OMB No. 0938-1378
Expires 7/31/2023
Election Period Effective Date of Coverage
Annual Election Period (AEP) (October 15 – December 7) January 1 of the following year
New to Medicare (Initial Coverage Election Period - ICEP) – If you’re new to Medicare, you can join during the period that starts three months before the month you get Medicare, and ends three months after you get Medicare. If you enroll during the first 3 months before the month you get Medicare—your effective date is the 1st day of the month you get Medicare.
If you enroll during or after the month you get Medicare, your effective date will be the 1st of the month following the month you enrolled in your Medicare plan.
Open Enrollment Period (OEP) (January 1 – March 31) – An MA-PD enrollee may use the OEP to switch to: (1) another MA-PD plan; (2) and MA-only plan; or (3) Original Medicare with or without a PDP.
An MA-only enrollee may use the OEP to switch to - (1) another MA-only plan; (2) an MA-PD plan; or (3) Original Medicare with or without a PDP.
Varies, generally the 1st of the following month
Open Enrollment Period for Institutionalized Individuals (OEPI) – The OEPI is continuous for institutionalized individuals. For purposes of enrollment under the OEPI election period, an institutionalized individual is defined as an individual who moves into, resides in, or moves out of an institution. The OEPI ends two months after the month the individual moves out of the institution. Varies, generally the 1st of the following month
Special Election Period (SEP) Varies, generally the 1st of the following month

Please select your election period.
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Please select an effective start month.
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Unless one of the statements below matches your current situation you CANNOT enroll at this time. The plan you have selected will contact you to confirm whether you meet one of the items listed below. If you do not meet any of them, the plan will not process your enrollment.


Please click the Click for more info next to the statements below for additional information about any of the criteria listed. By checking any of the following boxes below you are certifying that, to the best of your knowledge, you are eligible for a Special Election Enrollment Period. If we later determine that this information is incorrect, you may be disenrolled.