Ritter Insurance Marketing, Craig Ritter

Health Care Reform Bill Changes Annual Enrollment Period and Eliminates Enrollment into Medicare Advantage During Open Enrollment

UPDATE (3/29) I need to check with the final bill language to verify this.  I think this may not have been included in the final version.

UPDATE (3/30) – Language in this blog post has been corrected to reflect the Final Bill (PPACA 2010).

UPDATE (4/20) – See my notes on the 2011 FINAL CMS Call Letter, including enrollment dates.

The relevant sections of the Bill relating to enrollment periods is Section 3204 – Simplification of Annual Beneficiary Election Periods which can be found on page 338.  (I’ve copied and pasted the entire section below.)

Here are the changes:

  • Changes to the Annual Enrollment Period (formerly 11/15 to 12/31 of each year):    The actual language of the Bill was a bit fuzzy (begs the question if anyone read the whole thing, but one would think one person would have caught this error) as to whether this will begin in 2010 (for 2011 plan year) or 2011 (for 2012 plan year).  The 2011 CMS Call Letter clarifies that for 2010 (2011 Plan Year), the AEP will run from 11/15/2010 through 12/31/2010.  Starting in 2011, the AEP will be changed from 10/15/2011 through 12/7/2011.  I blogged about the lack of an AEP in 2010 for 2011 plans here.
  • The Open Enrollment Period will be shortened in 2011 to 45 days.  The term “Open Enrollment” is a bit of misnomer as now the only options during “Open” “Enrollment” will be to “Disenroll” from a Medicare Advantage plan.  Medicare Beneficiaries who disenroll from Medicare Advantage will be allowed to enroll in a Part D plan (Stand alone PDP) during the OEP.  A better name might be “Closed Disenrollment Period”, but that’s just my opinion.

As mentioned, here is the text:

SEC. 3204. SIMPLIFICATION OF ANNUAL BENEFICIARY ELECTION PERIODS.
(a) ANNUAL 45-DAY PERIOD FOR DISENROLLMENT FROM MA PLANS TO ELECT TO RECEIVE BENEFITS UNDER THE ORIGINAL MEDICARE FEE-FOR-SERVICE PROGRAM.—
(1) IN GENERAL.—Section 1851(e)(2)(C) of the Social Security Act (42 U.S.C. 1395w–1(e)(2)(C)) is amended to read as follows:  ‘‘(C) ANNUAL 45-DAY PERIOD FOR DISENROLLMENT FROM MA PLANS TO ELECT TO RECEIVE BENEFITS UNDER THE ORIGINAL MEDICARE FEE-FOR-SERVICE PROGRAM.—Subject to subparagraph (D), at any time during the first 45 days of a year (beginning with 2011), an individual who is enrolled in a Medicare Advantage plan may change the election under subsection (a)(1), but only with respect to coverage under the original medicare fee-for-service program under parts A and B, and may elect qualified prescription drug coverage in accordance with section 1860D–1.’’.
(2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply with respect to 2011 and succeeding years.
(b) TIMING OF THE ANNUAL, COORDINATED ELECTION PERIOD UNDER PARTS C AND D.—Section 1851(e)(3)(B) of the Social Security Act (42 U.S.C. 1395w–1(e)(3)(B)) is amended—
(1) in clause (iii), by striking ‘‘and’’ at the end;
(2) in clause (iv)—

(A) by striking ‘‘and succeeding years’’ and inserting ‘‘, 2008, 2009, and 2010’’; and
(B) by striking the period at the end and inserting ‘‘; and’’; and
(3) by adding at the end the following new clause:  ‘‘(v) with respect to 2012 and succeeding years, the period beginning on October 15 and ending on December 7 of the year before such year.’’.

Posted by filed under Enrollment Periods, News .

  • Just found this blog, shameful what this has done to the agents in name of protecting the seniors. In reality the MADP hurts the seniors by not letting them into a different MA plan!

  • Craig

    As a result of the recent health care legislation there have been siginfigant cuts to the Medicare Advantage program with many of these (subsidies) hitting in 2012. In reviewing some of the plans for 2011 I have noticed very little changes in premiums and/or cost sharing from the 2010 plans. I know you don’t have a crystal ball but you know alott more than most of us and I was wondering what you think might happen come 2012. Will there still be $O premium plans, if so, will many extra benefits be cut like eyeglasses, gym benefits, COMMISSIONS!! Will companies continue to offer Dual and Chronic Special Needs plans? I know many agents(including myself) that sell MA all year round and in particular to the lower income population and we are trying to determine as much as we can if we can continue to expect Medicare Advantage to be and in particular, $0 premium and SNP plans.

    If the Republicans take over the Congress and/oWhite House could all these changes enacted in PPCA be changed?

    • Craig:

      Depending on what happens in Congress, it’s possible that the funding for the PPACA bill could be modified. It’s not likely any other changes could be made as they would have to overcome a Presidential Veto. I’m not seeing any commission reductions currently in the MA market.

  • Jennifer

    the membership will become much more stabilized, higher retention rates with the implementation of this legislation.

  • Amy

    I can see my health insurance licenses (all 50 of them I have for each individual state) turing into worthless pieces of paper that mean nothing.

  • bryan

    Craig,
    MA Health Plan Director and Compliance Director just returned from CMS conference in Balitmore this week.

    They said that the interim director of CMS clearly defined (to a stunned an hushed crowd) that the AEP for 2011 will be 10/15 – 12/7/2010. Just wanted to pass this along.
    Bryan

    • Bryan:

      Thanks for the information! I was going off of the 2011 Call letter! This is big news, I have no idea how they are going to implement this . . .

