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Medicare Advantage Updates

Medicare Member Services Hours Extended

Member Services will extend business hours to include Sunday beginning October 1 through March 31. Phone lines will be open from 8:00 a.m. to 9:00 p.m. To contact Member Services, call 800-538-5038.

ABCs of Election Periods

Below are key elements to keep in mind as you assist your clients enrolling in a Medicare Advantage plan.

Annual Election Period (AEP) runs from October 15 through December 7 of every year. During AEP, your clients may enroll or disenroll from a Medicare Advantage plan. Please note: the last enrollment request made, determined by the application date, will be the enrollment request that takes effect. Effective date for your client is January 1.

Medicare Advantage Open Enrollment Period (MA OEP) runs from January 1 through March 31 every year. Your client may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Effective date for an MA OEP is the first of the month following receipt of the enrollment request.

Initial Election Period (IEP)—Enrollment periods for clients newly eligible to Medicare. The initial enrollment period for Medicare Part A and B, and Part D begins three months before the month an individual meets the eligibility requirements for Part B and ends three months after the month of eligibility. In the event your client’s Part D eligibility date is earlier, the date used is the day Part D eligibility begins.

Initial Coverage Enrollment Period (ICEP)—Used in the event your client delays Part B enrollment when first eligible. The window is reduced to the three months prior to the Part B eligibility date.

Special Election Period (SEP)—Enrollment periods outside of the usual IEP, ICEP, AEP, or MA OEP. Examples when these may apply include: when a client moves from a service area, has a change in income, or has a change in employment.

5-Star SEP—Your client(s) may enroll in an MA plan with a 5-Star rating during the year from December 8 through November 30 provided they meet the other requirements (e.g., reside within service area, etc.) The enrollment effective date is the first of the following month after the month in which the plan receives the enrollment request.

Below are examples of potential scenarios for education purposes:

  • Client requests to enroll in a new MA plan on October 15
    • Use AEP and start date is Jan 1
  • Client requests to enroll in a new MA plan on Dec 18
    • Use 5-Star SEP* and start date is Jan 1
  • Client requests to enroll in a new MA plan on Feb 2
    • Use MA OEP and start date is Mar 1 OR Use 5-Star SEP* and start date is Mar 1
  • Client requests to enroll in a new MA plan on April 18
    • Use a 5-Star SEP* and start date is May 1
  • Client requests to enroll for Original Medicare to a MAPD on Oct 15
    • Use an AEP and start date is Jan 1
  • Client requests to enroll for Original Medicare to a MAPD on June 6
    • Use a 5-Star SEP* and start date is July 1

*The 5-Star SEP is limited to one use per year for qualifying plans

Health Risk Assessment (HRA)

Don’t forget about the Health Risk Assessment (HRA) that can be completed following enrollment. Here are some helpful hints:

  • Enrollment must be run through the Link agent portal.
  • HRA Enrollment must be completed within seven days.
  • If it is not possible to complete the HRA with your client directly following enrollment, use the Medicare heading on the main landing page of Link and choose Member Search. The option to complete the HRA will be in the drop-down menu to the far left. This option will only show during the seven-day period.
  • If possible, use Google Chrome as an internet browser
  • There is a $55 payment for assisting members through the HRA questionnaire.
  • If you have additional questions, please contact your account manager.