Question

Alice is enrolled in a MAPD plan. She makes a permanent move across the country and wonders what her options are for continuing MAPD coverage. What would you say to her in regard to a special enrollment period?

Answer 1

The fact that Alice is enrolled in a MAPD plan means that as regards her special enrollment period, b. She is likely to qualify for a SEP. She can choose an effective date of up to three months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than the date of her permanent move.

Does Alice qualify for an SEP?

Alice most likely qualifies for an SEP but there are certain things she needs to do to qualify.

She would need to choose a date that the enrollment form for the Special Enrollment Period that would be considered the effective start date.

This period needs to be within 3 months of when she moves but she cannot put a date that is before her move as she would be under the MAPD plan then.

Options include:

• a. She is likely to qualify for a SEP. She can choose an effective date of up to six months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than 30 days prior to the date of her move.
• b. She is likely to qualify for a SEP. She can choose an effective date of up to three months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than the date of her permanent move.
• c. She is unlikely to qualify for a SEP but will be automatically covered by Original Medicare and a standalone Part D prescription drug plan.
• d. She is unlikely to qualify for a SEP and should remain on her current plan, relying on her current plan’s out-of-network benefits.

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