Controversial Limited Open Enrollment Period (L-OEP) Ended July 31, 2007

In our recent April/May newsletter edition, California Health Advocates described the beginning of a new controversial limited open enrollment period for Medicare Advantage plans. Now, as of July 31, 2007, that Limited Open Enrollment Period (L-OEP) has ended as a result of federal legislation. This ending is good news for Medicare beneficiaries as this L-OEP tended to favor enrollment in only one kind of Medicare Advantage (MA) plan – private fee-for-service (PFFS) plans – and created a potentially dangerous situation for beneficiaries seeking enrollment in other types of MA plans.

The L-OEP had allowed individuals in the original, fee-for-service Medicare program one extra opportunity during the year in 2007 and 2008 to enroll in a Medicare Advantage-only plan (meaning an MA plan without Part D coverage). Yet according to the Centers for Medicare and Medicaid Services’ (CMS) interpretation of this new enrollment period, Medicare enrollees with a stand-alone prescription drug plan (PDP) could lose their Part D coverage altogether if they enrolled in an MA-only health maintenance organization (HMO), preferred provider organization (PPO) or Regional PPO. Conversely, someone in original Medicare with a PDP would not lose their Part D coverage if they enrolled in a PFFS plan without drug coverage. This interpretation meant that beneficiaries who enrolled in a MA only plan (other than a PFFS plan) would have been automatically disenrolled from their PDP, been without drug coverage for the remainder of the year, and been charged penalties when re-enrolling in a Part D plan in the following year. Advocates strongly voiced their concerns about these potential dangers to CMS and Congress (see California Health Advocates’ February 2007 letter to CMS).

Senate Bill S1701, introduced on June 27, 2007 by Senators Max Baucus of Montana and Chuck Grassley of Iowa, contained a provision that sunsetted the L-OEP as of July 31, 2007. The bill was signed into law on July 18, 2007 (Public Law No: 110-048).

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.