disabled, your Medicare will end the same month your disability benefits end. SSA has work incentives to support people who are still medically disabled but try to work in spite of their disability. Continuation of Medicare coverage is a type of incentive. You may have at least 8½ years of extended Medicare coverage if you return to work. Medicare continues even if SSA determines you can no longer get cash benefits because you earn above the substantial gainful activity level. If, after you’ve exhausted your 8 ½ years of extended Medicare coverage, you continue to work and continue to have a disabling physical or mental impairment, you may buy Part A, or Part A and Part B for as long as you continue to be disabled. This provision is called “Medicare for the Working Disabled." In some cases, your state may help you pay your Part A premiums. See slide 45 for more information. If you were paying an increased Part B premium during the time you were getting premium-free Part A, but now are eligible for Part B because you’re enrolling in Part A for the working disabled, your Part B premium will go back to the standard rate. If you’re getting Medicare based on disability when you reach 65, you’ll have continuous coverage with no interruption. You’ll get Part A for free, even if you’ve been buying it. However, the reason for your Medicare entitlement changes from disability to age. If you didn’t have Part B when you were disabled, you’ll automatically be enrolled in Part B when you turn 65, and will again be able to decide whether or not to keep it. If you were paying a Part B late enrollment penalty while you were disabled, the penalty will be removed when you reach 65. August 2015 Understanding Medicare Enrollment Periods

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 You should apply for disability benefits as soon as you become disabled. Social Security (SSA) may be able to process your application faster if you provide Your Social Security number(s) for you and your dependents Your birth certificate, baptismal certificate, or other proof of your age Names, addresses, and phone numbers of the doctors, caseworkers, hospitals, and clinics that took care of you and the dates of your visits Names and dosages of all the medications you take Medical records from your doctors, therapists, hospitals, clinics, and caseworkers that are in your possession Laboratory and test results A summary of where you worked and the kind of work you did A copy of your most recent W-2 form, or if self-employed, your federal tax return You shouldn’t wait to apply even if you don’t have all of the information. The SSA office will help you get the information you need. If you have railroad employment, call the Railroad Retirement Board (RRB) at or your local RRB office. TTY users should call (312) NOTE: If you’re applying for Supplemental Security Income, you’ll also need to provide other financial information about your income and resources to find out if you qualify. August 2015 Understanding Medicare Enrollment Periods

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) You can get Medicare no matter how old you are if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and one of these applies to you You’ve worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee. You’re already getting or are eligible for Social Security or Railroad Retirement benefits. You’re the spouse or dependent child of a person who meets either of the requirements listed above. You may be eligible based on the earning records of a current or prior spouse if you were married for at least 10 years (if divorced). You must also file an application, and meet any deadlines or waiting periods that apply. NOTE: See CMS Product No “Medicare for Children With End-Stage Renal Disease,” at Medicare.gov/Pubs/pdf/11392.pdf for more information regarding children with ESRD. August 2015 Understanding Medicare Enrollment Periods

Medicare Part B (Medical Insurance) Eligibility
You can enroll in Part B if entitled to Part A based on ESRD You pay the monthly 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 If you qualify for Medicare Part A, you can also get Medicare Part B (Medical Insurance). Enrolling in Part B is your choice and isn't automatic. If you don’t enroll in Part B when you get Part A, you must wait until a General Enrollment Period (January 1-March 31 each year) to apply and you may have to pay a late enrollment penalty. You’ll need both Part A and Part B to get full benefits available Medicare to cover certain dialysis and kidney transplant services. Call your local Social Security office to make an appointment to enroll in Medicare based on End-Stage Renal Disease, and for more information about the amount of work needed under Social Security or as a federal employee to be eligible for Medicare. You can contact Social Security at TTY users should call If you work or worked for a railroad, call the Railroad Retirement Board (RRB) at TTY users should call NOTE: If you don’t qualify for Medicare, you may be able to get help from your state Medicaid agency to pay for your dialysis treatments. Your income must be below a certain level to receive Medicaid. In some states, if you have Medicare, Medicaid may pay some of the costs that Medicare doesn’t cover. To apply for Medicaid, talk with the social worker at your hospital or dialysis facility or contact your local Department of Human Services or Social Services. August 2015 Understanding Medicare Enrollment Periods

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 If you’re already enrolled in Medicare based on age or disability, and you’re already paying a higher Part B premium because you didn’t enroll in Part B when you were first eligible, you’ll no longer have to pay the penalty when you become entitled to Medicare based on ESRD. You’ll still have to pay the Part B premium. Call your local Social Security office to make an appointment to enroll in Medicare based on ESRD. If you’re receiving Medicare benefits based on ESRD when you turn 65, you have continuous coverage with no interruption. If you didn’t have Part B prior to 65, you’ll automatically be enrolled in Part B when you turn 65, but you can decide whether or not to keep it. If you were paying a higher Part B premium for late enrollment, the penalty will be removed when you turn 65. August 2015 Understanding Medicare Enrollment Periods

