Optima Medicare (PPO)
Enrollment Information
This page provides information you will need to understand when you can enroll in a Medicare Plan, and what plans you may enroll in.
The Centers for Medicare & Medicaid Services (CMS) determines when you may enroll in a Medicare Plan. There are (3) time periods when you may enroll in a Medicare Plan – the initial enrollment period, the annual enrollment period and the open enrollment period.
Initial Enrollment Period
You may enroll in an Optima Medicare Plan when you turn 65 or otherwise become eligible for Medicare. When turning 65, you may enroll as early as (3) months before, and (3) months after your eligibility month. If you would like your Medicare coverage to begin on the first day of your eligibility month, then you should enroll within the (3) months prior to your eligibility month.
We recommend that you enroll (1) month prior to your eligibility month, because otherwise your information may not yet have been entered into the Centers for Medicare & Medicaid Services’ (CMS) system.
If you choose to enroll during your eligibility month, or within the (3) months thereafter, your Medicare coverage will begin on the first day of the month after you enroll.
Optima Health encourages you to enroll during your Initial Enrollment Period because otherwise your monthly Medicare premium will be higher. If you haven’t joined a Medicare Plan during your Initial Enrollment Period, your standard monthly premium will be increased by approximately 1 percent of the national average premium.
Annual Enrollment Period
The annual enrollment period (AEP) for Medicare runs from November 15 through December 31 of each year for coverage effective January 1. During this time, you may enroll in, or disenroll from, a Medicare Advantage Plan.
Open Enrollment Period
During the open enrollment period (OEP), which runs from January 1 – March 31 of each year, you have one opportunity to switch to a different plan, but you can’t add or drop prescription drug coverage. The chart below shows the types of changes that you can make during the OEP.
| If current coverage is |
Can use OEP to get |
Cannot use OEP to get |
|
Medicare Advantage with
prescription drug
coverage (MA-PD) |
MA-PD or Original Medicare + PDP |
MA-only or Original Medicare only |
|
Medicare Advantage with no prescription drug coverage (MA-only) |
MA-only or Original Medicare only] |
MA-PD or Original Medicare + PDP |
|
Original Medicare and a prescription drug plan (PDP) |
MA-PD |
MA-only or a different PDP to use with Original Medicare |
|
Original Medicare only |
MA-only |
MAPD or Original Medicare + PDP |
You can enroll in one of our plans outside of the initial enrollment, annual enrollment or open enrollment periods if one of the following applies:
- you are turning 65
- you are newly eligible for Medicare
- you qualify for a Special Election Period. Some examples: you are moving outside of the service area your current plan covers or you are no longer eligible for employer coverage
- you qualify for a low-income subsidy
- you are eligible for both Medicare and Medicaid
- you reside in or are moving into or out of an institution such as a skilled nursing facility or long-term care facility.
There are a few other circumstances under which you can enroll or disenroll outside of the times discussed above.
For more information, please contact us.