42 CFR 422.62 - Election of coverage under an MA plan.
(a)General: Coverage election periods -
(1)Initial coverage election period for MA. The initial coverage election period is the period during which a newly MA-eligible individual may make an initial election. This period begins 3 months before the month the individual is first entitled to both Part A and Part B and ends on the later of -
(i) The last day of the month preceding the month of entitlement; or
(ii) If after May 15, 2006, the last day of the individual's Part B initial enrollment period.
(2)Annual coordinated election period.
(i) For 2002 through 2010, except for 2006, the annual coordinated election period for the following calendar year is November 15 through December 31.
(ii) For 2006, the annual coordinated election period begins on November 15, 2005 and ends on May 15, 2006.
(iii) Beginning in 2011, the annual coordinated election period for the following calendar year is October 15 through December 7.
(3)Open enrollment period for individuals enrolled in MA -
(i)For 2019 and subsequent years. Except as provided in paragraphs (a)(3)(ii) and (iii) and (a)(4) of this section, an individual who is enrolled in an MA plan may make an election once during the first 3 months of the year to enroll in another MA plan or disenroll to obtain Original
(ii)Newly eligible MA individual. For 2019 and subsequent years, a newly MA eligible individual who is enrolled in a MA plan may change his or her election once during the period that begins the month the individual is entitled to both Part A and Part B and ends on the last day of the third month of the entitlement. An individual who chooses to exercise this election may also make a coordinating election to enroll in or disenroll from Part D, as specified in § 423.38(e) of this chapter.
(iii)Single election limitation. The limitation to one election or change in paragraphs (a)(3)(i) and (ii) of this section does not apply to elections or changes made during the annual coordinated election period specified in paragraph (a)(2) of this section, or during a special election period specified in paragraph (b) of this section.
(4)Open enrollment period for institutionalized individuals. After 2005, an individual who is eligible to elect an MA plan and who is institutionalized, as defined in § 422.2, is not limited (except as provided for in paragraph (d) of this section for MA MSA plans) in the number of elections or changes he or she may make. Subject to the MA plan being open to enrollees as provided under § 422.60(a)(2), an MA eligible institutionalized individual may at any time elect an MA plan or change his or her election from an MA plan to Original
(5)Annual 45-day period for disenrollment from MA plans to Original
(b)Special election periods. An individual may at any time (that is, not limited to the annual coordinated election period) discontinue the election of an MA plan offered by an MA organization and change his or her election, in the form and manner specified by CMS, from an MA plan to original
(1) CMS or the organization has terminated the organization's contract for the plan, discontinued the plan in the area in which the individual resides, or the organization has notified the individual of the impending termination of the plan, or the impending discontinuation of the plan in the area in which the individual resides.
(2) The individual is not eligible to remain enrolled in the plan because of a change in his or her place of residence to a location out of the service area or continuation area or other change in circumstances as determined by CMS but not including terminations resulting from a failure to make timely payment of an MA monthly or supplemental beneficiary premium, or from disruptive behavior.
(i) The organization offering the plan substantially violated a material provision of its contract under this part in relation to the individual, including, but not limited to the following:
(B) Failure to provide medical services in accordance with applicable quality standards; or
(4) The individual meets such other exceptional conditions as CMS may provide.
(c)Special election period for individual age 65. Effective January 1, 2002, an MA eligible individual who elects an MA plan during the initial enrollment period, as defined under section 1837(d) of the Act, that surrounds his or her 65th birthday (this period begins 3 months before and ends 3 months after the month of the individual's 65th birthday) may discontinue the election of that plan and elect coverage under original
(d)Special rules for MA MSA plans -
(1)Enrollment. An individual may enroll in an MA MSA plan only during an initial coverage election period or annual coordinated election period described in paragraphs (a)(1) and (a)(2) of this section.
(A) An annual election period; or
(B) The special election period described in paragraph (b) of this section.
(ii)Exception. An individual who elects an MA MSA plan during an annual election period and has never before elected an MA MSA plan may revoke that election, no later than December 15 of that same year, by submitting to the organization that offers the MA MSA plan a signed and dated request in the form and manner prescribed by CMS or by filing the appropriate disenrollment form through other mechanisms as determined by CMS.
Title 42 published on 20-Jun-2018 04:47
The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 42 CFR Part 422 after this date.
- 42 CFR 422.66 — Coordination of Enrollment and Disenrollment Through MA Organizations.
- 42 CFR 422.74 — Disenrollment by the MA Organization.
- 42 CFR 422.60 — Election Process.
- 42 CFR 422.103 — Benefits Under an MA MSA Plan.
- 42 CFR 422.312 — Announcement of Annual Capitation Rate, Benchmarks, and Methodology Changes.
- 42 CFR 423.40 — Effective Dates.
- 42 CFR 422.68 — Effective Dates of Coverage and Change of Coverage.
- 42 CFR 423.38 — Enrollment Periods.