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-month period, you were eligible but not enrolled No Special Enrollment Period for those with End-Stage Renal Disease If you enroll in Part A and wait to enroll in Part B, you may have a gap in coverage, since most expenses incurred for ESRD are covered by Part B rather than Part A. You’ll only be able to enroll in Part B during a General Enrollment Period, January 1 to March 31 each year, with Part B coverage effective July 1 of the same year. In addition, your Part B premium may be higher. This late enrollment penalty is 10% for each 12-month period you were eligible but not enrolled. There’s no Special Enrollment Period (SEP) for Part B if you have ESRD. This includes individuals who are dually-entitled to Medicare based on ESRD and age or disability. August 2015 Understanding Medicare Enrollment Periods

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 months Medicare is the secondary payer during the 30-month coordination period Begins when first eligible for Medicare even if not enrolled Separate coordination period each time enrolled based on ESRD No 3-month waiting period New 30-month coordination period if you have GHP coverage If you’re eligible for Medicare because you get a regular course of dialysis treatments, your Medicare entitlement will usually start the fourth month of a regular course of dialysis. Therefore, Medicare generally won’t pay anything during your first 3 months of a regular course of dialysis unless you already have Medicare because of age or disability. If you’re covered by a group health plan (GHP), that plan is generally the only payer for the first 3 months of a regular course of dialysis. Once you have Medicare coverage because of ESRD: There’s a period when your GHP will pay first on your health care bills and Medicare will pay second. This period is called a 30-month coordination period. However, some Medicare plans sponsored by employers will pay first. Contact your plan’s benefits administrator for more information. There’s a separate 30-month coordination period each time you enroll in Medicare based on ESRD. For example, if you get a kidney transplant that functions for 36 months, your Medicare coverage will end. If after 36 months you enroll in Medicare again because you start dialysis or get another transplant, your Medicare coverage will start again right away. There will be no 3-month waiting period before Medicare begins to pay. However, there will be a new 30-month coordination period if you have GHP coverage. August 2015 Understanding Medicare Enrollment Periods

Enrollment Considerations– Immunosuppressive Drugs
If You Your Immunosuppressive Drugs 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 Are covered by Part B Medicare pays 80% You pay 20% Coinsurance costs don’t count toward catastrophic coverage under Part D Didn’t meet the transplant conditions above 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 Immunosuppressive drug therapy is only covered by Medicare Part B for people who were entitled to Part A at the time of a kidney transplant, provided that The transplant was performed at a Medicare-approved facility, and Medicare made a payment for the transplant, or If Medicare made no payment, Medicare was the secondary payer Medicare entitlement ends 36 months after a successful kidney transplant if ESRD is the only reason for Medicare entitlement, i.e., the person isn’t 65 and doesn’t get Social Security disability benefits. Enrolling in Part D (Medicare prescription drug coverage) doesn’t change this period. If Part B covers these drugs, and you have a Part D plan, the Part B coinsurance costs don’t count toward your Part D catastrophic coverage (True Out-of-Pocket costs). People who don’t meet the conditions for Part B coverage of immunosuppressive drugs may be able to get coverage by enrolling in Part D. However, Part D won’t cover immunosuppressive drugs if they would be covered by Part B, but the person hasn’t enrolled in Part B. Part D could help pay for outpatient drugs needed to treat other medical conditions, such as high blood pressure, uncontrolled blood sugar, or high cholesterol. August 2015 Understanding Medicare Enrollment Periods

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 The 30-month coordination period starts the first month you’re able to get Medicare, even if you haven't signed up yet. Example: You start dialysis in June. The 30-month coordination period generally starts September 1 (the fourth month of dialysis even if you don’t have Medicare). Tell your providers if you have group health plan (GHP) coverage during this period so your services are billed correctly. After the 30-month coordination period, Medicare pays first for all Medicare-covered services. Your GHP may pay for services not covered by Medicare. If you’re covered by an employer group health plan (EGHP), you may want to delay applying for Medicare. Here are some things to consider: If your GHP pays all of your health care costs with no deductible or coinsurance, you may want to delay enrolling in Medicare until shortly before the 30-month coordination period ends to avoid a break in coverage. Many EGHPs will cut off primary payment after the 30th month. If you pay a deductible or coinsurance under your GHP, enrolling in Medicare Parts A and B could pay those costs. If you enroll in Part A but delay Part B, you don’t pay the Part B premium during this time. However, you’ll have to wait until the next General Enrollment Period (January 1-March 31) to enroll (coverage effective July 1) and your premium may be higher. If you enroll in Part A but delay Part D (Medicare Prescription Drug Coverage), you don’t have to pay a Part D premium during this time. You may have to wait until the next Open Enrollment Period to enroll (from October 15–December 7, with coverage effective January 1) and your premium may be higher without creditable drug coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. August 2015 Understanding Medicare Enrollment Periods

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-month 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 You can enroll in Medicare Part A and Part B based on ESRD at your local Social Security office. Social Security will need your doctor or the dialysis facility to complete Form CMS-2728 to document that you have ESRD and can get Medicare. If Form CMS-2728 is sent to Social Security before you apply, the office may contact you to ask if you want to complete an application. In general, Medicare is the secondary payer of benefits for the first 30 months of Medicare eligibility (known as the 30-month coordination period) for people with ESRD who have an employer group health plan or union group health plan (GHP) coverage. If your GHP coverage will pay for most or all of your health care costs (for example, if it doesn’t have a yearly deductible), you may want to delay enrolling in Part A and Part B until you’re getting near to the end of the 30-month coordination period. If you delay enrollment, you won’t have to pay the Part B premium for coverage you don’t need yet. After the 30-month coordination period, you should enroll in Part A and Part B. If you’ll soon receive a kidney transplant, get the facts about eligibility and enrollment before deciding to delay because there are shorter time periods for eligibility and enrollment deadlines for transplant recipients (see slides 14-16). Call Social Security at to make an appointment to enroll in Medicare based on ESRD. TTY users should call August 2015 Understanding Medicare Enrollment Periods

