Plan Advisors Blog

New rules regarding when to use the IEP vs ICEP election code

Posted by Lance Hoeltke on Thu, Oct 04, 2012 @ 12:32 PM

As you know, selecting the correct election period for your client when facilitating an MAPD enrollment is an important step toward ensuring the beneficiary's enrollment form is processed for their proposed effective date. For 2013, there is a change in guidance of when to use IEP vs. ICEP. Let's take a closer look...

 Medicare election periods, IEP or ICEP, IEP vs ICEP, MAPD election periods

IEP:

 

IEP should be selected when the applicant is newly eligible for Medicare and enrolling into a drug plan for the first time.

This applies if enrolling into either a MAPD plan or stand-alone PDP.

 

IEP Scenario #1:

Danielle is aging into Medicare and is in her 7 month initial election period. She has both Parts A & B effective on the same date.

This will be the first time she is electing Part D coverage. She is choosing to enroll into a MAPD plan.

 

IEP Scenario #2:

John has just qualified for Medicare A & B due to disability and is in his 7 month initial election period. He has both Parts A & B effective on the same date and this will be his first time electing Part D coverage. He is choosing to enroll in a stand-alone PDP.

 

IEP Scenario #3:

Luther was living in Paris when he turned 65. Since he did not reside in the U.S. during his initial election period, he was not able to elect a drug plan. Luther is now moving back to the U.S. permanently so he will now meet all eligibility requirements for enrolling into a Part D.

He is electing drug coverage for the first time by enrolling into a MAPD.

Please note: If Luther had lived in the U.S. when he first became eligible for Part B and his IEP was either used or expired before he moved to Paris, then he would use SEP for permanent move to enroll into a drug plan when he moves back to the U.S. permanently.

 

IEP Scenario #4:

Ed became eligible for Medicare prior to the age of 65. He is now turning 65 and is within the 7 months surrounding his 65th birthday. He now has a second IEP election to enroll into either a stand-alone PDP or MAPD. (does not apply to MA only)

Please note: SEP ‘X’ has been eliminated from the Enrollment Period Job Aid due to the changes in the IEP in this example. This SEP allowed beneficiaries who had Medicare under the age of 65 to enroll into either a MA or MAPD upon turning 65.

 using correct election period, when do to use IEP, when to use ICEP

ICEP:

ICEP should be selected when:

 

1) The applicant is new to Medicare and in their 7 month initial election period and electing to enroll into a plan with NO RX coverage (MA only)

OR

2) The applicant delayed their Part B when first eligible. They are enrolling into Part B after the expiration of the IEP and are requesting to enroll in a MA/MAPD plan in the 3 months prior to their Part B effective date.

 

Please Note: For beneficiaries who had Medicare under age 65 there is NOT a second ICEP available upon turning 65.

See the elimination of SEP ‘X’ referenced above.

 

ICEP Scenario #1:

Liz is aging into Medicare and is in her 7 month initial election period. She has both Parts A & B effective on the same date.

She is choosing to enroll into a MA only plan since she gets her drugs through the VA.

 

ICEP Scenario #2:

Paul is 68 years old. He delayed his Part B at age 65 because he was still working but he enrolled in a Part D plan at that time.

The date is Sept. 21st and he will be retiring and enrolling in Part B effective 12/1. He is requesting to enroll in a MAPD plan with a 12/1 effective date.

Tags: ICEP, MAPD and PDP membership, MAPD, IEP2, CMS marketing guidelines, IEP election period, Medicare election periods, IEP vs ICEP, IEP, ICEP election period