Eligibility Restrictions
There are limits to when and how often you can change the way you get Medicare and what choices you can make when you make the change.
Here are the rules:
- From November 15, 2007 through December 31, 2007, anyone with Medicare can change the way of getting Medicare to another.
- From January 1, 2008 until March 31, 2008, anyone with Medicare has another chance to make one change in the way they get Medicare.
With this change, you are limited in the type of plan you may join. If you have Medicare prescription drug coverage when making your change, you will only be able to join a Medicare Advantage Plan or Medicare Private-Fee-For-Service plan that offers the Medicare Part D (Prescription Drug), or you will have to go to Original Medicare and join a Prescription Drug Plan. If you do not have Medicare prescription drug coverage when making this change, you will only be able to join a Medicare Advantage plan or Private-Fee-For-Service plan that does not offer the Medicare Part D, or go to Original Medicare.
Generally, you can't make any other changes during the year unless you meet special exceptions, such as if you move or if you have Medicaid coverage; contact us for information. Later in the year, from November 15 through December 31, anyone with Medicare can switch their way of getting Medicare to another way for the following year.
If you join another Medicare plan, including a Medicare Prescription Drug Plan, you will be disenrolled from our plan when your enrollment in the new plan begins. If you leave your current plan and don't join a plan that offers Medicare prescription drug coverage or a Medicare Prescription Drug Plan, and you don't have prescription drug coverage that is at least as good as the Medicare standard prescription drug benefit, you may have to pay a late enrollment penalty (higher premium) if you decide to join later. This means your monthly premium will be higher.
In most cases, your effective date will be the first day of the month that comes after the month we receive your request. For example, if we receive your request during the month of February, your effective date will be March 1.
Another restriction on enrolling is that the Centers for Medicare & Medicaid Services (CMS), the government agency that oversees Original Medicare, prohibits enrollment of anyone with End-Stage Renal Disease (ESRD). However, individuals with ESRD who are currently enrolled in a FirstCare health plan as a non-Medicare member, individuals who lose coverage due to another Medicare Advantage plan withdrawing from the market after December 31, 1998, or individuals who no longer require dialysis are eligible to join.
Contact us if you have any questions.
H4525-H6206 231.11 F
Last Updated:(2/22/2008)