When Medicare Coverage Based on ESRD Starts
Your Coverage Starts Under the Following Circumstances 1st day of the 4th month You get a regular course of dialysis in a facility 1st day of the month of the 1st month You participate in a home dialysis training program during the first 3 months of your regular course of dialysis (with expectation of completion) 1st day of the month You get a kidney transplant 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 month or within the following 2 months 2 months before the month of your transplant Your transplant is delayed more than 2 months after you’re admitted to the hospital for the transplant or for health care services you need for the transplant Medicare coverage will begin on the first day of the fourth month of a regular course of dialysis. This initial 3 month period is called the qualifying period. Coverage can begin the first month of a regular course of dialysis treatments if you meet all of these conditions: You participate in a home dialysis training program offered by a Medicare-approved training facility during the first 3 months of your regular course of dialysis, and Your doctor expects you to finish training and be able to do your own dialysis treatments. Medicare coverage begins the month you get a kidney transplant or the month you’re admitted to an approved hospital for a transplant or for procedures preliminary to a transplant, providing that the transplant takes place in that month or within the 2 following months. Medicare coverage can start 2 months before the month of your transplant, if your transplant is delayed more than 2 months after you’re admitted to the hospital for the transplant, or for health care services you need before your transplant. NOTE: When you enroll in Medicare based on ESRD and you’re on dialysis, Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments. This waiting period will start even if you haven’t signed up for Medicare. For example, if you don’t sign up until after you’ve met all the requirements, your coverage could begin up to 12 months before the month you apply. August 2015 Understanding Medicare Enrollment Periods

When Coverage for ESRD Ends, Continues or Resumes
When Coverage Ends When Coverage Continues When Coverage Resumes Entitlement based solely on ESRD Coverage ends 12 months after the month you no longer require a regular course of dialysis or Thirty-six months after the month of your kidney transplant No interruption in coverage if you start a regular course of dialysis again within 12 months after regular dialysis stopped or You have a kidney transplant or Regular course of dialysis starts within 36 months after transplant or you received another kidney transplant within 36 months after transplant 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 months after you stopped getting a regular course of dialysis You have another kidney transplant > 36 months later If you’re eligible for Medicare coverage only because of ESRD, your Medicare coverage will end Twelve months after the month you stop dialysis treatments, or Thirty-six months after the month you have a kidney transplant. Medicare coverage will continue without interruption. If you start a regular course of dialysis again or get a kidney transplant within 12 months after you stopped getting a regular course of dialysis, or You start a regular course of dialysis or get another kidney transplant before the end of the 36-month post-transplant period. Medicare coverage will resume with no waiting period if: You start a regular course of dialysis again or get a kidney transplant more than 12 months after you stopped getting a regular course of dialysis, or You start a regular course of dialysis or get another kidney transplant more than 36 months after the month of a kidney transplant. NOTE: It’s important to note that for coverage to resume, you must file a new application for this new period of Medicare entitlement (see process on slide 11). August 2015 Understanding Medicare Enrollment Periods

Kevin has an endocrine disorder and started receiving Social Security Disability Insurance this month. How long will Kevin have to wait until he can get Medicare? 24 months 36 months 48 months There is no waiting period. He can get Medicare immediately. Check Your Knowledge—Question 4 Kevin has an endocrine disorder and started receiving Social Security Disability Insurance this month. How long will Kevin have to wait until he can get Medicare? 24 months 36 months 48 months There is no waiting period. He can get Medicare immediately. Answer: a. 24 months Medicare usually begins after getting Social Security Disability Insurance (SSDI) for 24 months. Generally, this means you get Medicare in the 30th month after you become disabled. August 2015 Understanding Medicare Enrollment Periods

Lesson 3—Medigap (Medicare Supplement Insurance Policy) Enrollment Period Medigap Open Enrollment Switching Medigap Policies Lesson 3—Medigap (Medicare Supplement Insurance Policy) Enrollment Period Medigap Open Enrollment Switching Medigap Policies August 2015 Understanding Medicare Enrollment Periods

Medigap Open Enrollment Period
Your Medigap Open Enrollment Period (OEP) 6 months 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 It’s very important to understand your Medigap Open Enrollment Period (OEP). The best time to buy a Medigap policy is during your Medigap OEP. This period lasts for 6 months and begins on the first day of the month in which you’re both 65 or older and enrolled in Medicare Part B. If you apply during your Medigap OEP, 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 don’t purchase a plan within your 6 month OEP, insurance companies can deny coverage based on your health conditions. It’s also important to understand that your Medigap rights may depend on when you choose to enroll in Medicare Part B. If you’re 65 or older, your Medigap OEP 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 OEP. However, there are exceptions if you have employer coverage. While the insurance company can’t make you wait for your coverage to start, it may be able to make you wait for coverage related to a pre-existing condition (see slide 43). Remember, for Medicare‑covered services, Original Medicare will still cover the condition, even if the Medigap policy won’t cover your out‑of‑pocket expenses. You may buy a Medigap policy any time an insurance company will sell you one. NOTE: Some states have additional Medigap OEPs, including those for people under 65. August 2015 Understanding Medicare Enrollment Periods

