Understanding Medicare Advantage & Medicare Drug Plan .

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Revised September 2020Understanding MedicareAdvantage & Medicare DrugPlan Enrollment PeriodsEnrollment in Medicare is limited to certain times. This publication hasinformation about enrolling in Medicare Advantage Plans and Medicare drugplans (Part D). You must have Medicare Part A and Part B to join a MedicareAdvantage Plan.Note: For information about signing up for Medicare Part A (Hospital Insurance)and Medicare Part B (Medical Insurance), visit Medicare.gov/publications to viewthe booklet “Enrolling in Medicare Part A & Part B.”When can I sign up?There are specific times when you can sign up for a Medicare Advantage Plan orMedicare drug coverage, or make changes to coverage you already have: During your Initial Enrollment Period when you first become eligible for Medicare,or when you turn 65. See page 3. During certain enrollment periods each year. See page 5. Under certain circumstances that qualify you for a Special Enrollment Period, like: You move. You’re eligible for Medicaid. You qualify for Extra Help with Medicare drug costs. You’re getting care in an institution, like a skilled nursing facility orlong‑term care hospital. You want to switch to a plan with a 5-star overall quality rating. Qualityratings are available on Medicare.gov.See the charts beginning on page 7 for a list of different Special EnrollmentPeriods, including rules about how to qualify.

Is my plan right for me?Visit Medicare.gov/plan-compare to find and compare health and drug plans inyour area. You may be able to find plans that: Cost less Cover your drugs Let you go to the providers you want, like your doctor or pharmacy Offer extra benefits that Original Medicare doesn’t cover, like vision, hearing,dental, and more.You can also get: An estimate of your out-of-pocket costs Quality and customer service ratings from current plan membersHow do I compare the quality of Medicare health and drug plans?When you visit Medicare.gov/plan-compare, you’ll see a star ratingsystem for Medicare health and drug plans. The overall star rating gives anoverall rating of the plan’s quality and performance for the types of serviceseach plan offers.2

Initial Enrollment PeriodsIf this describes you.You can.At this time.You’re newly eligible forMedicare because you turn 65.Sign up for a MedicareAdvantage Plan (with orwithout drug coverage) or aMedicare drug plan.During the 7-month periodthat starts 3 months before themonth you turn 65, includes themonth you turn 65, and ends3 months after the month youturn 65.If you sign up for a MedicareAdvantage Plan during thistime, you can drop that planat any time during the next 12months and go back to OriginalMedicare.You’re newly eligible forMedicare because you have adisability and you’re under 65.Sign up for a MedicareAdvantage Plan (with orwithout drug coverage) or aMedicare drug plan.Starting 21 months afteryou get Social Security orRailroad Retirement Board(RRB) disability benefits. YourMedicare coverage begins 24months after you get SocialSecurity or RRB benefits. Yourchance to sign up lasts throughthe 28th month after you getSocial Security or RRB benefits.You’re already eligiblefor Medicare because of adisability, and you turn 65. Sign up for a MedicareAdvantage Plan (with orwithout drug coverage) or aMedicare drug plan. Switch from your currentMedicare Advantage orMedicare drug plan toanother plan. Drop a Medicare Advantageor Medicare drug plancompletely.During the 7-month periodthat starts 3 months before themonth you turn 65, includes themonth you turn 65, and ends3 months after the month youturn 65.You have Medicare Part Acoverage, and you get Part Bfor the first time by enrollingduring the Part B GeneralEnrollment Period(January 1–March 31).Sign up for a MedicareAdvantage Plan (with orwithout drug coverage).Between April 1–June 30.3

Medicare drug coverage (Part D) late enrollmentpenaltyThe late enrollment penalty is an amount that’s permanently added to your Medicaredrug coverage (Part D) premium. You may owe a late enrollment penalty if at anytime after your Initial Enrollment Period is over, there’s a period of 63 or moredays in a row when you don’t have Medicare drug coverage or other creditableprescription drug coverage. Creditable prescription drug coverage is coverage (forexample, from an employer or union) that’s expected to pay, on average, at leastas much as Medicare’s standard prescription drug coverage. If you have a penalty,you’ll generally have to pay it for as long as you have Medicare drug coverage. Formore information about the late enrollment penalty, visit Medicare.gov, or call1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.4

