When Can You Enroll in a Medicare Plan?
Once you’ve decided which EmblemHealth VIP Medicare plan is right for you, you’re ready to enroll. There are 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.
Who Can Join an EmblemHealth VIP Medicare plan?
To join an EmblemHealth VIP Medicare plan, you must: Qualify and be enrolled in Medicare Part A (you are 65 or older, or under 65 with certain disabilities); and
- Be enrolled in and continue to pay for Medicare Part B; and
- Live in EmblemHealth’s service area for that plan; and
- Not have End-Stage Renal Disease (permanent kidney disease requiring dialysis or a kidney transplant), except under certain limited circumstances.
- View EmblemHealth's 2019 Service Area maps which include the following counties in New York: Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland Suffolk, Sullivan, Westchester and Ulster.
|2019 EmblemHealth HMO Medicare Service Area Map
- View EmblemHealth's 2018 Service Area maps which include the following counties in New York: Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland Suffolk and Westchester.
When Can You Join or Switch plans?
You can enroll in an EmblemHealth Medicare Advantage Plan during specific enrollment periods.
Enrolling in Medicare for the First Time
Initial Coverage Election Period (ICEP)
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.
Switching PlansOctober 15 - December 7 (Annual Enrollment Period)
If you are eligible for Medicare, you can enroll in or switch plans during the Annual Enrollment 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 Enrollment Period.
Can I Enroll Outside of the Annual Enrollment or Open Enrollment 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. Visit who can qualify for an SEP section to learn more..
If you qualify for a Special Needs Plan (SNP), you can enroll, change or drop Medicare Advantage or Medicare prescription drug coverage year-round. SNPs are available for those who are in a Medicare savings plan, or are receiving help from the state. For more information visit EmblemHealth VIP Dual (HMO SNP).
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 an 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 or long-term care facility).
- You recently left a PACE 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.
Learn more about the circumstances that qualify you for an SEP
Who is eligible to get help from the state?
To find out if you are eligible to receive help from the state, contact your local Department of Social Services or your local Medicaid Office.
New York State also offers a program, called Elderly Pharmaceutical Insurance Coverage (EPIC), which helps seniors pay for their prescription drugs.
For more information, please call toll-free 800-332-3742 (TTY: 800-290-9138) from 8 am until 5 pm, Monday through Friday.
How Can I Enroll in an EmblemHealth VIP Medicare Plan?
We can answer your questions, help you understand EmblemHealth’s VIP Medicare plans and their benefits, and if you are ready we can help you enroll.
There are four easy ways to enroll in a plan.
- By phone
- Make an In-home appointment
- By Mail
What Happens After I Enroll?
We will confirm we received your application by mail. After that, we will send your application to the Centers for Medicare and Medicaid Services (CMS), the federal agency that runs the Medicare program, for approval.
When Am I Officially an EmblemHealth Member?
You should get your EmblemHealth VIP member ID card and Welcome Kit in the mail about seven business days after you receive our confirmation letter. An EmblemHealth Customer Service Advocate will also call you to answer your questions and help you understand your benefits.
During one of these calls, you will be asked some questions about your health. This is because CMS asks all Medicare Advantage plans to do a Health Risk Assessment (HRA) for members. It will not affect your membership in EmblemHealth in any way. And your answers may help EmblemHealth to serve you better.
How can a person disenroll?
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 (see above), please send your request in writing, signed and dated to us.
- You can also call 1-800-MEDICARE (1-800-633-4227). If 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).