MEDICARE

MEDICARE + CHOICE ENROLLMENT CHANGES FOR 2002 & BEYOND

Beginning in January, 2002, the Balanced Budget Act of 1997 (BBA) permits Medicare beneficiaries to enroll in or disenroll from a Medicare managed care plan only once from January through June 2002 (open enrollment period) . After 6/30/02, beneficiaries are not allowed to make any changes until November 2002 (annual election period). Any changes made in November 2002 will be effective January 1, 2003.

In 2003 and thereafter, beneficiaries will be able to enroll or disenroll from a Medicare managed care plan only one time, and only from 1/1/03 - 3/31/03.

EXCEPTIONS TO THE LOCK-IN RULES

Some categories of beneficiaries are not bound by the lock-in rules; that is, they can enroll and disenroll from Medicare managed care plans in other that the annual election or open enrollment periods. They include:

Beneficiaries who first become eligible for Medicare in 2002. These beneficiaries will have an open enrollment period for newly eligible individuals (OEPNEW) for six months, starting with the date they first become eligible for Medicare. During this time they can join a plan and make one switch. In 2003 and thereafter the length of the OEPNEW will be three months.
Beneficiaries who elect a M + C plan when they first become eligible for Medicare can disenroll from the M + C plan and elect original Medicare any time during the 12 month period that begins on the first day they are covered in the M + C plan.
Beneficiaries who are inpatients in an institution such as a skilled nursing facility or rehab. hospital. Such individuals are entitled to a continuous open enrollment period (OEPI) as long as they remain in the institution.
Enrollees of M + C organizations that cease offering a Medicare plan get a special enrollment period (SEP).
Enrollees who permanently move out of their plan’s service area get a SEP.

Beneficiaries who enroll in a M + C health plan through their former employer/union get a SEP.

Enrollees whose plan substantially violates its contract get a SEP.

Individuals enrolled in a PACE program who are dually-eligible (eligible for both Medicare and Medicaid) or lose their dual-eligibility get a SEP.

Beneficiaries from counties which have no M + C plans and where M + C organizations open or expand their service areas mid-year, get a SEP.

CMS can create a SEP if it determines there are exceptional circumstances.

COUNTING ELECTIONS

Switching from one plan to another with the same M + C organization counts as one election.

Disenrolling from one plan and enrolling in a new plan for the same effective date counts as one election as does just enrolling in the new plan.

Adding or removing supplemental benefits from the same plan does not count as an election.
Being involuntarily disenrolled from a plan does not count as an election.