Enrollment periods that happen each yearEach year, you can make changes to your Medicare Advantage or Medicare prescription drugcoverage for the following year. There are 2 separate enrollment periods each year. See the chartbelow for specific dates.During this enrollmentperiod.October 15–December 7(Changes will take effect onJanuary 1.)January 1–March 31Medicare Advantage OpenEnrollment Period(You can only make onechange during this period.Changes will take effect thefirst of the month after theplan gets your request.)You can. Change from Original Medicare (with or without a MedicarePrescription Drug Plan) to a Medicare Advantage Plan. Change from a Medicare Advantage Plan back to OriginalMedicare (with or without a Medicare drug plan). Switch from one Medicare Advantage Plan to anotherMedicare Advantage Plan. Switch from a Medicare Advantage Plan that doesn’t offerdrug coverage to a Medicare Advantage Plan that offers drugcoverage. Switch from a Medicare Advantage Plan that offers drugcoverage to a Medicare Advantage Plan that doesn’t offer drugcoverage. Join a Medicare drug plan. Switch from one Medicare drug plan to another MedicarePrescription drug plan. Drop your Medicare drug coverage completely. If you’re in a Medicare Advantage Plan (with or without drugcoverage), switch to another Medicare Advantage Plan (withor without drug coverage). Disenroll from your Medicare Advantage Plan and return toOriginal Medicare. If you choose to do so, you’ll be able tojoin a Medicare drug plan. If you enrolled in a Medicare Advantage Plan during yourInitial Enrollment Period, change to another MedicareAdvantage Plan (with or without drug coverage) or go backto Original Medicare (with or without a Medicare drug plan)within the first 3 months you have Medicare.You can’t. Switch from Original Medicare to a Medicare Advantage Plan. Join a Medicare drug plan if you’re in Original Medicare. Switch from one Medicare Prescription Drug Plan to anotherif you’re in Original Medicare.5

Special Enrollment PeriodsWhen certain events happen in your life, like if you move or lose other insurancecoverage, you may be able to make changes to your Medicare health and drugcoverage. These chances to make changes are called Special Enrollment Periods.Rules about when you can make changes and the type of changes you can make aredifferent for each Special Enrollment Period.The situations on the next pages are reasons you may qualify for a SpecialEnrollment Period. This list doesn’t include every situation. For more informationabout Special Enrollment Periods, call 1-800-MEDICARE (1-800-633-4227).TTY users can call 1-877-486-2048.6

Changes in where you liveIf this describes you You can At this time.You move to a new addressthat isn’t in your plan’sservice area.Switch to a new MedicareAdvantage or Medicare drugplan.If you tell your planbefore you move, yourchance to switch plansbegins the month beforethe month you moveand continues for 2 fullmonths after you move.You move to a new addressthat’s still in your plan’sservice area, but you havenew plan options in your newlocation.You can also choose to returnto Original Medicare if you’rein a Medicare AdvantagePlan and you move outsideyour plan’s service area. If youdon’t enroll in a new MedicareAdvantage Plan during thisSpecial Enrollment Period,you’ll be enrolled in OriginalMedicare when you’redisenrolled from your oldMedicare Advantage Plan.If you tell your planafter you move, yourchance to switch plansbegins the month youtell your plan, plus 2more full months.You move back to the U.S.after living outside thecountry.Join a Medicare Advantage orMedicare Prescription DrugPlan.Your chance to join lastsfor 2 full months afterthe month you moveback to the U.S.You live in, or recentlymoved out of an institution(like a nursing home orrehabilitation hospital). Join a Medicare Advantageor Medicare drug plan. Switch from your currentplan to another MedicareAdvantage or Medicaredrug plan. Drop your MedicareAdvantage Plan and returnto Original Medicare. Drop your Medicare drugcoverage.Your chance to join,switch, or drop coveragelasts as long as you livein the institution and for2 full months after themonth you move out ofthe institution.You’re released from jail.Join a Medicare Advantage orMedicare drug plan.Your chance to joinlasts for 2 full monthsafter the month you’rereleased from jail.7

