Eligibility & Enrollment Periods

Eligibility Requirements  

Are You Eligible for BlueAdvantage PFFS? 

You may enroll in a BlueAdvantage PFFS plan if:

• You are enrolled in Medicare Part A and Part B due to your age or disability.
• You are a resident of Tennessee.
• You are enrolling during one of the enrollment periods below.
• You are not medically determined to have chronic end-stage renal disease (ESRD) on the date you sign your enrollment form. ESRD means that your kidneys are permanently and irreversibly damaged requiring regular dialysis or transplantation.

Exceptions to the ESRD Restriction

You may be eligible if one of the following applies:

• You are currently a non-Medicare member of a BlueCross BlueShield of Tennessee health plan.
• You are affected by the termination, non-renewal or service area reduction (d) of your current Medicare Advantage plan.
• You have had a successful kidney transplant and no longer require dialysis.
• You started dialysis treatments for ESRD, but recovered original kidney function and no longer require dialysis.

Note: If you develop a kidney disease after you enroll, you cannot be asked to leave or be disenrolled for any health-related reason. However if you develop ESRD while on a BlueAdvantage plan, you are not eligible to enroll in another Medicare Advantage plan from a different company.

Enrollment Periods For Current Medicare Beneficiaries

Annual Coordinated Election Period: Nov. 15 to Dec. 31 

Each year during this time, you can enroll in a new Medicare Advantage health plan or a standalone Medicare Part D Prescription Drug Plan for coverage beginning on Jan. 1 of the following year.

Open Enrollment Period: Jan. 1 to March 31 

If you are enrolled in a Medicare Advantage plan or standalone Medicare Part D Prescription Drug Plan, you may change to a different plan during the Open Enrollment Period. The chart below explains what kind of changes you are allowed to make during this time.

Guide to Open Enrollment Period Changes

If Your Current Coverage is:	You Can Change  Your Plan to:	You Cannot Change Your Plan to:
Medicare Advantage with Prescription Drug Coverage (MA-PD)	MA-PD or Original Medicare plus a PDP	Medicare Advantage (MA) or Original Medicare
Medicare Advantage without prescription drug coverage (MA)	MA or Original Medicare	MA-PD or Original Medicare plus a PDP
Original Medicare and a standalone Prescription Drug Plan (PDP)	MA-PD	MA or a different PDP for use with Original Medicare
Original Medicare Only	MA	MA-PD or Original Medicare plus a PDP.

Enrollment Periods For New Medicare Beneficiaries

Initial Coverage Election Period 

When you become eligible for Medicare because of your age or a disability, you have seven months to enroll in a Medicare Advantage Plan with or without drug coverage or a standalone Medicare Part D Prescription Drug Plan. You may enroll at any time during the month you are eligible and the three months before and after.  If you get Medicare due to a disability, you can join during the three months after your 25^th of disability benefits. If you do not choose to enroll in a plan with prescription drug coverage during this time period, you may have to pay a penalty in the form of a higher premium to enroll later.

Open Enrollment Period

If you are enrolled in Medicare, Medicare Advantage or a standalone Medicare Part D Prescription Drug Plan during your Initial Coverage Election Period, you may make one change to a different plan during the Open Enrollment Period for Newly Eligible Individuals. This period begins on the first day of the month you become entitled to both Medicare Parts A and B and ends on the last day of the third month you are entitled to Medicare or December 31 of the same year, whichever comes first. The chart below explains what kind of changes you are allowed to make during this time.

Guide to Open Enrollment Period Changes

If Your Current Coverage is:	You Can Change  Your Plan to:	You Cannot Change Your Plan to:
Medicare Advantage with Prescription Drug Coverage (MA-PD)	MA-PD or Original Medicare plus a PDP	Medicare Advantage (MA) or Original Medicare
Medicare Advantage without prescription drug coverage (MA)	MA or Original Medicare	MA-PD or Original Medicare plus a PDP
Original Medicare and a standalone Prescription Drug Plan (PDP)	MA-PD	MA or a different PDP for use with Original Medicare
Original Medicare Only	MA	MA-PD or Original Medicare plus a PDP.

Limitations on Enrollment Periods

Once your Open Enrollment Period ends, you may not change your coverage until the next Annual Coordinated Election Period, unless you qualify for a Special Enrollment Period.

Special Enrollment Periods

After you have enrolled in a plan, you may become eligible for a Special Enrollment Period for one of the following reasons:

• You move out of your plan’s service area.
• Your plan does not renew its Medicare Advantage contract.
• Your plan’s Medicare Contract ends or it is no longer offered in your area.

See Disenrollment 

Please call 1-800-841-7434 (or for the hearing impaired TTY/TDD: 1-888-423-9490) 8 a.m. to 9 p.m. ET seven days a week for more information.

From March 2^nd to September 30^th, you may be required to leave a voice mail on weekends and holidays. Calls will be returned within one business day.