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30 – Election Periods and Effective Dates Social Security Act §§ 1851(c)(1), 1851(g), and 1860D-1(b)(1)(B); 42 CFR §§ 422.60, 422.62, 422.68, 423.32, 423.36, and 423.38

An individual’s enrollment or disenrollment request must be received during a valid election period.

It is the responsibility of the plan to determine the election period of each enrollment or disenrollment request. To make this determination, the plan may need to contact the individual directly. The plan may incorporate specific statements regarding eligibility of an election period with the enrollment or disenrollment request. However, if this information is not provided with the request, the plan must attempt to contact the individual by phone or other communication mechanism and determine within the seven-day requirement if they are eligible to make an election at that time (see MA Exhibits 5 and 11a; Part D Exhibits 3 and 11a).

Unless stated otherwise in this guidance, the organization must accept an individual’s verbal or written confirmation regarding the conditions that make them eligible for the election period. Determination of eligibility for some election periods requires that the organization obtain the date on which the individual’s circumstances changed (i.e., change in residence, loss of special needs status, etc.). Organizations that obtain this information on the enrollment or disenrollment request are not required to obtain an additional verbal or written confirmation of election period eligibility.

For enrollment requests obtained during a face-to-face interview or telephone request, the determination of election period eligibility can be made at that time. For enrollment requests made using paper, or via an electronic enrollment mechanism or the Medicare OEC (without accompanying CMS approval), the organization is not required to contact the applicant to confirm eligibility if the enrollment request includes the applicant’s attestation of election period eligibility.

Generally, the enrollment effective date, i.e., when coverage begins under a plan, is the first of the month following a plan’s receipt of an enrollment request. An individual can, in most situations, submit more than one enrollment request prior to the effective date. The last enrollment choice made, determined by plan receipt date, will be the choice that becomes effective. Once an election takes effect, eligibility for that election period ends. Please refer to § 70.1 for further information on “multiple transactions.”

Unless a CMS-approved capacity limit or a CMS-issued enrollment sanction applies, all plans (with the exception of Medicare MSA and MA RFB plans) must accept requests to enroll during all election periods listed below. A plan that is closed due to a capacity limit must remain closed to all applicants (with the exception of MA plan reserved vacancies) until the limit is lifted. See § 50.10 for further information on capacity limits.

There are six types of election periods during which individuals may make elections: