Scenario
Our client just moved last week.
SEP / Change in Residence
SEP - 5 star (MAPD)
Reside in a county within the 5-Star plan’s service area. An individual using this SEP can enroll in an MA-Only or an MA-PD plan, even if coming from Original Medicare (with or without concurrent enrollment in a PDP)
Medicare Advantage Open Enrollment Period
Begins 1/1 Ends 3/31
Enrolling into a 5 star PDP
SEP - Corresponding PDP 5 Star
Our client is receiving both parts A/B next month.
IEP - Initial Election Period
SEP - Loss of EGHP
Voluntary/involuntary termination of group coverage
SEP Change of Residence
Notified Before Move : Begins month before permanent move Ends 2 months after the move
Notified After Move: Begins month consumer notified current plan of the move or the month the member was termed by the plan due to residing outside of the service area (This only applies if the member moved. Election not available if member failed to respond to Out of Area letters.) Ends 2 months after notification of move or after notification of Plan term
Client just received Medicaid
SEP Change in Dual/LIS Status
Our client has had both A and B for years, but are now turning the age of 65.
IEP2 - Age in
OEPI - Institutionalized
Moves into, resides in, or moves out of a Skilled Nursing Facility (SNF), nursing facility (NF), intermediate care facility for the mentally disabled, psychiatric hospital, rehabilitation hospital, Long Term Care (LTC) hospital, or swing-bed hospital with an expecting stay of at least 90 days.
SEP - Contract Nonrenewing
Begins Dec 8 of that year Ends Last day of February of the following year
Client has Medicaid and/or LIS and would like to change their PDP plan
SEP Dual/LIS maintaining
*** Note this is no longer valid for switching MAPD plans
Our client has had Part A for years, but just decided to sign up for Part B (effective next month).
ICEP - Enrolling into Part B After Delaying Enrollment***
Just a Election Period for MA/MAPD not PDP - a good probing question is to ask if they are losing employer coverage if enrolling into PDP (SEP Loss of EGHP)
SEP - Change in Dual/LIS Status
▪ Became eligible for any type of dual or LIS assistance ▪ Losing/Lost eligibility of any type of assistance
▪ Have a change in the level of assistance received
SEP - Loss of SNP Status
(Special Needs Status Change for Members of SNP )
Begins month of effective date of disenrollment
Ends 3 month after the date of involuntary disenrollment
Client is in an area impacted by a Government declared disaster and was missed a valid election period
Code: SEP Reason: Declared Disaster/Emergency
** Note only valid until 03/31/2025 - after clients will need to contact CMS to use this EP
Our Client's Medicare entitlement was determined retroactively and they want to enroll into a PDP.
IEP
Integrated Care SEP
Allows enrollment once per month into a Fully Integrated Dual Eligible SNP (FIDE), Highly Integrated Dual Eligible SNP (HIDE), or Applicable Integrate Plan (AIP) for full benefit dually eligible individuals who are enrolled in, or are in the process of enrolling in, the D-SNP’s affiliated Medicaid Managed Care Organization (MCO) to align enrollment
Chronic Condition - SEP: Special need/Chronic
Begins upon qualification of disabling condition
Ends when enrolled in SNP
Client recently moved out of a Skilled Nursing Facility.
OEPI