Pre-existing Conditions and Medigap
Health problem you had before the new insurance policy starts Treated or diagnosed 6 months 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 months (“look-back period”) Without 6 months of prior creditable coverage and no break in coverage more than 63 days The insurance company may be able to make you wait for coverage related to a pre- existing condition (i.e., a health problem you have before the date a new insurance policy starts) for up to 6 months. This is called a “pre-existing condition waiting period.” After 6 months, the Medigap policy will cover the pre-existing condition. Coverage for a pre-existing condition can only be excluded in a Medigap policy if the condition was treated or diagnosed within 6 months before the date the coverage starts under the Medigap policy. This is called the “look-back period.” Original Medicare will still cover the condition, even if the Medigap policy won’t cover your out-of-pocket costs, but you’re responsible for the Medicare coinsurance or copayment. If you buy a Medigap policy during your Medigap Open Enrollment Period and you’re replacing certain kinds of health coverage that count as “creditable coverage” (generally any other health coverage you recently had before applying for a Medigap policy), it’s possible to avoid or shorten this waiting period. If you had at least 6 months of continuous prior creditable coverage (with no break in coverage for more than 63 days), the Medigap insurance company can’t make you wait before it covers your pre-existing conditions. You can learn more about creditable coverage by reviewing the Code of Federal Regulations, 45 CFR at ecfr.gov/cgi-bin/ECFR?page=browse. If you buy a Medigap policy when you have a guaranteed issue right, the insurance company can’t use a pre-existing condition waiting period. The Affordable Care Act doesn’t impact the pre-existing condition waiting period for Medigap coverage. August 2015 Understanding Medicare Enrollment Periods

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 Guaranteed issue rights are federal protections you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy. In these situations, an insurance company can’t deny you a Medigap policy, or place conditions on a Medigap policy, such as exclusions for pre- existing conditions, and can’t charge you more for a Medigap policy because of a past or present health problem. In many cases, you have a guaranteed issue right when you have other health coverage that changes in some way, such as when you lose or drop the other health care coverage. In other cases you have a “Trial Right” to try a Medicare Advantage Plan and still buy a Medigap policy if you change your mind. Some states have additional protections. More detail about Guaranteed Issue Rights is contained at 1882(s)(3)(A) of the Social Security Act. August 2015 Understanding Medicare Enrollment Periods

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 If you’re under 65 and have Medicare because of a disability or End-Stage Renal Disease (ESRD), you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law doesn’t require insurance companies to sell Medigap policies to people under 65. However, the following states require Medigap insurance companies to sell you a Medigap policy, even if you’re under 65 in: California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, and Wisconsin However, Medigap isn't available to people with ESRD under 65 in California, Massachusetts, or Vermont. In Delaware, Medigap is only available to people under 65 with ESRD. Even if your state isn’t on the list above, some insurance companies may voluntarily sell Medigap policies to people under 65, although they’ll probably cost you more than Medigap policies sold to people over 65, and they can use medical underwriting. Check with your State Insurance Department (see Appendix B for a list of phone numbers) about what rights you might have under state law. Remember, if you’re already enrolled in Medicare Part B, you’ll get a Medigap Open Enrollment Period when you turn 65. You’ll probably have a wider choice of Medigap policies and be able to get a lower premium at that time. During your Medigap OEP, insurance companies can’t refuse to sell you any Medigap policy due to a disability or other health problem, or charge you a higher premium (based on health status) than they charge other people who are 65. Because Medicare (Part A and/or Part B) is creditable coverage, if you had Medicare for more than 6 months before you turned 65, you may not have a pre-existing condition waiting period. August 2015 Understanding Medicare Enrollment Periods

Sarah turns 65 next month, and has enrolled in Medicare Parts A and B. How many Medigap Open Enrollment Periods will she get? None – you can sign up for a Medigap plan anytime One One each year Two each year, if you count Special Enrollment periods Check Your Knowledge—Question 5 Sarah turns 65 next month, and has enrolled in Medicare Parts A and B. How many Medigap Open Enrollment Periods (OEP) will she get? None – you can sign up for a Medigap plan anytime One One each year Two each year, if you count Special Enrollment periods Answer: b. One The best time to buy a Medigap policy is during your Medigap OEP. This period lasts for 6 months and begins on the first day of the month in which you’re both 65 or older and enrolled in Medicare Part B. If you apply during your Medigap OEP, 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 don’t purchase a plan within your 6 month OEP, insurance companies can deny coverage based on your health conditions. August 2015 Understanding Medicare Enrollment Periods

Lesson 4—Enrollment Periods for Medicare Prescription Drug Coverage (Part D) Initial Enrollment Period Open Enrollment Period Special Enrollment Periods Lesson 4—Enrollment Periods for Medicare Prescription Drug Coverage Initial Enrollment Period Open Enrollment Period Special Enrollment Periods August 2015 Understanding Medicare Enrollment Periods

