Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage plans. Richard has several clients who have recently come to him for help who are in their initial coverage election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the coverage when he retired early to travel overseas. Bob, who has just turned 65, is now back in the United States. Charlotte, who will turn 65 next month, has coverage through Athena Health plan - a company Richard also represents. Who qualifies for the opt-in simplified enrollment mechanism?

Alice will be the only one who can do the opt-in because she never had a break in any of her coverage. The only ones who have already been with a specific company/carrier will be able to choose their same carrier for MAPD.

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topeadeniran2 topeadeniran2 · Answer 2 · 2021-09-21T18:29:54+02:00

In this case, Alice is the person who qualifies for the opt-in simplified enrollment mechanism.

The Initial Coverage Election Period refers to the period which is usually three months before an individual will be enrolled into Medicare part A.

Since Bob had health coverage through Spartan but then dropped the coverage, he's not eligible. On the other hand, since Alice will soon turn 65 and retire and she also has coverage through Spartan Health Plan offered by her employer, then she's the one that's eligible.

In conclusion, Alice is the one that qualifies for the plan.

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