Once you’ve decided which EmblemHealth Medicare plan is right for you, you’re ready to enroll.
There are specific enrollment periods and rules for when you can enroll, how often you can change the way you get Medicare, and what choices you have when you make the change.
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Medicare Enrollment Periods
When can you enroll in a Medicare plan?
Initial Coverage Election Period
You can enroll when you first become eligible for Medicare (three months before the month you turn age 65 until three months after the month you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments.
October 15 - December 7 (Annual Election Period)
If you are eligible for Medicare, you can enroll in or switch plans during the Annual Election Period. For example, you can switch from Original Medicare to a Medicare Advantage Plan. Your coverage will be effective on January 1 of the upcoming year.
January 1 - March 31 (Open Enrollment Period)
People enrolled in a Medicare Advantage Plan as of January 1 can make one plan change.
You can:
- Switch Medicare Advantage Plans
- Switch Medicare Advantage Part D Plans
- Switch to Original Medicare (with or without a stand-alone Part D); or
- Add or drop a Part D drug plan.
If you enrolled in Original Medicare for January 1, you will not be able to switch to a Medicare Advantage Plan at this time unless you qualify for a Special Election. You will need to wait until the next Annual Election Period.
Enrolling outside of Open Enrollment or the Annual Election Period
You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, such as a move or a loss of other insurance coverage. These chances to make changes are called Special Election Periods(SEPs). Rules about when you can make changes and the type of changes you can make are different for each SEP.
If you qualify for a Special Needs Plan (SNP), you can enroll in Medicare Advantage or Medicare prescription drug coverage year-round. People who are already enrolled with a Special Needs Plan may switch plans once per quarter from January 1 through September 30.
SNPs are available for those who are in a Medicare savings plan, or are receiving help from the state.
When does Special Election Period (SEP) coverage become effective?
- If you enroll in Medicare Part B while covered by a group health plan or during the first full month after coverage ends, your Medicare Part B coverage starts on the first day of the month you enroll. You also can delay the start date for Medicare Part B coverage until the first day of any of the following three months.
- If you enroll during any of the seven remaining months of the SEP, your Medicare Part B coverage begins the month after you enroll.
Who can qualify for a Special Election Period (SEP)?
For a variety of reasons, you may qualify to enroll in Medicare coverage at any time of the year. Below are situations that might qualify you for an SEP:
- You recently moved outside of the service area for your current plan.
- You recently had a change in your Medicaid (newly got Medicaid, had a change in level of Medicaid assistance, or lost Medicaid).
- You recently had a change in your Extra Help paying for Medicare prescription drug coverage (newly got Extra Help, had a change in the level of Extra Help, or lost Extra Help).
- You have both Medicare and Medicaid (or the state helps pay for your Medicare premiums) or you get Extra Help paying for your Medicare prescription drug coverage but haven’t had a change.
- You are moving into, live in, or recently moved out of a Long-Term Care Facility (for example, a nursing home).
- You recently left a PACE (Programs of All-Inclusive Care for the Elderly) program.
- You recently involuntarily lost your creditable prescription drug coverage (coverage as good as Medicare’s).
- You are leaving employer or union coverage.
- You belong to a pharmacy assistance program provided by the state.
- You recently returned to the United States after living permanently outside of the U.S.
- Your plan is ending its contract with Medicare, or Medicare is ending its contract with your plan.
- You were enrolled in a plan by Medicare (or your state) and you want to choose a different plan.
- You were enrolled in a Special Needs Plan (SNP), but you have lost the special needs qualification required to be in that plan.
Visit the SEP section on Medicare.gov to learn more about the circumstances that qualify you for an SEP.
We are sure that you will be happy with all the benefits EmblemHealth has to offer. But should you wish to leave your plan, you may do so in one of two ways:
- If you wish to leave the plan during the Medicare Advantage Disenrollment or Special Election Periods, please send your request in writing, signed and dated to us, or
- You can call 800-MEDICARE (800-633-4227). If you use a TTY, please call 877-486-2048.
After you submit the request, the plan will make a decision on whether to approve or deny the disenrollment request within 10 calendar days of receipt of the request to disenroll. If you leave our plan, it may take time before your membership ends and your new Medicare coverage goes into effect. During this time, you must continue to get your medical care and prescription drugs through us.
You can continue to use your network pharmacies to get your prescriptions filled until your membership in your current plan ends. If you are hospitalized on the day your membership ends, your hospital stay will usually be covered by the plan until you’re discharged (even if you’re discharged after your new health coverage begins).
Last Updated 10/01/2020
Y0026_200570 Accepted 9/29/20