Medicare Parts C and D have different "enrollment" or "election" periods that determine when a beneficiary is eligible to change plans. There is the initial enrollment period (ICEP, IEP), normal open enrollment period (OEP), annual enrollment period (AEP), and many special election periods (SEP), of which 5 are critical to be aware of. We review them all below.
NOTE: CMS will deny applications with the wrong enrollment/election. CMS may also deny applications with “Other” as the chosen enrollment/election period. It is imperative to choose the correct enrollment/election period.
- ICEP/IEP - ICEP = Medical Coverage / IEP = Prescription Coverage
- IEP is for Part D coverage (MAPD or PDP), not MA-only. The total enrollment period is seven (7) months beginning three (3) months before the effective date of Medicare Part A and B, includes the month Medicare begins, and continues for three (3) additional months.
- ICEP is for Medical-only coverage (MA-only), not MAPD or PDP. The total enrollment period is seven (7) months beginning three (3) months before the individual’s entitlement to Medicare Part A or enrollment into Medicare Part B, includes the month Medicare begins, and continues for three (3) additional months.
- (MA) OEP/OEP-New = Open Enrollment
- OEP Beneficiaries already enrolled in a Medicare Advantage plan (MA/MAPD) may make one plan change during the first three (3) months of each year (1/1-3/31) to enroll in another Medicare Advantage plan OR to disenroll to obtain Original Medicare (and get a PDP).
- OEP-New is available to new Medicare Advantage enrollees following IEP/ICEP with their Medicare entitlement. The one-time election begins the month of entitlement (effective date) to Part A and Part B and for two additional months.
- SEP = Special Enrollment Periods (SEPs) (Rules about when you can make changes and the type of changes you can make are different for each SEP. Visit Medicare for a complete list.
- SEP - MOV SEP available for permanent change of residence.
- SEP - LCC Involuntary loss of creditable coverage, including a reduction in the level of coverage so that it is no longer creditable
- SEP - SNP individuals enrolled in a SNP who are no longer eligible for the SNP because they no longer meet the specific special needs status.
- SEP - CHR individuals with severe or disabling chronic conditions to enroll in a CC-SNP designed to serve individuals with those conditions
- SEP - 5ST A Medicare beneficiary may enroll in a MA/MAPD/PDP that has an overall Plan Rating of five (5) Stars. Use ONLY between 12/8 - 11/30
- AEP = Annual Enrollment Period / October 15 - December 7 each year.
- During AEP, beneficiaries may choose how they receive their Medicare benefits for the upcoming year. The last election made, determined by the application date, will be the plan that takes effect on January 1. The Annual Enrollment Period is open for all plan types: MA, MAPD and PDP, but excludes Medicare Supplements.
- OEP-I = Open Enrollment Institutional
- This is an open and unlimited use enrollment period for Medicare beneficiaries residing in an institution lasting for up to two (2) months after leaving the facility.
Special Enrollment Periods for beneficiaries who receive Extra Help (LIS), Medicaid or State Pharmaceutical Assistance Program (SPAP)
Most people with Medicare can only make changes to their drug coverage at certain times of the year. If you have Medicaid or receive Extra Help, you may be able to make changes to your coverage one time during each of these periods:
January – March April – June July – September
If you make a change, it will begin the first day of the following month. You’ll have to wait for the next period to make another change. You can’t use this Special Enrollment Period October – December. However, all people with Medicare can make changes to their coverage October 15 – December 7. The changes will begin on January 1
Special Enrollment Periods for beneficiaries in FEMA-declared disaster zones
Last updated: 12/15/23