      Craig

    • If MA companies don’t submit their plan proposals until June, this seems like a tight schedule. And in the past, companies did not send out their ANOC until the end of October. And agents did not attend training on MA plans until October. Seems like there are lots of pieces that will need to be moved around to make this work.

  • Bryan

    Craig, Anymore update on AEP/OEP for 2011 plan year?
    Thanks,
    Bryan

  • Ray

    This has been Pelosi’s plan all along. They’ve figured out that MA plans work and can actually turn a profit if managed correctly. They want the money! First they cut commissions and now the slow death part!

  • Sell it!!

    Stop telling and start selling.

  • Jeff

    If I apply the changes of 3204(b) to 1851(e)(3)(b), I end up with:

    (B) Annual, coordinated election period.—For purposes of this section, the term `annual, coordinated election period’ means—
    (i) with respect to a year before 2002, the month of November before such year;
    (ii) with respect to 2002, 2003, 2004, and 2005, the period beginning on November 15 and ending on December 31 of the year before such year;
    (iii) with respect to 2006, the period beginning on November 15, 2005, and ending on May 15, 2006;
    (iv) with respect to 2007, 2008, 2009, and 2010, the period beginning on November 15 and ending on December 31 of the year before such year; and
    (v) with respect to 2012 and succeeding years, the period beginning on October 15 and ending on December 7 of the year before such year.

    It sure does seem like there won’t be an AEP in 2011.

    • Jeff:

      I did the same exercise and I came to the same conclusion. the 2011 AEP is completely overlooked.

      I’ll blog on this credit you!

      Craig

  • Jeff

    On the Final House bill seems to have a typo. It says (v) with respect to 2012 and succeeding years, the period beginning on November 1 and ending on December 7 of the year before such year.

    The way the bill is written, there will be no AEP for 2011.

  • I emailed MedicareRights.org and got a quick reply:

    Thank you very much for contacting us. The information on the side-by-side is indeed correct. The Annual Coordinated Election Period (AEP) will be from 10/15 (not 10/1) through 12/7.

    Please see section 3204 (b) (3) of the Patient Protection and Affordable Care Act. It says:

    ‘‘(v) with respect to 2012 and succeeding years,
    the period beginning on October 15 and ending on
    December 7 of the year before such year.’’.

  • Jeff

    Craig,
    I read the new election period to be from Jan 1st to Mar 15th according to the latest version of the senate bill on http://www.OpenCongress.org. It is just now clear if it starts in 2011 then does that mean we will not have an AEP for this year?

    • Jeff:

      I think I have the final version here: http://blog.ritterim.com/2010/03/29/text-of-final-health-care-reform-bill-h-r-3590-the-patient-protection-and-affordable-care-act/

      Does this jibe with what you are looking at?

      This would only allow for the DISENROLLMENT from an MA or MAPD plan for 45 days, NOT for the ENROLLMENT into an MA or MAPD plan for the 45 day period.

      See page 338 (Section 3204). Let me know what you think!

      I’m going to do a bit more study on this, but I’m sitting on over 100 emails from the weekend!!

      Craig

    • Jeff:

      I think the AEP changes will occur for the 2012 plan year and that the AEP for 2011 will stay as we currently understand it. I think the elimination of OEP for MA enrollment will take affect this coming year. By that I mean that there will be no OEP for MA Enrollments in 2011. . .only for disenrollment into original medicare (per the final bill language as I read it).

      Craig

      • Jeff

        I hope so.. What’s scary is that the law seems to exclude an AEP for 2011. One line is updated to end with 2010 and line v is updated to read 2012.. Weird…

  • alex sickert

    Other than signing up during the “age-in” period, the revision certainly makes for a very condenced time to switch plans and no chance to change your mind…..I bet, this will be loosened up somewhat.

  • I read on the Medicarerights.org website the following information which is part of a list of how the health care reform law will affect Medicare:

    Creates single Annual Enrollment Period (AEP) for drug and health plan changes from October 15 – December 7

    Allows Medicare Advantage enrollees to enroll in Original
    Medicare during first 45 days of the year

    • Denise:

      I saw that in the Senate Bill, however, i looking at the Reconciled bill, it appears that the dates are different and the OEP is eliminated.

      Tonight, I’m going to try and find the Bill which President Obama will be signing tomorrow and see what that bill says. I assumed that the language will be the same as the reconciled bill, but maybe that got adjusted by the Senate during the reconciliation process?

      Craig

  • Don

    I like the change in the first time sign up (11/1 12/15)! The elimination of the second I do not agree with at all. There are other things to not agree with but that would require a whole blog page!

  • Dave B

    The whole reform bill is nasty to medicare, MA plans especially. From an agent’s perspective, it makes working in this marketplace more condensed and it will tend to allow our block of business to persist from year to year. One thing is for sure, we’d better hit the ground rinning 11/1/2010…..

  • Phil

    Just one more way to kill MA plans. They just reduced the time seniors have to review and change their plans by 67%.

  • Craig,

    Got this from a consultant presentation:

    Simplification of Annual Beneficiary Election Periods

    Beginning in 2011, annual enrollment period dates for MA and Part D will be
    10/15 – 12/7

    Beginning in 2011, annual open enrollment period (1/1 – 3/31) for MA plans will
    be eliminated

    Beginning in 2011, new 45-day period (1/1 – 2/15) in which beneficiaries who enroll in MA or PDP plans during the AEP could dis-enroll and return to FFS

    Also, a mention about Medicare Supplemental Insurance that I wasn’t quite sure about. Maybe you could clarify…

    Medigap
    Requests that the NAIC create new plans for C and F that include normal cost
    sharing
    Encourages the use of appropriate Part B physician services; Available in 2015

    Joe


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