SHICK/Medicare Forms For Appointments

---

Understanding the different enrollment periods are important to ensuring you have the coverage you need when you need it. 

Think of the Open Enrollment Period as your annual opportunity to review and adjust your Medicare coverage. This period runs from October 15th to December 7th each year and allows current Medicare beneficiaries to make changes to their existing coverage. This is particularly important as your healthcare needs may evolve, and new plan options become available.

During the Open Enrollment Period, you can:

• Switch from Original Medicare (Parts A &B) to a Medicare Advantage (Part C) plan. This allows you to receive your Medicare benefits through a private insurance company offering an alternative to traditional Medicare.
• Switch from a Medicare Advantage plan back to Original Medicare.  This offers a return to the government-run system, giving you access to a wider network of doctors and hospitals.
• Change Medicare Advantage plans.  If you're already enrolled in a Medicare Advantage plan, you can switch to a different one that better suits your needs. Consider factors like doctor networks, covered benefits, and out-of-pocket costs.
• Join, drop, or switch Medicare Part D (prescription drug) plans. This allows you to choose a prescription drug plan that covers the medications you need at a cost that fits your budget.
• Enroll in a Medicare Advantage plan with prescription drug coverage. This combines your medical and prescription drug coverage into one single plan.

Important Note: Changes made during the Open Enrollment Period take effect on January 1st of the following year.

What happens if you need to enroll in or change your Medicare outside the regular Open Enrollment Period? This is where Special Enrollment Periods (SEPs) come into play. These periods are triggered by specific life events that allow you to enroll in or change your Medicare plan outside of the standard enrollment periods.

Common qualifying events for a Special Enrollment Period include:

• Loss of Creditable Prescription Drug Coverage: If you lose coverage from an employer-sponsored plan or other source that is considered "creditable" (meaning it's at least as good as Medicare Part D), you're eligible for an SEP.
• Moving Out of Your Plan's Service Area: If you move to a new location that is outside of your current Medicare Advantage or Part D plan's service area, you can enroll in a anew plan that covers your new location.
• Loss of Employer-Sponsored Health Insurance After Retirement: This is a very common situation. If you retire and lose your employer-sponsored health insurance, you become eligible for a SEP to enroll in Medicare.
• Changes in Medicaid Eligibility: If you lose Medicaid coverage, you're eligible for a SEP to enroll in Medicare.
• Dual Eligible (Medicare and Medicaid) or Low-Income Subsidy (LIS) Status: If you gain, lose, or have changes to your Dual Eligible or LIS status, you're eligible for a SEP.
• Certain Exceptional Circumstances: CMS (Centers for Medicare & Medicaid Services) may grant a SEP under exceptional circumstances, such as if you were affected by a natural disaster or had difficulty enrolling due to misinformation.
• Involuntary Loss of Other Creditable Coverage:  If you lose coverage from an employer or union for reasons beyond your control, such as the plan being dropped.

Important Considerations for SEPs:

• Documentation is Key: Be prepared to provide documentation to prove your eligibility for the SEP. This might include a letter from your employer, proof of address change, or other relevant documents.
• Time Limits Exist: SEPs typically last for a limited time period, often two or three months following the qualifying event. It's important to act quickly to take advantage of your SEP eligibility.
• Not All SEPs are Created the same: The rules for SEPs can be complex, and the allowable changes may vary depending on the specific qualifying event.
• Seek Assistance: If you're unsure whether you qualify for a SEP or have questions about the enrollment process, contact Medicare directly or consult with a SHICK representative.

This enrollment window is primarily for individuals who:

• Did not enroll in Medicare Part A and or Part B when they were first eligible. This often happens because they were covered under an employer-sponsored health plan and didn't need Medicare coverage immediately.
• Are not eligible for a Special Enrollment Period (SEP). SEPs are triggered by specific life events, like losing employer-sponsored coverage or moving out of a plan's service area.
• Want to enroll in Part B even if they are already enrolled in Part A.

Key Things to Remember about  the GEP:

• Enrollment Dates:  January 1st to March 31st.
• Coverage Start Date: Coverage will begin on July 1st of the same year. This is important to keep in mind, as there will be a gap between enrollment and coverage activation.
• Late Enrollment Penalties: Enrolling in Medicare Part B during the GEP may result in a late enrollment penalty. This penalty is a permanent increase in your monthly Part B premium and is calculated based on how long you delayed enrollment. For Part A, you may also face a penalty if you were not eligible for premium-free Part A.

Medicare Advantage Open Enrollment Period (MA OEP)

This period also runs from January 1st to March 31st, but it is different from the GEP. 

Understanding the Medicare Advantage Open Enrollment Period (MA OEP): 

While the GEP focuses on initial enrollment in Medicare Parts A and B, the Medicare Advantage Open Enrollment Period (MA OEP) serves a different purpose. If you are already enrolled in a Medicare Advantage plan (Part C), the MA OEP allows you to:

• Switch from your current Medicare Advantage plan to another Medicare Advantage plan.
• Disenrollment from Medicare Advantage plan and returning to Original Medicare (Parts A & B). You will be able to enroll in a stand-alone Medicare Part D prescription drug plan.

Important Note: You cannot use the MA OEP to enroll in a stand-alone prescription drug plan (Part D) if you are already enrolled in Original Medicare.