A blog about Medicare. What you and your employees need to know
The Alphabet Soup of Enrollment Periods
Author: Lora Drummond
Medicare Transition Specialist
The Alphabet Soup of Enrollment Periods
A common topic of confusion from my HR professional partners regards what the Medicare enrollment period acronyms stand for. During my business tenure, nowhere does the “alphabet soup” of acronym utilization appear to be more popular than in the insurance industry!
Now seems like a good time to help break down the confusion about the most popular Medicare enrollment period acronyms since we are currently in AEP, the Annual Election Period.
IEP (Initial Enrollment Period)
This period occurs when folks turn age 65 (as defined by their birthday) and typically enroll in Medicare plans as the first time they are eligible.This period is defined as three months before, their birth month, and three months after. Your soon-to-be 65-year-old employee would likely come to you first for guidance, asking:
- Can I defer Medicare enrollment and remain on my group plan?
- Is my current medical plan creditable?
- Can I compare the costs of Medicare vs. my group plan?
We can help you with responses if those questions come up.
SEP (Special Election Period)
A SEP enrollment period implies the need for a unique enrollment opportunity because current benefit coverage has created a significant impact to the member’s current benefit source. These period opportunities follow specific criteria allowances and include a limited time to enroll. Most commonly, an exception to an employee’s Medicare plan or eligibility has occurred. Folks qualify for a SEP when they:
- Lose employer coverage: The most popular SEP is for folks who deferred Medicare enrollment while continuing to work past age 65 and sign up for Medicare upon leaving their creditable employer group plan. (Remember, creditable means: You continue to work for an employer with at least 20 employees, and their medical plan is deemed by the insurance carrier to be as good as Medicare). If your employer plan meets these requirements, employees can hold off enrolling in Medicare with no worries and sign up at a future date.
- Move out of their plan’s service area: Some Medicare plans are network driven by a member’s zip code. If a member leaves their current coverage area, they could lose their Medicare Advantage Plan or Part D drug plan. Those members are granted a “Special Election” period to select new Medicare plans in their new geographic area. It’s a limited window of time to make a change but allows the member to continue coverage without a break in care.
- Develop a permanent chronic health condition: If you are diagnosed with a chronic medical condition like diabetes you qualify to change to a Medicare Advantage Special Needs plan without having to wait for an Annual Election Period to make the plan change.
- Involuntarily lose coverage: You deferred Medicare by going on your spouse’s employer’s health coverage and must now enroll due to the loss of that coverage. Or when you involuntarily lose your coverage due to other employer exit situations- termination, covid, etc. Again the Medicare deferral must have been due to prior coverage on a creditable employer plan. COBRA, exchange plans, and non-creditable coverage do not qualify for SEP enrollment.
Considering a SEP enrollment period would be best discussed with a Certified Medicare Planner® prior to or immediately due to the event that warrants the enrollment. The window between the event and enrollment is very narrow in most of these cases.
AEP (Annual Election Period)
AEP occurs annually (October 15th through December 7th) to allow folks that are ALREADY ON MEDICARE to switch specific Medicare plans for the coming new year. You will see advertising by insurance companies ramp up during this period. Traditionally, this is a popular time of year for Medicare members to review their current Medicare Advantage plans and Medicare Part D (drug) plans and make changes to benefit them in cost and coverage preferences. Sometimes this is a perfect opportunity for members to compare their employer plans with Medicare and transition if it makes sense. We can help with those comparisons and discussions.
OEP (Open Enrollment Period)
This is the “oops” period (January 1st through March 31st). Suppose a member makes a mistake with a Medicare Advantage Plan selection during the AEP. For instance, their primary care doctor leaves the network after they enrolled during AEP. There is an opportunity to make a one-time correction for the current year. There are many rules and regulations on switching during this time. So if you get a question about this less popular enrollment period, it’s best to seek professional guidance from a Certified Medicare Planner®.
This period is often referred to as a General Enrollment Period (GEP) also. If you miss the IEP window to enroll, you can use this time to enroll but your plan won’t be effective until July 1. This period is often used by people who bridge from COBRA when they should have enrolled in Medicare when eligible.
If Medicare acronym ‘soup’ is causing you to spend time googling for answers, please contact us instead. We will save you time and provide the responses you need to help your employees with a successful journey to Medicare.
An aging workforce can benefit from having ready access to partners trained to guide with Medicare so that open discussions can help them. Why not add this partnership to your team?
Consider working with a team of Certified Medicare Planners ® to guide Medicare discussions with your employees.
With our partnership, you support these opportunities:
- Save them from paying for more coverage than they need,
- Avoid Medicare pitfalls later when they are making an exit plan,
- Readies employees to transition to Medicare when it’s appropriate for them, and
- Creates a non-bias, carrier-agnostic relationship for providing expert support of ALL the Medicare plans in an area.
Best of all… our services are free to you and your employees.
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