I had two interesting questions on Special Election Periods (SEP’s) for Medicare Advantage come up today:
1. The first question was about the State Pharmaceutical Assistance Program (SPAP) in PA called the PACE/PACEnet program. To summarize, the question was whether the PACE/PACENET program entitled an enrollee to a special election because it is considered Low Income Subsidy (LIS).
This is sort of true. Technically, the SPAP election is distinct from the LIS election. The SPAP election is one time through the end of this year, however, someone on LIS is in a “Continuous” Special Election.
2. The second situation was regarding a Medicare Beneficiary who was enrolled in a stand alone Part D Plan (PDP). Their husband was now qualified for Employer Group Health Plans (EGHP). The question was whether the individual was “locked into” their PDP. ANSWER: The SEP for EGHP allows for both enrollment into a PDP/MA/MAPD or disenrollment from a PDP/MA/MAPD. So in this case, the individual could disenroll. Assuming the EGHP was “creditable”, there would be no late enrollment penalty and, if they lost creditable coverage, they would have an SEP back to a PDP/MA/MAPD.
Here is a my recorded training on elections during lock in.
Here is a Guide to Medicare\’s Election Periods.