Part D Initial Enrollment Period (IEP)
When you first become eligible to get Medicare 7-month IEP for Part D If You Join Coverage Begins During the 3 months before you turn 65 Date eligible for Medicare During the month you turn 65 First day of the following month During the 3 months after you turn 65 First day of the month after month you apply When you first become eligible to get Medicare, you have a 7-month Initial Enrollment Period (IEP) for Part D: You can apply as early as 3 months before your month of Medicare eligibility. Coverage will start on the date you become eligible for Medicare. If you apply during your month of eligibility, then your Medicare drug coverage begins the first day of the following month. You can apply during the 3 months after your month of eligibility, with coverage beginning the first day of the month after the month you apply. Some groups of people who become eligible to get Medicare will be enrolled in a Medicare drug plan by CMS unless they join a plan on their own. NOTE: If you get Social Security or Railroad Retirement benefits when you turn 65, you’ll be enrolled automatically in Medicare Parts A and Part B. However, you’ll still need to choose and enroll in a Part D plan during your IEP if you’d like to have Medicare drug coverage. If you enroll later, you may pay a penalty. August 2015 Understanding Medicare Enrollment Periods

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 Medicare’s Open Enrollment Period runs from October 15–December 7 each year with changes going into effect on January 1 January 1–February 14 If you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch, you have until February 14 to also join a Medicare drug plan to add drug coverage. Coverage starts the first day of the month after the plan gets the enrollment form. April 1–June 30 (limited) If you don’t have Medicare Part A coverage, and enroll in Medicare Part B during the Part B General Enrollment Period (January 1–March 31), you can sign up for a Medicare Prescription Drug Plan from April 1–June 30. Your coverage begins July 1. August 2015 Understanding Medicare Enrollment Periods

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 You can make changes to your Medicare prescription drug coverage when certain events happen in your life. These chances to make changes are called Special Enrollment Periods (SEPs). Each SEP has different rules about when you can make changes and the type of changes you can make. These chances to make changes are in addition to the regular enrollment periods that happen each year. The SEPs listed below are examples. The list doesn’t include every situation: If you permanently move out of your plan’s service area If you lose your other creditable prescription drug coverage If you weren’t properly told that your other coverage wasn’t creditable, or that the other coverage was reduced so that it’s no longer creditable If you enter, live at, or leave a long-term care facility like a nursing home If you qualify for Extra Help, you have a continuous SEP, and can change your Medicare drug plan at any time If you belong to a State Pharmaceutical Assistance Program Other exceptional circumstances, like if you no longer qualify for Extra Help NOTE: It’s important to remember that the SEPs for Part B and Part D have different time frames for when you need to sign up for coverage. You may be eligible for a Medicare Part B SEP if you’re over 65 and you (or your spouse) are still working and have health insurance through active employment. Your Part B SEP lasts for 8 months and begins the month after your employment ends. However, your Part D SEP lasts for only 2 full months after the month your coverage ends. SEP options will display for you if you enroll through the Medicare Plan Finder on Medicare.gov. By checking any of the listed SEPs, you’re certifying that, to the best of your knowledge, you’re eligible for an enrollment period. If at a later time it’s determined that this information was incorrect, you may be disenrolled from the plan. August 2015 Understanding Medicare Enrollment Periods

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 month 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 Plans are assigned their star rating once per year, in October. However, the plan won’t actually get this rating until the following January 1. To find star rating information, visit the Medicare Plan Finder at Medicare.gov/find-a-plan. Look for the Overall Plan Rating to identify 5-star plans that you can change to during this Special Enrollment Period (SEP). The “Medicare & You” handbook doesn’t have the full, updated ratings for this SEP. Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall star ratings to plans. Plans get rated from 1 to 5 stars. A 5-star rating is considered excellent. At any time during the year, you can use the 5-star SEP to enroll in a 5-star Medicare Advantage (MA)– only plan, a 5-star MA plan with prescription drug coverage (MA-PD), a 5-star Medicare Prescription Drug Plan (PDP), or a 5-star Cost Plan, as long as you meet the plan’s enrollment requirements (for example, living within the service area). If you’re currently enrolled in a plan with a 5-star overall rating, you may use this SEP to switch to a different plan with a 5-star overall rating. CMS also created a coordinating SEP for prescription drug plans. This SEP lets people who enroll in certain types of 5-star plans without drug coverage choose a PDP, if that combination is allowed under CMS rules. You may use the 5-star SEP to change plans one time between December 8 and November 30 of the following year. Once you enroll in a 5-star plan, your SEP ends for that year and you’re allowed to make changes only during other appropriate enrollment periods. Your enrollment will start the first day of the month following the month in which the plan gets your enrollment request. For more information, please see the “5-Star Enrollment Period Job Aid” at CMS.gov/Outreach-and- Education/Training/CMSNationalTrainingProgram/Downloads/ Star-Plan-Ratings-Overview-Job- Aid.pdf. NOTE: You may lose prescription drug coverage if you use this SEP to move from a plan that has drug coverage to a plan that has no drug coverage. You’ll have to wait until the next applicable enrollment period to get drug coverage and may have to pay a penalty. August 2015 Understanding Medicare Enrollment Periods