You lose your current coverage8If this describes you.You can.At this time.You’re no longer eligible forMedicaid. Join a Medicare Advantageor Medicare drug plan. Switch from your currentplan to another MedicareAdvantage or Medicare drugplan. Drop your MedicareAdvantage Plan and returnto Original Medicare. Drop your Medicare drugcoverage.Your chance to change lasts for3 full months from either thedate you’re no longer eligibleor notified you’re no longereligible, whichever is later.You find out that you won’t beeligible for Extra Help for thefollowing year. Join a Medicare Advantageor Medicare drug plan. Switch from your currentplan to another MedicareAdvantage or Medicare drugplan. Drop your MedicareAdvantage Plan and returnto Original Medicare. Drop your Medicare drugcoverage.Your chance to change lasts for3 full months from either thedate you’re no longer eligibleor notified you’re no longereligible, whichever is later.You leave coverage from youremployer or union.Join a Medicare Advantage orMedicare drug plan.Your chance to join lasts for 2full months after the monthyour coverage ends.You involuntarily lose otherdrug coverage that’s as goodas Medicare drug coverage(creditable coverage), or yourother coverage changes and isno longer creditable.Join a Medicare AdvantagePlan with drug coverage or aMedicare drug plan.Your chance to join lasts for 2full months after the monthyou lose your creditablecoverage or are notified of theloss of creditable coverage,whichever is later.You have drug coveragethrough a Medicare Cost Planand you leave the plan.Join a Medicare PrescriptionDrug Plan.Your chance to join lasts for 2full months after the monthyou drop your Medicare CostPlan.You drop your coverage in aProgram of All-inclusive Carefor the Elderly (PACE) Plan.Join a Medicare Advantage orMedicare drug plan.Your chance to join lasts for 2full months after the monthyou drop your PACE plan.

You have a chance to get other coverageIf this describes you.You can.At this time.You have a chance to enroll inother coverage offered by youremployer or union.Drop your current MedicareAdvantage or Medicare drugplan to enroll in the privateplan offered by your employeror union.Whenever your employer orunion allows you to enrollYou have or are enrolling inother drug coverage as good asMedicare drug coverage (likeTRICARE or VA coverage).Drop your current MedicareAdvantage Plan with drugcoverage or your Medicaredrug plan.Anytime.You enroll in a Program ofAll-inclusive Care for theElderly (PACE) Plan.Drop your current MedicareAdvantage or Medicare drugplan.Anytime.You live in the service areaof one or more MedicareAdvantage or Medicare drugplans with an overall qualityrating of 5 stars. Medicare usesstar ratings from 1-5 to helpyou compare plans based onquality and performance.Join a Medicare Advantage,Medicare Cost, or Medicaredrug plan with an overallquality rating of 5 stars.One time betweenDecember 8–November 30.Changes in your plan’s contract with MedicareIf this happens.You can.At this time.Medicare takes an officialaction (called a “sanction”)because of a problem with theplan that affects you.Switch from your MedicareAdvantage or Medicare drugplan to another plan.Your chance to switch isdetermined by Medicare ona case-by-case basis.Your plan ends (terminates) itscontract with Medicare duringthe contract year.Switch from your MedicareAdvantage or Medicare drugplan to another plan.Your chance to switch starts2 months before and ends 1full month after the contractends.Your Medicare AdvantagePlan, Medicare drug plan, orMedicare Cost Plan’s contractwith Medicare isn’t renewed forthe next contract year.Switch from your MedicareAdvantage or Medicare DrugPlan to another plan.Between October 15 and thelast day in February.9

Other special situations10If this describes you You can.At this time.You’re enrolled in a plan that’shad a star rating of less than 3stars for the last 3 years.Switch to a MedicareAdvantage Plan or Medicaredrug plan with a star rating of 3stars or higher.While you’re enrolled in the lowperforming plan.You’re enrolled in a plan thatwas recently taken over bythe state because of financialissues.Switch from your MedicareAdvantage or Medicare drugplan to another plan.Until the state action is no longer ineffect or until you join another plan,whichever occurs first.You’re eligible for bothMedicare and Medicaid.Join, switch, or drop a MedicareAdvantage Plan or Medicaredrug coverage.Once during each of these periods,and the change will take effect on thefirst day of the next month: January–March April–June July–September(You can also make a change fromOctober 15–December 7, and thechange will take effect on January 1.)You get Extra Help paying forMedicare drug coverage.Join, switch, or drop Medicaredrug coverage.Once during each of these periods: January–March April–June July–September(You can also make a change fromOctober 15–December 7, and thechange will take effect on January 1.)You’re enrolled in a StatePharmaceutical AssistanceProgram (SPAP).Join either a Medicare drugplan or a Medicare AdvantagePlan with drug coverage.Once during the calendar year.You’re enrolled in a StatePharmaceutical AssistanceProgram (SPAP) and you loseSPAP eligibility.Join either a Medicare drugplan or a Medicare AdvantagePlan with drug coverage.Your chance to switch starts eitherthe month you lose eligibility or arenotified of the loss, whichever isearlier. It ends 2 months after eitherthe month of the loss of eligibility ornotification of the loss, whichever islater.You dropped a MedicareSupplemental Insurance(Medigap) policy the firsttime you joined a MedicareAdvantage Plan.Drop your Medicare AdvantagePlan and enroll in OriginalMedicare. You’ll have specialrights to buy a Medigap policy.Your chance to drop your MedicareAdvantage Plan lasts for 12 monthsafter you join the MedicareAdvantage Plan for the first time.

