HIGHMARK SENIOR MARKETS

CommonSpecial Enrollment Period Questions (and Answers!)

Special Enrollment Periods (SEPs) can be difficult for clients to navigate. We've pulled some information together to help you help them.

Reminder: 5-Star SEP Details

With Highmark Senior Markets achieving 5-Star Ratings from CMS for its 2022 Pennsylvania HMO and PPO products*, members and prospects are able to switch from their current Medicare plan (including Original Medicare) to a Medicare plan with a 5-star quality rating between December 8, 2021 and November 30, 2022. The following are some important factors for clients to keep in mind when considering this action.

*Pennsylvania products with 5-Star ratings for 2022: Community Blue Medicare HMO, Community Blue Medicare PPO, Complete Blue PPO, Freedom Blue PPO, and Security Blue HMO-POS.

If a Medicare Advantage Plan, Medicare drug plan, or Medicare Cost Plan with a 5-star rating becomes available, MA members can use the 5-star Special Enrollment Period to switch from their current Medicare plan to a Medicare plan with a “5-star” quality rating.
Members can use this Special Enrollment Period only once between December 8 and November 30. When discussing this with Members, you may want to encourage them to first utilize any other applicable SEP provisions.
If an MA member moves from a Medicare Advantage Plan that includes prescription drug coverage to a stand-alone Medicare Prescription Drug Plan, they will be disenrolled from their Medicare Advantage Plan, including the health benefit. They will be returned to Original Medicare for coverage of their health services. Members can only switch to a 5-star Medicare Prescription Drug Plan if one is available in their area.
If an MA Member moves from a Medicare Advantage Plan that has drug coverage to a 5‑star Medicare Advantage Plan that doesn’t, they may lose their prescription drug coverage. They’ll have to wait until their next enrollment opportunity to get drug coverage, and they may have to pay a Part D late enrollment penalty.

Other Common SEP Scenarios

Below are several additional common SEPs that generate questions, and how you can answer them.What can I do if...

... I moved to a new address that isn't in my plan's service area?

Switch to a new Medicare Advantage Plan or Medicare Prescription Drug Plan. *If you’re in a Medicare Advantage (MA) Plan and you move outside your plan’s service area, you can also choose to return to Original Medicare. If you don’t enroll in a new MA Plan during the time explained below, you’ll be enrolled in Original Medicare when you’re disenrolled from your old Medicare Advantage Plan.
If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move. If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months.

... I'm no longer eligible for Medicaid?

Join a Medicare Advantage Plan or Medicare Prescription Drug Plan. Switch from your current plan to another Medicare Advantage Plan or Medicare Prescription Drug Plan. Drop your Medicare Advantage Plan and return to Original Medicare . Drop your Medicare prescription drug coverage.
Your chance to change lasts for 3 full months from either the date you're no longer eligible or notified, whichever is later.

... I left coverage from my employer or union (including COBRA coverage)?

Join a Medicare Advantage Plan or Medicare Prescription Drug Plan.
Your chance to join lasts for 2 full months after the month your coverage ends.

... I involuntarily lose other drug coverage that's as good as Medicare drug coverage (creditable coverage), or my other coverage changes and is no longer credible?

Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan
Your chance to join lasts 2 full months after the month you lose your creditable coverage or you're notified that your current coverage is no longer creditable, whichever is later.

... I'm eligible for both Medicare and Medicaid?

Join, switch, or drop your Medicare Advantage Plan or Medicare prescription drug coverage.
One time during each of these periods: January–March / April–June / July–September
If you make a change, it will take effect on 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 from October–December. However, all people with Medicare can make changes to their coverage from October 15–December 7, and the changes will take effect on January 1.

... I qualify for Extra Help paying for Medicare prescription drug coverage?

Join, switch, or drop Medicare prescription drug coverage.
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.

... I'm enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility?

Join either a Medicare drug plan or a Medicare Advantage Plan with prescription drug coverage.
Once during the calendar year.

... I dropped a Medigap policy the first time I joined a Medicare Advantage Plan?

Drop your Medicare Advantage Plan and enroll in Original Medicare. You'll have special rights to buy a Medigap Policy.
Your chance to drop your Medicare Advantage Plan lasts for 12 months after you join the Medicare Advantage Plan for the first time.

This email was sent from the Highmark Senior Markets Sales team. If you have questions, please contact our Broker Services Team at highmarkseniormarkets@highmark.com or call (800) 652-9459.