Annual Election and Enrollment Periods
- Participating Physician Groups (PPG)
On an ongoing basis, individuals who meet the criteria for enrollment in Cal MediConnect may switch:
- From Original Medicare to a Cal MediConnect health plan
- From a Medicare Advantage (MA) or a stand-alone prescription drug (Part D) plan to a Cal MediConnect health plan.
- From a Cal MediConnect health plan to a non-Dual Special Needs Plan (D-SNP) Medicare Advantage or a stand-alone Medicare Part D Prescription Drug Plan (PDP). Members are required to enroll in a Medi-Cal Managed Care Plan for their Medi-Cal benefits
- From one Cal MediConnect health plan to another Cal MediConnect health plan
- From a Cal MediConnect health plan to Original Medicare. Members are required to enroll in a Medi-Cal managed care plan for their Medi-Cal benefits
- From a Cal MediConnect health plan to a PACE organization
- From a PACE organization to a Cal MediConnect health plan
- From a Cal MediConnect health plan to a Medi-Cal managed care plan
- From a Medi-Cal managed care plan to a Cal MediConnect health plan
- From Medi-Cal fee-for-service (FFS) to a Cal MediConnect health plan
In the Medicare Advantage (MA) program, most beneficiaries have specific election periods during which they can request to enroll in, or disenroll from, Cal MediConnect. Election periods are applicable to enrollment in Cal MediConnect. For the initial coordinated election period, individuals may elect a plan up to three months in advance of the month in which their entitlement to Medicare Part A and enrollment into Medicare Part B are effective.
There are also special enrollment periods (SEP) that permit changes at additional times during the year. Medicare-Medicaid enrollees who are entitled to Medicare Part A and Part B and receive any type of assistance from the Title XIX (Medicaid) program have a continuous Medicare SEP to request enrollment in or disenrollment from a Medicare health or drug plan. This SEP begins the month the individual becomes dually eligible and exists as long as he or she is eligible for both Medicare and Medicaid. This SEP permits individuals to enroll in or disenroll from Cal MediConnect in any month, including switching Cal MediConnect plans. The effective date of an election made using this SEP is the first of the month following receipt of the enrollment or disenrollment request.