SEP HIERARCHY
1ST PRIORITY MA or MAPD
ICEP
Individuals who Gain, Lose or Have a Change in their LIS-Eligible Statushave a SEP which includes those who:•Become eligible for LIS (but who do not receive Medicaid benefits); or •Lose eligibility for any type of assistance; or•Have a change in the level of assistance they receive.
SEP: NLS - Who Gain, Lose or Have a Change in their LIS Status
Delayed Part B while already has Part A
2) ICEP3-month period to enroll ina MA/MAPD(NOT for PDP. PDP-only plan NOT eligible under delayed Part B)
ICEP - Delayed Part B while already has Part A
Your coverage starts the first day of the month when the Medicare Parts A & B becomes effective.
When you're first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. For example, if you're eligible for Medicare when you turn 65, you can sign up during the 7-month period that: Begins 3 months before the month you turn 65.
IEP/ICEP - I am new to Medicare.
1ST PRIORITY PDP or MAPD
IEP
Individuals who Gain, Lose or Have a Change in their Medicaid (Dual Eligible) :•Become eligible for any type of assistance from the Title XIX program (including “partial duals” who receive cost sharing assistance under Medicaid); or •Lose eligibility for any type of assistance; or •Have a change in the level of assistance they receive (e.g., stop receiving Medicaid benefits, but still qualify for LIS, those who have a change in cost sharing).
SEP-MCD- Who Gain, Lose or Have a Change in their Medicaid Status
10/15 - 12/07 annually
AEP- To enroll into a MA, MAPD or PDP with a Jan. 1 plan effective date
LCC - Involuntary Loss of Creditable Prescription Drug Coverage
The first day of the month after you submit a completed application; or Up to two months after your SEP ends, if you request it.
Beneficiaries who have Medicare A and B and receive any type of Federal or State assistance from Medicaid or Low Income Subsidy (LIS) a.k.a. Extra Help. This SEP allows an individual to enroll in or disenroll from a MA, MAPD or PDP once during Jan-Mar, once during Apr-Jun and once during Jul-Sept.
MDE - Dual-Eligible Individuals (Medicare and Medicaid) and Other LIS-Eligible .
PRIORITY AFTER AEP
OEP
Involuntary loss of creditable coverage, including a reduction in the level of coverage so that it is no longer creditable, NOT including any loss or reduction due to a failure to pay premiums. The SEP permits enrollment in a MAPD/PDP and begins with the month in which the individual is advised of the loss of creditable coverage and continues for two additional calendar months after either the loss (or reduction) occurs or the individual received notice, whichever is later.
SEP-LCC- . Involuntary Loss of Creditable Prescription Drug Coverage
Member notifies plan that they moved or have been out of service area for 6+ months and have yet to be disenrolled
3) SEP: MOV For enrollment into MA, MAPD or PDP
PAP/SPAP - You lose SPAP eligibility.
The first day of the month after you submit a completed application.
SEP available for permanent change of residence. Beneficiaries may choose an effective date of up to 3 months after the month in which the enrollment form is received but the effective date may NOT be earlier than the date of permanent move. May enroll in any plan for which the beneficiary is eligible in the new service area, regardless of coverage in former service area. Individuals who move and have new Medicare health or Part D plans available to them as a result of the move, but continue to reside in the current plan.
MOV - New Move
PRIORITY AFTER MA-OEP
OEP NEW
Individuals who have Medicare A and B and receive any type of Federal or State assistance from Medicaid or Low Income Subsidy (LIS) a.k.a. Extra Help (due to financial reasons), including Full Benefit Dual Eligible (FBDE), QMB, QMB+, SLMB, SLMB+, QI, the Medicare Savings Program, or are only eligible for LIS have a onetime-per-calendar-quarter SEP between January through September. This SEP allows an individual to enroll in or disenroll from a MA, MAPD or PDP once during Jan-Mar, once during Apr-Jun and once during Jul-Sept. This coverage is effective the first of the upcoming month.
SEP-MDE- Dual-Eligible Individuals (Medicare and Medicaid) and Other LIS-Eligible
Involuntary Loss of Creditable Prescription Drug Coverage
SEP:LCCFor enrollment into MAPD or PDP
CHR - You’re eligible to enroll in a Medicare C-SNP.
The first day of the month after you submit a completed application. ***If you have a chronic condition and want to join a chronic care SNP for which you are eligible, you can do so at any time. The SEP ends when you join the private health or drug plan. Note: If you have another chronic condition, you get another SEP to join a different SNP that covers this other condition.
SEP available to switch to another private health or drug plan, beginning the month you tell your plan, plus two more full months thereafter.
MOV - Member notifies plan that they moved or have been out of service area for 6+ months and have yet to be disenrolled.
Last Priority After Other Election Periods
SEP
This is an open and unlimited use enrollment period for Medicare beneficiaries residing in an institution lasting for up to two (2) months after leaving the facility. An “institution” is defined as a skilled nursing facility, nursing home, intermediate care facility for the mentally disabled, psychiatric hospital, rehabilitation hospital or long term care hospital (it does NOT include assisted living facilities or residential homes).
SEP- OEP-I -Open Enrollment Institutional
Individuals found ineligible for a CC-SNP
2) SEP: CHR --For enrollment into MA, MAPD or PDP. ***THERE IS 3 WAYS TO USE CHR-SEP. #2 is: After enrollment, Individuals who are found to not have the qualifying condition necessary to enroll in the CC-SNP will have this SEP to enroll in a different plan. This normally occurs when the required post enrollment verification with the provider did not confirm the information provided during the pre-enrollment assessment. This SEP begins when the plan notifies the individual of the lack of eligibility and continues for two additional calendar months. The SEP ends when the individual makes an enrollment election or on the last day of the 2nd month following the notification.
IEP2- Turning 65 if has Medicare due to Disability; a.k.a. 2nd Initial Election
The first day of the following month after you submit a completed application.
Plan Performance Ratings are released every fall and apply to the following calendar year. Your SEP to join a five-star Medicare Advantage or Part D plan starts December 8 of the year before the plan is considered a five-star plan. It lasts through November 30 of the year the plan is considered a five-star plan. You can use this SEP to change plans one time per year.
5ST - You want to enroll in a Medicare Advantage or Part D plan that has an overall Plan Performance Rating of five stars and you’re otherwise eligible to enroll in the plan.