If this describes you You can.At this time.You have a severe or disablingcondition, and there’s aMedicare Chronic Care SpecialNeeds Plan (SNP) availablethat serves people with yourcondition.Join a Medicare Chronic CareSNP that serves people withyour condition.You can join anytime,but once you join, yourchance to make changesusing this SEP ends.You joined a plan, or chose notto join a plan, due to an errorby a federal employee. Join a Medicare AdvantagePlan with drug coverage or aMedicare drug plan. Switch from your currentplan to another MedicareAdvantage Plan with drugcoverage or a Medicare drugplan. Drop your MedicareAdvantage Plan with drugcoverage and return toOriginal Medicare. Drop your Medicare drugcoverage.Your chance to changecoverage lasts for 2 fullmonths after the monthyou get a notice of theerror from Medicare.You weren’t properly toldthat your other private drugcoverage wasn’t as good asMedicare drug coverage(creditable coverage).Join a Medicare AdvantagePlan with drug coverage or aMedicare drug plan.Your chance to join lastsfor 2 full months after themonth you get a notice ofthe error.You weren’t properly told thatyou were losing private drugcoverage that was as goodas Medicare drug coverage(creditable coverage).Join a Medicare AdvantagePlan with drug coverage or aMedicare drug Plan.Your chance to join lastsfor 2 full months after themonth you get a notice ofthe error.You don’t have Part A coverage,and you enroll in MedicarePart B during the Part BGeneral Enrollment Period(January 1–March 31).Join a Medicare drug plan.Between April 1–June 30.11

Get more informationFor more detailed information about signing up, including instructionson how to join, visit Medicare.gov. You can also call 1-800-MEDICARE(1-800-633-4227). TTY users can call 1-877-486-2048.Extra Help is available!If you have limited income and resources, you may be able to get ExtraHelp paying your Medicare Part D drug coverage costs. People whoqualify may be able to get their prescriptions filled and pay little ornothing out of pocket. You can apply for Extra Help at any time for free.You should apply even if you’re not sure if you qualify. To apply online,visit socialsecurity.gov/i1020. Or, call Social Security at 1‑800‑772‑1213to apply by phone or get a paper application. TTY users can call1‑800‑325‑0778.You have the right to get Medicare information in an accessible format, like largeprint, Braille, or audio. You also have the right to file a complaint if you feel you’vebeen discriminated against.Visit ion-notice, or call1-800-MEDICARE (1-800-633-4227) for more information. TTY users can call1-877-486-2048.Paid for by the Department of Health & Human Services.CMS Product No. 11219

Medicare drug coverage (Part D) late enrollment penalty The late enrollment penalty is an amount that’s permanently added to your Medicare drug coverage (Part D) premium. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more

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sponsors the group Humana Medicare Advantage plan or Medicare Part D prescription drug plan. Instead, with the help of a OneExchange Licensed Benefit Advisor, retirees enrolled in both Medicare Parts A and B should have selected a Medicare Advantage plan or a Medigap (Medicare Supplement) Plan and a Medicare D prescription drug plan using the

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare.

vary by cost and coverage (i.e. formulary, network, and cost sharing) Two ways to get Medicare prescription drug coverage: 1. Purchasing drug coverage with Original Medicare, called a Prescription Drug Plan (PDP) 2. Pick a Medicare Advantage plan one that offers Part D coverage. You must have Part A and Part B to join a Medicare Advantage Plan.

INDIVIDUAL ENROLLMENT REQUEST FORM TO ENROLL IN A MEDICARE ADVANTAGE PLAN (PART C) Who can use this form? People with Medicare who want to join a Medicare Advantage Plan . How do I get help with this form? Call Western Health Advantage at 916.246.7494 or 888.992.7494. TTY users can call 711. Or, call Medicare at 1.800.MEDICARE (1.800.633.4227 .

Medicare Part C, also known as Medicare Advantage, combines Part A, Part B and often Part D into one plan. Many Medicare Advantage plans provide coverage for things that Original Medicare does not, including prescription drugs, vision and dental care. Medicare Advantage plans have to offer benefits that are equal to or better than Original .

Medicare Supplement) Oct. 15 -Dec. 7 Annual Election Period (AEP): You can enroll in a Medicare Advantage or prescription drug plan for the next calendar year. Jan. 1 -March 31 Annual Enrollment Period for Medicare Advantage plans and prescription drug plans: If you're enrolled in a Medicare Advantage Plan, you can switch to