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Am I granted a Special Enrollment Period when CMS terminates my Medicare Advantage plan's contract?


Yes.  The Centers for Medicare and Medicaid Services (CMS) provides a Special Enrollment Period (SEP) for members of a Medicare Part D (PDP) or Medicare Advantage plan (MA, MAPD, or SNP) who are enrolled in Medicare plan when CMS terminates the plan's contract.  The SEP begins 1 month before the termination and continues for 2 months after the Medicare plan's contract termination.

CMS provides the following example to illustrate the "CMS Termination of MA organization Contract" SEP:
"If CMS terminates an MA [Medicare Advantage plan] organization contract effective June 30, an SEP lasts from June 1 through August 31. In this scenario, a beneficiary could choose an effective date of July 1, August 1, or September 1; however, the effective date may not be earlier than the date the new MA organization receives the enrollment request."
Question:  What does this mean if I was a members of this plan?

If your Medicare Advantage plan is terminated, you will be returned to your original Medicare Part A and Part B coverage and CMS provides a Special Enrollment Period (SEP) allowing members of a terminated Medicare plan to join another Medicare Part D (PDP) or Medicare Advantage (MA, MAPD, or SNP) plan that is available in their area. For assistance finding or joining a new Medicare plan, please call a Medicare representative at 1-800-633-4227 (1-800-Medicare).  You can also view all Medicare Part D plans in your area using our PDP-Finder.com or see all Medicare Advantage plans in your area using our MA-Finder.com.

Supporting Information

The Medicare Advantage Enrollment / Disenrollment Manual, Section 30.4.3 - SEPs for Non-renewals or Terminations provides:

"CMS Termination of MA organization Contract - A SEP exists for members of plans that will be affected by MA organization contract terminations by CMS (42 CFR 422.510). The SEP begins 1 month before the termination effective date and ends 2 months after the effective date of the termination.

Please note that if an individual does not elect an MA plan before the termination effective date, he/she will be defaulted to Original Medicare on the effective date of the termination. However, the SEP will still be in effect for two months after the effective date of the termination should the individual wish to subsequently elect an MA plan (for a current, not retroactive, effective date).

Beneficiaries affected by these types of terminations may select an effective date of up to three months after the month of termination. However, the effective date may not be earlier than the date the new MA organization receives the enrollment request.

. . .

Immediate Terminations By CMS - CMS will establish the SEP during the termination process for immediate terminations by CMS (42 CFR 422.510(b)(2)), where CMS provides notice of termination to an MA plan’s members and the termination may be mid-month. "

Sources:

Medicare Managed Care Manual, Chapter 2 - Medicare Advantage Enrollment and Disenrollment, Updated: August 19, 2011 (Revised: November 16, 2011, August 7, 2012, August 30, 2013, August 14, 2014, July 6, 2015, September 1, 2015, September 14, 2015, December 30, 2015, May 27, 2016, August 25, 2016, June 15, 2017, July 31, 2018 & August 12, 2020)

Medicare Prescription Drug Benefit Manual, Chapter 3 - Eligibility, Enrollment and Disenrollment, Updated: August 19, 2011 (Revised: November 16, 2011, August 7, 2012, August 30, 2013, August 30, 2014, July 6, 2015, September 1, 2015, September 14, 2015, December 30, 2015, May 27, 2016, August 25, 2016, June 15, 2017, July 31, 2018 & August 12, 2020)

See also the example Medicare Advantage plan contract termination:

"CMS Notice of Expedited Termination of Constellation Medicare Advantage – Prescription Drug Contract Numbers H3054, H4876, and H8266" in Puerto Rico - https://q1medicare.com/news/Article.php?article_id=758





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