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 2018 Service Area maps which include the following counties in New York: Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland Suffolk and Westchester.
2018 EmblemHealth HMO Medicare Service Area Map
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.
Disenrollment PeriodJanuary 1 - February 14 (Medicare Advantage Disenrollment Period)
Beginning in 2011, Medicare beneficiaries have the opportunity to disenroll from their Medicare Advantage program during the period of January 1st through February 14th. If a beneficiary decides to disenroll, he or she must switch to Original Medicare and must select a Part D carrier if disenrolling from a Medicare Advantage Prescription Drug plan (MAPD). All changes are effective the first day of the next month.Can I Enroll Outside of the Annual 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 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 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 move permanently outside your plan’s service area.
- You’re enrolled in another prescription drug plan or a Medicare Advantage Plan whose contract is terminated.
- You are eligible for both Medicare and Medicaid (a "dual eligible")
- You recently qualified or no longer qualify for extra help paying for prescription drugs
- You belong to a pharmacy assistance program provided by the state.
- You want to move from an employer sponsored Prescription Drug Plan to a Medicare Prescription Drug Plan.
- Your enrollment or non-enrollment is caused by an error by a federal employee or contractor hired by the federal government.
- You lose your previous creditable coverage through no action of your own.
- Your Medicare entitlement determination is made retroactively.
- You want to leave your current Medicare Prescription Drug Plan because it was reprimanded by the federal government or the federal government has determined the plan violated a material provision of its Medicare contract in relation to services provided to you.
- You wish to enroll in a stand-alone Prescription Drug Plan (PDP) between January 1 and February 14, and you recently ended your enrollment in a Medicare Advantage plan between these dates.
- You’re enrolled in a Cost Plan that isn’t renewing its contract with Medicare. This SEP begins 90 calendar days prior to the end of the contract year (i.e., October 1) and ends on December 31 of the same year.
- You want to move from a Program of All- Inclusive Care for the Elderly — PACE — to an MA-PD.
- You live in — or are moving in or out of — a skilled nursing facility, nursing facility, intermediate care facility for the mentally retarded, psychiatric hospital or unit, rehabilitation hospital or unit, long-term care hospital, or swing-bed hospital.
- You are not eligible for premium free Part A and enroll in Medicare Part B during the Part B General Enrollment Period.
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 1-800-332-3742 (TTY: 1-800-290-9138) 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 1-877-486-2048.
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).
HIP Health Plan of New York (HIP) is a HMO plan with a Medicare contract.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare part B premium. Our Medicare Special Needs Plan is for people with both Medicare and Medicaid. Your eligibility to enroll in this plan may depend on your Medicaid status. Premium, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.