Lesson 2: Beneficiary Enrollment and Disenrollment

1. Lesson 2:Beneficiary Enrollment and Disenrollment 2011 MIPPA Agent Training

2. MA Eligibility • Enrollees are eligible for Medicare part C (also known as Medicare Advantage, or MA) if they are: • Entitled to Medicare Part A -and- • Enrolled in Medicare Part B -and- • Permanently reside in the plan service area • Enrollees generally cannot change plans during the year • People can be enrolled in only one plan at a time

3. MA Eligibility (cont’d) • Enrollees first become eligible to enroll in an MA during: • Initial Coverage Election Period (ICEP) • In addition, enrollees may be eligible to switch to MA during: • Annual Election Period • Special Enrollment Period (SEP)

4. MA Enrollment Periods:Initial Coverage Election Period • The Initial Coverage Election Period (ICEP) is the one-time period when an individual may first request to enroll in an MA plan. • This period occurs 3 months before an individual is entitled to both Medicare Part A and B. It ends on either the last day of the month before his/her entitlement to Part A and B or the last day of his/her Part B Initial Enrollment Period (whichever is later). • The Part B Initial Enrollment Period occurs 3 months before the month the individual turns 65 until 3 months after the month he/she turns 65. • If a member chooses not to enroll in an MA plan during their Initial Enrollment Period then his/her ICEP will begin 3 months before the individual’s effective Part B enrollment date.

5. MA Enrollment Periods:Annual Election Period • This is the key time for enrollees to make changes to their health and prescription drug coverage • Enrollees should review their current coverage and decide whether to keep it or make changes for the next year • MA plans must accept new members during this period • Occurs November 15 – December 31, 2010 • Coverage begins on January 1

6. 2011 Changes to Election Period • Prior to 2011 there was an Open Election Period from January 1 through March 31. During this time MA members could change to another similar plan. • As of January 1, 2011, there will no longer be an Open Enrollment Period. • There will be a Medicare Advantage Disenrollment Period (MADP).

7. 2011 Changes to Election Periods (continued) • Members of a MA plan may only disenroll to Original Medicare with a standalone PDP. • They no longer have the option to change to another similar MA plan. • This MADP is January 1 to February 14 of 2011. • The Annual Election Period for 2011 will be October 15 to December 7 for a January 1 effective date

8. MA Enrollment Periods:Special Enrollment Period • There is no specific time for enrollees to make changes. SEPs depend on the member’s circumstance. • Enrollees can make changes to their health plan if they meet one of the following special circumstances (partial list): • Enrollee moves out of the plan’s service area or moves and has new health and/or drug plan options available • Plan leaves the Medicare program • Plan reduces its service area • Enrollee loses creditable prescription drug coverage • Enrollee qualifies for “extra Help” from Medicare • Enrollee moves into, resides in or moves out of a long-term care facility, such a s a nursing home

9. Involuntary Disenrollment:Plan Types A plan must end an enrollee’s membership if the enrollee:

10. Involuntary Disenrollment:Falsifying and Withholding Information A plan may end an enrollee’s membership if the enrollee: • Knowingly falsifies or withholds information about other parties that provide reimbursement for their prescription drug coverage • Intentionally gives the plan incorrect information on their enrollment request that would affect their eligibility to enroll in the plan • Allows another to use the enrollee’s insurance card to receive medical care or benefits (may not be applicable to all plans)

11. Involuntary Disenrollment:Paying Plan Premiums A plan may end an enrollee’s membership if the enrollee: • Does not pay the plan premiums • The plan will tell the enrollee in writing that he/she has a certain time frame or grace period during which the enrollee may pay the plan premiums before their membership ends • The plan will tell the enrollee in writing before the enrollee is required to leave the plan

12. Involuntary Disenrollment:Impairing Member Benefits A plan may end an enrollee’s membership if the enrollee: • Seriously impairs the plan’s ability to arrange or provide care for the enrollee or for others who are members of the plan. However, the plan cannot make the enrollee leave the plan for this reason unless they get permission first from Medicare

13. Involuntary Disenrollment:Enrollee’s Rights A plan is NOT allowed to end an enrollee’s membership: • For any reason related to the enrollee’s health (For all plan types except SNPs) If the enrollee ever feels that they are being encouraged or asked to leave a plan because of their health, the enrollee should call the national Medicare help line: • 1-800-MEDICARE (1-800-633-4227) • TTY users should call 1-877-486-2048 • Enrollees may call 24 hours a day, 7 days a week