Beneficiaries Using the Medicare Advantage Disenrollment Period Have Until Feb. 14 to Enroll in a New Part D Plan

Beneficiaries Using the Medicare Advantage Disenrollment Period Have Until Feb. 14 to Enroll in a New Part D Plan

There is a coordinating Part D special election period (SEP) for beneficiaries who disenroll from a Medicare Advantage (MA) plan during new Medicare Advantage Disenrollment Period (MADP) from January 1 to February 14. Unlike the MA Open Enrollment Period in previous years, the new MADP only allows beneficiaries to disenroll from an MA plan to return to Original Medicare. Beneficiaries cannot use the MADP to join an MA plan. A beneficiary who disenrolls from an MA plan has a coordinating SEP to enroll in a stand-alone Part D plan. The coordinating SEP ends February 14 or when the beneficiary enrolls in a stand-alone Part D plan, whichever is earlier.

Example 1: A beneficiary wants to disenroll from an MA plan with a prescription drug benefit (MA-PD) to go back to Original Medicare and continue Medicare prescription drug coverage. He may do so simply by enrolling in a stand-alone Part D plan during the MADP. By enrolling in a stand-alone Part D plan, he will be automatically disenrolled from the MA-PD plan and enrolled back in Original Medicare.

Alternatively, he may contact the MA plan to disenroll during the MADP. By contacting the plan to disenroll (by phone or mail), he will be automatically enrolled back in Original Medicare but he will not have Medicare prescription drug coverage. If he wants Medicare prescription drug coverage, he has the coordinating SEP to enroll in a stand-alone Part D plan by February 14.

Example 2: A beneficiary is in an MA private fee-for-service (PFFS) plan and has no prescription drug coverage. She wants to disenroll from the MA PFFS plan, go back to Original Medicare and get a stand-alone Part D plan. She must contact the MA PFFS plan to disenroll during the MADP. By disenrolling from the MA PFFS plan, she will be enrolled back in Original Medicare and get the coordinating SEP to enroll in a stand-alone Part D plan. She should enroll in a stand-alone Part D plan before the SEP ends on February 14.

Example 3: A beneficiary is in an MA private fee-for-service (PFFS) plan and has a separate stand-alone Part D plan. He wants to disenroll from the MA PFFS plan and go back to Original Medicare. He must contact the MA PFFS plan to disenroll during the MADP. By disenrolling from the MA PFFS plan, he will be enrolled back in Original Medicare. He may not change stand-alone Part D plans during the MADP; he must keep the stand-alone Part D plan he already has.

Disenrolling from an MA plan during the MADP does not give beneficiaries a guaranteed issue right to buy a Medigap policy (i.e. without health screening). Beneficiaries may apply for Medigap policies at any time and be subject to health screening unless they are in their open enrollment period or have a guaranteed issue period. (Visit our Medigap section for more info on these periods).

See our Education section for charts of the 2011 Part D stand-alone prescription drug plans in California, and the 2011 Part D benchmark plans (PDF) for beneficiaries who qualify for the Part D low-income subsidy (LIS).

See our Prescription Drugs and Medicare Advantage sections for more general information on Medicare Part D and Part C respectively.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.