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 A contract that gets less than 3 stars for its Part C or D summary rating for at least the last 3 years (i.e., rated 2.5 or fewer stars for the 2013, 2014, and 2015 Plan Ratings for Part C or Part D), will be marked with the above icon on Medicare Plan Finder. Medicare sends the “Important Information About Your Medicare Plan Options,” CMS Product Number 11633, to members of these plans giving them a one-time option to switch to another Medicare drug plan with 3 stars or better. Visit CMS.gov/Medicare/Eligibility-and- Enrollment/MedicareMangCareEligEnrol/Downloads/Feb2015_LPI_Notice_CMS pdf to view the notice in English and Spanish. The summary rating gives an overall score on the drug plan’s quality and performance in many different topics that fall into 4 categories: Drug plan customer service—Includes how well the plan handles member appeals. Member complaints and changes in the drug plan’s performance—Includes how often Medicare found problems with the plan, and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time. Member experience with the plan’s drug services—Includes ratings of member satisfaction with the plan. Drug safety and accuracy of drug pricing—Includes how accurate the plan’s pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is considered safer and clinically recommended for their condition. This information is gathered from several different sources. In some cases it is based on member surveys. In other cases, it is based on reviews of billing and other information that plans submit to Medicare results from Medicare’s regular monitoring activities. August 2015 Understanding Medicare Enrollment Periods

You can add or switch a Medicare Part D plan during Medicare’s Open Enrollment Period (October 15–December 7) each year. True False 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. True False Answer: a. True August 2015 Understanding Medicare Enrollment Periods

Lesson 5—Enrollment Periods for Medicare Advantage Plans (Part C)
Initial Enrollment Period Open Enrollment Period Special Enrollment Periods 5-Star Special Enrollment Period Lesson 5—Medicare 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

When You Can Join or Switch Medicare Advantage Plans
Initial Enrollment Period 7-month period begins 3 months before the month you turn 65 Includes the month you turn 65 Ends 3 months after the month you turn 65 Medicare Advantage Initial Enrollment 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 months immediately before your first entitlement to both Medicare Parts A and B ends, and the later of The last day of the month preceding entitlement to both Part A and Part B or The last day of the individual’s Part B initial enrollment period Medicare Open Enrollment Period October 15–December 7 Coverage begins January 1 Medicare due to a Disability 7-month period begins 3 months before the 25th month of disability. Ends 3 months after the 25th month of disability. You can join a Medicare Advantage (MA) Plan during the following times: When you first become eligible for Medicare, i.e., during your Initial Enrollment Period, which begins 3 months immediately before your first entitlement to both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) During your Medicare Advantage Plan Initial Enrollment. You must have both Medicare Part A and Part B to enroll in a MA plan. If you didn’t enroll in Medicare Part B when you enrolled in Part A, (e.g., you were working and covered by your employer’s health plan), your MA enrollment period begins 3 months immediately before your first entitlement to both Medicare Part A and Part B, and ends the later of either the last day of the month preceding entitlement to Both Part A or Part B, or the last day of your Part B initial enrollment period. Here’s an example of how this applies. Carol turns 65 in July. Her initial Medicare Part A and Part B enrollment period runs between April and October. If Carol enrolls in April, May or June, her coverage begins in July. If she enrolls in July, August, September or October, her coverage begins the first day of the next month. Carol is working and covered by an Employer Group Health Plan. She signs up for Medicare Part A in June, so her coverage begins in July. But she doesn’t sign up for Part B. Carol plans to retire in March, and she waits to sign up for Medicare Part B. Carol wants to enroll in a MA plan when she retires. She’ll first need to enroll in Medicare Part B. Carol has 8 months to sign up for Medicare Part B. However, the MA enrollment period is 3 months. Since Carol wants to get her Medicare benefits through a MA plan, she’ll need to enroll in one between March and May. During the Medicare Open Enrollment Period (OEP) You can switch to another MA Plan or to Original Medicare during the OEP, also known as the Annual Enrollment Period. This period runs from October 15 through December 7 each year, with coverage starting January 1. If you get Medicare due to a disability, you can join during the 7-month period that begins 3 months before your twenty fifth month of disability and ends 3 months after your twenty fifty month of disability. You can only join one MA Plan at a time, and enrollment in a plan is generally for a calendar year. Plans must be allowing new members to join. Plans may be prohibited from accepting new members if there is a Centers for Medicare & Medicaid Services (CMS)—approved capacity limit or a CMS-issued enrollment sanction in effect.

When You Can Join or Switch Plans
Special Enrollment Periods (SEP) 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 You may be able to join or switch plans if any of these special circumstances that grant a Special Enrollment Period (SEP) apply to you: Move out of your plan’s service area Are enrolled in a plan that decides to leave the Medicare program or reduce its service area at the end of the year Leave or are losing employer or union coverage Enter, live at, or are leaving a long-term care facility Qualify for Extra Help (you have a continuous SEP, meaning you can enroll in or switch your plan at any time) Lose your Extra Help status Join or switch to a plan that has a 5-star rating Receive notice of retroactive Medicare entitlement Other exceptional circumstances NOTE: In the case of retroactive entitlement, there are special rules that allow for enrollment in a Medicare Advantage Plan, or Original Medicare and a Medigap policy. More information about conditions that allow an exception can be found in Chapter 2 of the “Medicare Managed Care Manual,” Section 30.4 at CMS.gov/medicare/health-plans/healthplansgeninfo/downloads/mc86c02.pdf. August 2015 Understanding Medicare Enrollment Periods

