SEP 1
What is IEP
Initial eligibility for Medicare. Begins three months before A+B effective dates, month of and three months after. If Enrollment is submitted before A+B start date the effective date is the month of A+B dates otherwise plan will start the following month of Enrollment
What is OEP?
Anyone already enrolled in an MA/MAPD can make a one time change to enroll in a different MA/MAPD or drop back to O.G. Medicare and enroll in a PDP
What is NLS?
Individuals who gain, lose or have a change in the level of LIS (do not qualify for Medicaid)
What is MOV SEP
SEP available for permanent change of residence. Can notify before or after move
When is the OEP Period?
1/1-3/31 every year
What is LCC?
Individuals losing coverage Medicare deems as creditable. SEP begins the month of losing coverage and continues two months after
What is OEP-I?
An individual who has resided in an institution for up to 2 months and has left the facility Institutions include nursing home, SNF, mental health facility, rehab hospital or long term care hospital
What is AEP?
10/15-12/7 every year. Anyone receiving Medicare can change plans with an effective date of 1/1
What is ICEP Medical only
This is when the client is in their IEP (that’s why the timeframe is still 3-1-3) but enrolling into an MAO
When can an agent use the ICEP Delayed Part B?
3-0-0 Before the effective date of the delayed Part B?
What is SPAP?
Once per year, change for individuals who are eligible for an State Pharmaceutical Assistance Program. Can also be used if they no longer qualify and lose that status
What is LEC?
Individuals who are leaving group/employer coverage. SEP begins the month of losing coverage and continues two months after
What is DST?
Reside, or resided at the start of the incident period, in an area for which FEMA has declared an emergency or a major disaster and has designated affected counties as being eligible to apply for individual or public level assistance. •Had another valid election period at the time of incident period; and •Did NOT make an election during that other valid election period
What is NON?
Any plan not renewing its contract or leaving the service area for the following year. SEP begins December 8 and lasts until the end of February
What is SNP?
Individuals enrolled in an SNP plan and who no longer qualify for special needs status. SEP begins the month they no longer qualify and extends 2 months after
What changes are allowed during oep
MAPD to MAO
MAPD to MAPD
MAO to MAO
MAO to MAPD
MAO or MAPD to Original Medicare and a PDP
What is IEP-2?
When someone who had Medicare prior to turning 65, turns 65 year's old
What is OTH SEP?
Individuals who are involuntarily disenrolled from an MAPD plan due to loss of Part B (failure to pay part B premium), but who continue to be entitled to Part A have a SEP to enroll in a PDP. SEP begins when the individual is advised of the loss of Part B continues for two (2) additional months
What is MCD?
Individuals who gain, lose, or have a change in their level of Medicaid (still qualify for LIS). Eligibility begins the month of change/loss and extends two months after.
Can you use MDE during the 4th Quarter after AEP is over?
NO. MDE can only be used during the first 3 quarters of the year.
What process do you follow to re-obtain an election that is not gone/used
If a beneficiary has "buyers' remorse" before the proposed effective date, the beneficiary must contact the plan to cancel the submitted enrollment application in order to have that election code used for a different plan enrollment application.
What is OEP-N
OEP is available to new Medicare Advantage enrollees following IEP/ICEP with their Medicare entitlement. The onetime election begins the month of entitlement (effective date) to Part A and Part B and for two additional months.
When can the effective date of a MOV SEP enrollment be?
The enrollment period begins the day they notify the plan or leave the service area. EFFECTIVE DATE CANNOT BE BEFORE THE MOVE DATE
What is MRD
MRD election would be used if the client is in their IEP 2 timeframe, but enrolling into an MAO (Medical Only Plan)
What is OCC?
Individuals who are leaving Part D coverage to enroll in another creditable coverage plan such as Tricare or V.A. coverage. Use this to disenroll from PDP/MAPD and enroll into MA-Only