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Beginning January 1, 2024, there will be a new Medicare Part D and Medicare Advantage (MA) special enrollment period (SEP). This new SEP allows individuals who use the Medicare premium Part A and Part B SEP due to Exceptional Conditions to select and enroll in either a stand-alone Part D plan that covers only prescription drugs or a Medicare Advantage (MA) plan.
Background
The new Part D and MA SEP begins once an individual applies for the separate Part A and/or Part B SEP for Exceptional Conditions. According to the Centers for Medicare and Medicaid Services (CMS), the new Part D and MA SEP “continues for the first two months of enrollment in Premium Part A or Part B.” Any Part D or MA plan enrollment submitted during this SEP are effective the month following the month the plan receives the enrollment.
As a reminder, the Part A and Part B SEP for Exceptional Conditions began in 2023 and provides eligible individuals an SEP to enroll in Premium Part A and Part B (or Part B only if already enrolled in Part A) because they missed the opportunity to do so during their Medicare initial enrollment period (IEP), the annual general enrolment period (GEP), or another applicable SEP. Individuals who qualify for Part A premium-free because they have 40 Social Security covered work credits and did not enroll in Medicare when first eligible, can enroll at any time during the year without a penalty.
The SEP is available for the following exceptional situations:
- Individuals impacted by an emergency or natural disaster
- When an individual can demonstrate that their employer or health plan materially misrepresented information related to enrolling in Medicare timely
- Formerly incarcerated individuals following their release from correctional facilities
- Individuals who lose Medicaid after January 1, 2023, and missed a Medicare enrollment period while covered by Medicaid (can apply for this SEP upon Medicaid termination or notification of termination)
- Other Exceptional Condition granted on a case-by-case basis when circumstances beyond the individual’s control prevented them from enrolling during the IEP, GEP or other SEP
For additional information about the Part A and Part B SEP for Exceptional Conditions, please visit: https://www.cms.gov/files/document/application-medicare-part-part-b-special-enrollment-period-exceptional-conditions.pdf.
For additional information about this new Part D and MA SEP, visit Chapter 2 of the Medicare Managed Care manual: https://www.cms.gov/files/document/cy-2024-ma-enrollment-and-disenrollment-guidance.pdf (section 30.4.4 #20).
If you have any questions, please feel free to email avisery@ageoptions.org
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