TN 48 (05-22)

HI 00801.133 Enrollment and Coverage Periods

A. Policy — Basic rules

An individual who is not subject to Part A buy-in as discussed in HI 00801.140 may only enroll for Premium-HI during the
following periods:

  • Initial Enrollment Period (IEP): the IEP begins 3 months before the first month of eligibility (generally, the month of attainment of age 65; see HI 00801.131 C. for exceptions) and continues for 7 months. Coverage based on an IEP enrollment begins as provided for in HI 00805.165. The IEP for Premium-HI is generally the same as the IEP for SMI.

  • General Enrollment Period (GEP): the GEP is January through March of each year. Coverage based on a GEP enrollment begins the first day of the month following the month of enrollment.

  • Special Enrollment Period (SEP): the SEP is an enrollment opportunity for individuals whose employer group health plan coverage based on current employment has ended. (See HI 00805.265ff. for a complete discussion of the SEP provisions.)

  • Transfer Enrollment Period: This is a special enrollment opportunity for Medicare beneficiaries who are also Health Maintenance Organization (HMO) or Competitive Medical Plan (CMP) enrollees and whose HMO or CMP enrollment is terminated either on a voluntary basis or because of termination of the HMO or CMP contract. (See HI 00801.143 for further discussion.)

B. Policy — Additional considerations

The following provisions which apply to SMI enrollment also apply to Premium-HI enrollment for the Aged:

  • Deemed IEP (see HI 00805.150ff.);

  • Equitable Relief (see HI 00805.170ff.);

  • Group Premium Payer (see HI 01001.230).

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HI 00801.133 - Enrollment and Coverage Periods - 05/17/2022
Batch run: 05/17/2022