MultiHealthOptions

Annual Enrollment Period (AEP)

Oct 15 – Dec 7 — Beneficiaries can join, switch, or drop MA and Part D plans. Changes take effect Jan 1.

Open Enrollment Period (OEP)

Jan 1 – Mar 31 — MA enrollees can make one plan change: switch MA plans or return to Original Medicare (+ join a PDP). Effective the first of the following month.

Initial Enrollment Period (IEP)

7-month window around a beneficiary's 65th birthday: starts 3 months before the birthday month, includes the birthday month, and ends 3 months after.

Special Enrollment Periods (SEPs)

• Loss of employer coverage
• Moving out of plan service area
• Qualifying institutional status
• Dual-eligible / Extra Help / LIS qualification
• 5-Star plan enrollment (year-round)

CMS rates MA and Part D plans on a 1-to-5 star scale annually. Ratings drive plan quality bonuses and affect beneficiary options.

• 5 Stars: Excellent performance — enrollees can switch to this plan year-round
• 4 Stars: Above average
• 3 Stars: Average
• 2 Stars: Below average
• 1 Star: Poor — plans may face sanctions or contract termination

Ratings are based on drug safety, customer service, chronic disease management, member experience surveys, and administrative performance.

C-SNP (Chronic Condition)

For individuals with specific severe or disabling chronic conditions such as diabetes, ESRD, heart failure, or chronic lung disorders.

D-SNP (Dual Eligible)

For beneficiaries who qualify for both Medicare and Medicaid. Provides coordinated care and may have $0 premiums and low copays.

I-SNP (Institutional)

For individuals who live in institutional settings (nursing homes, long-term care facilities) or require an institutional level of care at home.

Part A — Hospital Insurance

Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Most people do not pay a premium for Part A if they (or a spouse) paid Medicare taxes for 10+ years.

Part B — Medical Insurance

Covers outpatient care, preventive services, physician visits, durable medical equipment, and some home health services. Standard 2025 premium: $185/month (income-dependent adjustments may apply).

Part C — Medicare Advantage (MA)

Bundled alternative to Original Medicare offered by private insurers. Includes Part A + B coverage, often includes Part D, and may offer additional benefits (dental, vision, hearing, fitness). Requires continued Part B premium payment.

Part D — Prescription Drug Coverage

Covers outpatient prescription drugs via standalone PDPs or as part of an MA plan. Plans vary by formulary, pharmacy network, and premium. Late enrollment penalty applies if there is a coverage gap of 63+ days without creditable drug coverage.

Part A

• Inpatient deductible: ~$1,676 per benefit period
• Daily coinsurance (days 61–90): ~$419/day
• Lifetime reserve days (91+): ~$838/day

Part B

• Standard monthly premium: ~$190.40
• Annual deductible: ~$257
• After deductible: 20% coinsurance for most services

Part D

• National average monthly premium: ~$43
• Annual deductible: ~$590
• Catastrophic threshold: ~$8,000 TrOOP