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 month 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 Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall star ratings to plans. Plans get rated from 1 to 5 stars. A 5-star rating is considered excellent. You can use the 5-star Special Enrollment Period (SEP) to enroll in a 5-star Medicare Advantage (MA)—only Plan, a 5-star MA Plan with prescription drug coverage (MA-PD), a 5-star Medicare Prescription Drug Plan (PDP), or a 5-star Cost Plan, as long as you meet the plan’s enrollment requirements (for example, living within the service area). If you’re currently enrolled in a plan with a 5-star overall rating, you may use this SEP to switch to a different plan with a 5-star overall rating. The Centers for Medicare & Medicaid Services (CMS) also created a coordinating SEP for prescription drug plans. This SEP lets people who enroll in certain types of 5-star plans without drug coverage choose a prescription drug plan, if that combination is allowed under CMS rules. You may use the 5-star SEP to change plans one time between December 8, 2014 – November 30, Once you enroll in a 5-star plan, your SEP ends for that year and you’re allowed to make changes only during other appropriate enrollment periods. Your enrollment will start the first day of the month following the month in which the plan gets your enrollment request. Plans get their star ratings in October each year. Although CMS assigns the plan star ratings in October, plans won’t actually have the rating effective until January 1. To find star rating information, visit the Medicare Plan Finder at Medicare.gov/find-a-plan. Look for the Overall Plan Rating to identify 5-star plans that you can change to during this SEP. The “Medicare & You” handbook doesn’t have the full, updated ratings for this SEP. NOTE: You may lose prescription drug coverage if you use this SEP to move from a plan that has drug coverage to a plan that doesn’t. You’ll have to wait until the next applicable enrollment period to get coverage and may have to pay a penalty. August 2015 Understanding Medicare Enrollment Periods

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 month after the plan gets enrollment form Check whether you could get a Medigap policy Medicare Advantage (MA) Plans are one of the four parts of Medicare. They are sometimes referred to as Part C. Between January 1 and February 14 you can leave an MA Plan or MAPD plan and switch to Original Medicare. Original Medicare is Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). If you make this change you may also join a Medicare Prescription Drug Plan (Part D) to add drug coverage. Coverage begins the first of the month after the plan gets the enrollment form Check to see if you would be able to get a Medigap (Medicare supplement insurance) policy to help pay the gaps in Original Medicare coverage. You might have limited or no options depending on the state you live in. NOTE: This time period doesn't allow changes in enrollment from one MA or MAPD plan to another except in limited circumstances, or unless you are qualified for a Special Enrollment Period. August 2015 Understanding Medicare Enrollment Periods

Which of these is not a reason to qualify for a Medicare Advantage Plan Special Enrollment Period? You move out of the plan’s serving area Your doctor leaves the Medicare Advantage Plan You have a chance to enroll in other coverage offered by your employer or union You’re released from jail Check Your Knowledge—Question 7 Which of these is not a reason to qualify for a Medicare Advantage Plan Special Enrollment Period? You move out of the plan’s serving area Your doctor leaves the Medicare Advantage Plan You have a chance to enroll in other coverage offered by your employer or union You’re released from jail Answer: b. Your doctor leaves the MA Plan. This doesn’t qualify for a MA Plan Special Enrollment Period. August 2015 Understanding Medicare Enrollment Periods

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 This training module is provided by the CMS National Training Program (NTP). To view all available CMS NTP materials, including additional training modules, job aids, educational activities, and webinar and workshop schedules, or to subscribe to our list, visit CMS.gov/Outreach-and-Education/Training/ CMSNationalTrainingProgram/index.html. For questions about these training products,

Appendix A – page 1 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. 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

Appendix A – page 2 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) 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

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. Switch to a new Medicare Advantage or Medicare Prescription Drug Plan. If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move. If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months. 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. Join a Medicare Advantage or Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month you move back to the U.S. If you move to a new address that isn’t in your plan’s service area or 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 can switch to a new Medicare Advantage or Medicare Prescription Drug Plan. If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move. If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months. If you move back to the U.S. after living outside the country, you can join a Medicare Advantage or Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month you move back to the U.S. August 2015 Understanding Medicare Enrollment Periods

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 long-term care hospital). 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, switch, or drop coverage lasts as long as you live in the institution and for 2 full months after the month you move out of the institution. You’re released from jail. Join a Medicare Advantage or Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month you’re released from jail. If you just moved into, currently live in, or just moved out of an institution (like a skilled nursing facility or long-term care hospital), you can: 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, switch, or drop coverage lasts as long as you live in the institution and for 2 full months after the month you move out of the institution. If you’re released from jail, you can join a Medicare Advantage or Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month you’re released from jail. August 2015 Understanding Medicare Enrollment Periods

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. 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 change lasts for 2 full months after the month you find out you’re no longer eligible for Medicaid. You leave coverage from your employer or union. Join a Medicare Advantage or Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month your coverage ends. If you’re no longer eligible for Medicaid, you can: 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 change lasts for 2 full months after the month you find out you’re no longer eligible for Medicaid. If you leave coverage from your employer or union, you can join a Medicare Advantage or Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month your coverage ends. August 2015 Understanding Medicare Enrollment Periods

