MEDICARE + CHOICE :
DELAY OF "LOCK-IN" RULES AND
CHANGE IN ANNUAL OPEN ENROLLMENT PERIOD

On June 12, 2002 President Bush signed into law a bioterroism bill which includes Medicare+Choice provisions related to enrollment. (PL 107-188). The new law rolls back limits on the ability to enroll and disenroll from Medicare+Choice plans. Effective immediately Medicare beneficiaries may enroll and disenroll from a Medicare+Choice plan at any time.

The Balanced Budget Act of 1997 (BBA) created specific enrollment periods for enrollment in the new Medicare+Choice (M+C) plans. Beneficiaries could enroll when they first became eligible for Medicare, during the Annual Enrollment Period held in November of each year, and during Open Enrollment periods. Through 2001, the statute provided for continuous open enrollment. A beneficiary could enroll in or disenroll from a M+C plan any time during the year, without restrictions on the number of enrollments or disenrollments, provided the M+C plan in which s/he wanted to enroll was accepting new enrollees. 42 U.S.C. § 1395w-21(e).

Beginning in January 2002, BBA placed limitations on Open Enrollment Periods. These limitations were known as the "lock-in" rules, since beneficiaries became "locked-in" to the choices they made during the previous November’s annual enrollment period. Continuous open enrollment would no longer be available to Medicare beneficiaries. Instead, Medicare beneficiaries could enroll in or disenroll from a M+C plan only once from January through June 2002 (Open Enrollment Period) . After June 30, 2002, beneficiaries would not be allowed to make any changes until November 2002 (Annual Election Period). Any changes made in November 2002 would be effective January 1, 2003. Under the lock-in rules, in 2003 and thereafter, beneficiaries would be able to enroll in or disenroll from a M+C plan only one time in addition to the annual election period, from January 1 through March 31 of each year. 42 U.S.C. § 1395w-21(e)(2).

Effective January 2002, BIPA also created Special Enrollment Periods that would allow beneficiaries who would otherwise be subject to lock-in to disenroll from a M+C plan under circumstances specified in the statute. 42 U.S.C. § 1395w-21(e)(3).

Congress included measures in the bioterrorism bill, Public Law 107-188, signed by President Bush on June 12, 2002, that change M+C enrollment. Congress agreed:

C To suspend for three years (until 2005) implementation of the restrictions on the ability of Medicare beneficiaries to make multiple M+C enrollment changes during the course of the year.

C To move the Annual Election Period (for a three year period) for beneficiaries to select a M+C plan. During 2002, 2003, and 2004, annual election will take place from November 15-December 31.

In exchange, Congress changed the deadline for M+C organizations to submit to the Centers for Medicare & Medicaid Services proposed premium and benefit information, or to indicate their intention to end their M+C contracts, from July 1 to the second Monday in September. The change in reporting deadline is also effective for three years, 2002, 2003, 2004.

Both the changes in the beneficiary lock-in provisions and in the M+C reporting requirements take effect immediately.

Copyright © Center for Medicare Advocacy, Inc. 05/05/2008