March 31 is a Double Deadline for Folks Eligible for Medicare

March 31 is a Double Deadline for Folks Eligible for Medicare


Medicare advocates ought to concentrate on two essential alternatives with a March 31 deadline:

Medicare Basic Enrollment Interval (GEP): January 1 – March 31

This deadline is especially essential for people in Alabama, Arizona, Colorado, Illinois, Kansas, Kentucky, Missouri, Nebraska, New Jersey, New Mexico, South Carolina, Utah and Virginia who do NOT have premium-free Half A and are financially eligible for the Certified Medicare Beneficiary (QMB) program. In these states (known as “group payer” states), people with out premium-free Half A protection can purchase it by making use of at SSA for “conditional” Half A in the course of the GEP after which instantly making use of with their state Medicaid workplace for QMB to pay the premium for Half A in addition to B. In the event that they miss the March 31 deadline, they have to wait till the following 12 months earlier than they will apply for QMB. A Justice in Growing old truth sheet explains the method and the way it differs from different states (known as “Half A buy-in” states) the place people can apply for conditional Half A at any time of 12 months.

2025 Replace

As of January 1, 2025, California grew to become a Half A buy-in state permitting low-income Californians eligible for QMB to use for conditional Half A at any time within the 12 months. Constructing on the teachings realized in California, a Justice in Growing old challenge transient supplies advocates in group payer states with methods to transition to a Half A buy-in state.

Medicare Benefit Open Enrollment Interval (MA-OEP): January 1 – March 31

  • Through the MA-OEP, people enrolled in Medicare Benefit (MA) plans can:
    • Drop their MA protection and select authentic Medicare with a Prescription Drug Plan (PDP), or
    • Change from one MA plan to a different, with or with out prescription drug protection.
  • Through the MA-OEP, people in Authentic Medicare can’t change their stand-alone Half D Plan or be a part of an MA plan, until they’re inside one other plan enrollment interval, reminiscent of:
    • Their Preliminary Enrollment Interval after they first change into eligible for Half A or are new to Half B; or
    • A Particular Enrollment Interval (SEP) for altering plans (e.g., for people who’ve misplaced Medicaid, people leaving incarceration, or people in different particular circumstances).  
  • For enrollees with out Medicaid or the Low-Earnings Subsidy (LIS) often known as Further Assist, the MA-OEP is the final alternative till the annual election interval (October 15-December 7) to vary protection in the course of the 12 months until they qualify for a Particular Enrollment Interval (SEP).

New Particular Enrollment Intervals for Folks with the Low-Earnings Subsidy and Medicaid

Along with the MA-OEP, people with LIS or who’ve Medicaid efficient January 2025 now have extra SEPs to make modifications on a month-to-month foundation:

  • Dropping a Medicare Benefit Plan or switching from one standalone Prescription Drug Plan to a different standalone Prescription Drug Plan. Medicare enrollees with LIS or Medicaid have an SEP as soon as per 30 days to change to a special Medicare stand-alone Half D drug plan or drop a Medicare Benefit plan (that has prescription drug protection) and return to Authentic Medicare by enrolling in a stand-alone Half D drug plan. This SEP is out there to people on LIS or Medicaid, whether or not partial-benefit Medicaid or full-benefit Medicaid. People can’t use this SEP to change from one Medicare Benefit plan to a different Medicare Benefit plan.
  • Switching Medicare Benefit Plans. Medicare enrollees with full Medicaid advantages, often known as full-benefit twin eligibles – have an extra SEP that gives one alternative every month to change Medicare Benefit plans, however provided that that plan is an built-in and aligned Twin Eligible Particular Wants Plan (D-SNP). Built-in D-SNP plans are varieties of Medicare Benefit plans that meet particular necessities to offer coordination between Medicare and Medicaid advantages. A D-SNP is aligned with an individual’s Medicaid managed care group if their firms are associated. For extra info, together with extra element on what it means for a plan to be built-in and aligned, see Justice in Growing old’s truth sheet on the brand new SEPs and the “different particular conditions” within the particular enrollment interval part by way of Medicare.gov.

Dually eligible people can nonetheless change from one Medicare Benefit Plan to a different throughout MA-OEP and different enrollment durations. Their Medicare Benefit Plans do not need to be built-in and aligned. The built-in and aligned requirement solely applies to the Built-in Care SEP.

Nobody is required to enroll in Medicare Benefit plans. Dually eligible people can select to obtain their Medicare advantages by means of Conventional Medicare, by means of a Medicare Benefit plan (together with by means of a Particular Wants Plan like a twin eligible particular wants plan, often known as a D-SNP), by means of the Program for All-Inclusive Look after the Aged (PACE) (when supplied of their space), or by means of a state Medicaid-Medicare Plan (when supplied of their space).

Medicare plan advertising is intense throughout each the autumn enrollment interval and the MA-OEP. The supplemental advantages that MA plans provide additionally make selecting a plan extra advanced and complicated. The MA-OEP is an efficient alternative for advocates to induce Medicare enrollees to hunt unbiased help from SHIP counselors to make sure that they’re making applicable selections, have entry to their most well-liked suppliers, and are getting prescription drug protection that meets their wants.



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