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. Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month you lose your creditable coverage or are notified of the loss of creditable coverage, whichever is later. You have drug coverage through a Medicare Cost Plan and you leave the plan. Join a Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month you drop your Medicare Cost Plan. If 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 can join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month you lose your creditable coverage or are notified of the loss of creditable coverage, whichever is later. If you have drug coverage through a Medicare Cost Plan and you leave the plan, you can join a Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month you drop your Medicare Cost Plan. August 2015 Understanding Medicare Enrollment Periods

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 All- inclusive Care for the Elderly (PACE) plan. Join a Medicare Advantage or Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month you drop your 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. 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 change is between January 1–March 31. If you drop your coverage in a Program of All-inclusive Care for the Elderly (PACE) plan, you can join a Medicare Advantage or Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month you drop your PACE plan. If you find out that you won’t be eligible for Extra Help for the following year, you can: 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 change is between January 1–March 31. August 2015 Understanding Medicare Enrollment Periods

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. Drop your current Medicare Advantage or Medicare Prescription Drug Plan to enroll in the private plan offered by your employer or union. Whenever your employer or union allows you to make changes in your plan. 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 Plan with drug coverage or your Medicare Prescription Drug Plan. Anytime. If you have a chance to enroll in other coverage offered by your employer or union, you can drop your current Medicare Advantage or Medicare Prescription Drug Plan to enroll in the private plan offered by your employer or union. You may do so whenever your employer or union allows you to make changes in your plan. If you have or are enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage), you can drop your current Medicare Advantage Plan with drug coverage or your Medicare Prescription Drug Plan at anytime. August 2015 Understanding Medicare Enrollment Periods

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 If you enroll in a Program of All-inclusive Care for the Elderly (PACE) plan, you can drop your current Medicare Advantage or Medicare Prescription Drug Plan at any time. If 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, you can join a Medicare Advantage, Medicare Cost, or Medicare Prescription Drug plan with an overall quality rating of 5 stars. You can make this change one time between December 8 –November 30 of each year. August 2015 Understanding Medicare Enrollment Periods

Changes in your plan’s contract with Medicare If this describes you… You can… At this time… Medicare takes an official action (called a “sanction”) because of a problem with the plan that affects you Switch from your Medicare Advantage or Medicare Prescription Drug Plan to another plan Your chance to switch is determined by Medicare on a case-by-case basis Your plan’s contract ends (terminates) during the contract year Switch from your Medicare Advantage or Medicare Prescription Drug Plan to another plan Your chance to switch starts 1 months before and ends 2 full month after the contract ends Your Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan’s contract with Medicare isn’t renewed for the next contract year Join another Medicare Advantage or Medicare Prescription Drug Plan Between October 15 and the last day in February If Medicare takes an official action (called a “sanction”) because of a problem with the plan that affects you, you can switch from your Medicare Advantage (MA) Plan or Medicare Prescription Drug Plan to another plan. Your chance to switch is determined by Medicare on a case-by-case basis. If your plan’s contract ends (terminates) during the contract year, you can switch from your MA or Medicare Prescription Drug Plan to another plan. Your chance to switch starts one month before, and ends 2 full months after the contract ends. If your MA Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan’s contract with Medicare isn’t renewed for the next contract year, you can join another MA or Medicare Prescription Drug Plan between October 15 and the last day of February. August 2015 Understanding Medicare Enrollment Periods

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 Join, switch, or drop Medicare prescription drug coverage You’re enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility Join either a Medicare Prescription Drug Plan or a Medicare Advantage Plan with prescription drug coverage Once during the calendar year If you’re eligible for both Medicare and Medicaid, you can join, switch, or drop a Medicare Advantage (MA) Plan or Medicare prescription drug coverage at any time. If you qualify for Extra Help paying for Medicare prescription drug coverage, you can join, switch, or drop Medicare prescription drug coverage at any time. If you’re enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility, you can join either a Medicare Prescription Drug Plan or a MA Plan with prescription drug coverage once during the calendar year. August 2015 Understanding Medicare Enrollment Periods

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 months 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 If you dropped a Medicare Supplemental Insurance (Medigap) policy the first time you joined a Medicare Advantage Plan, you can 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 months after you join the Medicare Advantage Plan for the first time. If 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, you can 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

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) Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan Your chance to join lasts for 2 full months after the month you get a notice of the error from Medicare You weren’t properly told that you were losing private drug coverage that was as good as Medicare drug coverage (creditable coverage) If you weren’t properly told that your other private drug coverage wasn’t as good as Medicare drug coverage (creditable coverage), you can join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month you get a notice of the error from Medicare. If you weren’t properly told that you were losing private drug coverage that was as good as Medicare drug coverage (creditable coverage), you can join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month you get a notice of the error from Medicare. August 2015 Understanding Medicare Enrollment Periods

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 months after the month you get a notice of the error from Medicare If you joined a plan, or chose not to join a plan, due to an error by a federal employee, you can: Join a Medicare Advantage (MA) Plan with drug coverage or a Medicare Prescription Drug Plan. Switch from your current plan to another MA Plan with drug coverage or a Medicare Prescription Drug Plan. Drop your MA Plan with drug coverage and return to Original Medicare. Drop your Medicare prescription drug coverage. Your chance to change coverage lasts for 2 full months after the month you get a notice of the error from Medicare August 2015 Understanding Medicare Enrollment Periods

Understanding Medicare Enrollment Periods

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Understanding Medicare Enrollment Periods

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