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Special Enrollment Periods (SEPs) - Important Changes and Dates

For persons on Medicare, there are certain times (Enrollment Periods) when you can sign up or change your Medicare coverage – some Enrollment Periods happen every year, like the Open Enrollment Period every fall (October 15th to December 7th). And then there are other Enrollment Periods called Special Enrollment Periods (SEPs) that happen throughout the year when a special event in your life occurs, such as changing where you live, loss of other insurance coverage, or even if Medicare no longer contracts with your current plan. Understanding Special Enrollment Periods and how they work can help you avoid gaps in coverage and/or financial penalties. Please read below for some important SEPs that may currently impact your coverage: 

  1. Plan Sanctions SEP for Clear Spring 

The Clear Spring Health Value Rx drug plan was sanctioned in fall of 2023 by the Centers for Medicare and Medicaid Services due to poor performance.  As a result of this poor performance, Clear Spring cannot provide Part D (prescription) plans in 2025. If you lost   Clear Spring coverage on December 31, 2024, you have until February 28, 2025, to enroll in a new Part D (prescription plan). 

  1. Plan Cancellations 

Every fall, Medicare Advantage Plans and standalone Prescription Drug plans may decide not to renew their contracts with the Centers for Medicare and Medicaid Services the next year.  If you are in a plan that did not renew their contract at the end of last year, you will have a two-month SEP (until February 28th, 2025) to sign up for a new plan. 

This year in Iowa the following Medicare Advantage Plans were cancelled:

  • AARP Medicare Advantage from UHC NE-0001 PPO (H1278-001)
  • Aetna Medicare SmartFit PPO (H1608-065)
  • HealthPartners UnityPoint Align PPO (H3416-001-006; H3416-001-007)
  • HealthPartners UnityPoint Symmetry PPO (H3416-002-004: H3416-002-005)
  • HumanaChoice PPO (H5216-254)
  • Mercy Iowa City Senior Plan Cost Plan (H1651-016)
  • Humana Gold Plus Diabetes and Heart HMO C-SNP (H0028-057)
  • UHC Care Advantage Plan I-SNP PPO (H0710-060)
  • UHC Nursing Home Plan I-SNP PPO (H0710-046)

And the following Part D (prescription) plans were cancelled:

  • Clear Spring Health Value Rx (S6946-022)
  • Mutual of Omaha Rx Plus (S7126-024)
  • Mutual of Omaha Rx Premier (S7126-094)
  • Mutual of Omaha Rx Essential (S7126-127)
  1. Service area changes

During their annual renewals with the Centers for Medicare and Medicaid Services, some Medicare Advantage Plans may also change which counties they cover. If your county is no longer in area covered by the Medicare Advantage Plan, this change would happen effective January 1, 2025, and you would have a two-month period (until February 28th, 2025) to enroll in a new plan. 

  1. Medicare Advantage Provider Network Change 

This year in Iowa we also saw the first SEP provided by the Centers for Medicare and Medicaid Services based on a significant provider change.  Health care providers must contract with a Medicare Advantage Plan to become part of their network.  When contract renegotiations are not successful, the Centers for Medicare and Medicaid Services review whether the change in provider network is significant enough to create a SEP for those in the plan.  If the Centers for Medicare and Medicaid Services decides that these changes have a significant impact, members in the Medicare Advantage Plan impacted by the provider change will receive a letter from their plan informing them of their SEP and how/when they can make any changes. This occurred for the first time in Iowa this year when negotiations between Humana and MercyOne were unsuccessful in some areas of the State. 

  1. NEW Monthly SEP for Persons with Medicare and Medicaid, and Low-Income Subsidy Recipients

For anyone receiving State assistance with your Medicare costs or the Low Income Subsidy (also called Extra Help) for your prescriptions, there is a new SEP that allows you to change your drug plan each month, if needed.  This SEP allows you to switch standalone drug plans (if you have Original Medicare) or from a Medicare Advantage plan back into Original Medicare with a drug plan.  (Anytime you switch from Medicare Advantage to Original Medicare, though, you will want to consider what will act as a supplement to cover the costs leftover after Original Medicare pays your claims.) The SEP cannot be used to switch or enroll into a Medicare Advantage plan. 

This SEP can be used once per month. 

For all of the SEPs listed above, you will receive communications in the mail from your plan.  This makes it critical that you open and read all mail you receive from your plan and CMS (Centers for Medicare & Medicaid Services).  If you do have a change as a result of an SEP, you can contact Medicare at 1-800-Medicare (1-800-633-4227) for assistance enrolling in a new plan, or contact SHIIP at 1-800-351-4664, or visit https://shiip.iowa.gov/find-resources/find-counselor to find your local office for assistance.