So much attention is focused on the Annual Coordinated Election Period (AEP)
for Medicare Advantage (MA) plans and prescription drug plans (PDPs) that
beneficiaries and their advocates may be unaware of other Medicare enrollment
periods. These enrollment periods and their acronyms are confusing and
overlapping. A beneficiary who does not act carefully may lose needed Part B or
Part D coverage or may affect the way Medicare services are received. In some
situations beneficiaries have only two weeks left, until the end of March, to
effectuate a change.
Annual Coordinated Election Period (AEP)
The Annual Coordinated Election Period runs from November 15 through December
31 each year. During this time beneficiaries may change prescription drug
plans, change Medicare Advantage plans, return to original Medicare, or enroll
in a Medicare Advantage plan for the first time. Enrollment changes take
effect on January 1.
General Enrollment Period (GEP)
Medicare beneficiaries who did not enroll in Part B when they first became
eligible for Medicare may elect Part B coverage during the General Enrollment
Period, which extends from January 1 through March 31 each year.
Enrollment becomes effective on July 1 of the same year.
Beneficiaries who delay enrollment in Part B will be assessed a late
enrollment penalty on their Part B premium. The penalty is 10% for each
full year of delayed enrollment for as long as the beneficiary remains covered
under Part B.
Someone who enrolls in Part B during the General Enrollment Period also has a
Special Enrollment Period (SEP) for Part D. From April through June of
each year a new Part B enrollee may make one election to join a Part D plan.
Because beneficiaries who only have Part A and not Part B are not eligible to
enroll in a Medicare Advantage plan, the SEP enables beneficiaries who elect
Part B during the General Enrollment Period to enroll in a Medicare Advantage
plan with drug coverage (MA-PD).
Open Enrollment Period (OEP)
The Open Enrollment Period provides Medicare beneficiaries with one
opportunity to enroll in, disenroll from, or change a Medicare Advantage plan.
Like the General Enrollment Period, the Open Enrollment Period extends from
January 1 through March 31 each year. Unlike enrollment in Part B, the
change in Medicare Advantage enrollment or disenrollment becomes effective the
month after the change is made.
Only beneficiaries who are eligible to enroll in a Medicare Advantage plan
may make a change during the Open Enrollment Period. In other words, a
beneficiary who wants to change must have both Medicare Part A and Medicare Part
B and must live in the area served by the Medicare Advantage plan.
Beneficiaries may not add or drop Part D drug coverage during the Open
Enrollment Period. Those who already have drug coverage can only change to
another option with drug coverage. Those who do not have drug coverage may
not change to an option that provides drug coverage. Permissible changes
during the Open Enrollment Period include:
MA-PD to a different MA-PD
MA-PD to Original Medicare and a PDP
Original Medicare and a PDP to an MA-PD
MA-only plan to a different MA-only plan
MA-only plan to original Medicare
Original Medicare to an MA-only plan
Beneficiaries who want to use the Open Enrollment Period to return to
Original Medicare from an MA-PD must do so by enrolling in a PDP.
Enrollment in a PDP during either the Annual Coordinated Election Period or the
Open Enrollment Period terminates enrollment in a Medicare Advantage plan.
Because beneficiaries are generally limited to changing their prescription drug
coverage during the Annual Coordinated Election Period, MA-PD enrollees who want
to return to Original Medicare during the Open Enrollment Period have a Part D
Special Enrollment Period that allows them to make one enrollment into a PDP.
Limited Open Enrollment Period (L-OEP)
This enrollment period was repealed, effective July 31, 2007, by
Public Law No. 110-048.
Special Enrollment Period (SEP)
Special Enrollment Periods allow beneficiaries to make an enrollment change
outside of the GEP, the AEP, the OEP and the L-OEP.
Beneficiaries who delay enrolling in Part B because they are covered by
employer-sponsored health insurance as an active worker or as a dependent of an
active worker are not limited to enrolling in Part B during the GEP. They have
an SEP that runs for eight months from the time they (or their spouse) retire or
they lose their health insurance. Part B coverage starts the month after the
election is made, and no late premium penalty is assessed.
A number of SEPs exist for Medicare Advantage and PDP enrollment and
disenrollment. For example, someone who moves out of a Medicare Advantage
Plan or PDP service area has an SEP to enroll in a plan that serves their new
home. Beneficiaries who move into, reside in, or move out of a nursing home may
also have an SEP. Individuals who are eligible for Medicare and Medicaid
have an SEP that allows them to change Part D drug plans at any time. CMS
has the authority to create SEPs for exceptional circumstances.
For more details about Part D SEPs see the PDP Eligibility, Enrollment and
The Medicare Advantage SEPS are described in the Medicare Managed
Care Manual, Chapter 2, Medicare Advantage Enrollment and