Enrolling into a Medicare Prescription Drug Plan or a Medicare Advantage plan can be done at multiple times during the year. Medicare beneficiaries have their Initial Enrollment Period when they first become Medicare eligible, but the only time that all Medicare recipients can change their plan after their Initial Enrollment Period is during the yearly Open Enrollment Period.
This period is between October 15th and December 7th annually. This opportunity is very important because Prescription Drug Plans and Medicare Advantage plans can change each year. Consumers should take advantage of this time each year and compare plans to make sure their current plan still has the best coverage based upon their individual needs.
What if you need to change your plan outside of the Initial Enrollment Period and Open enrollment?
Outside of the Initial Enrollment and the yearly Open Enrollment, beneficiaries cannot enroll into a new Prescription Drug Plan or Medicare Advantage plan without first qualifying for a Special Enrollment Period.
A Special Enrollment Period is a situation in which a qualifying life event entitles a beneficiary an allotted amount of time to enroll in a new plan. There are several ways to qualify for a Special Enrollment period such as changing where you live, losing your current coverage to no fault of your own, being released from jail, retiring and losing employer coverage, or your plan changes its contract with Medicare.
For example, if a beneficiary is enrolled in a Medicare Advantage plan and they move, their plan may not be offered in the new county of residence. In that situation, the beneficiary would have a three-month Special Enrollment Period beginning the month before they move and lasting two months after they move. Another qualifying event would be if the beneficiary’s plan drops them or the company goes out of business. The key point in this situation is that it cannot be the beneficiary’s fault they are losing coverage to qualify.
If a beneficiary loses their coverage and it is due to the beneficiary personally cancelling the policy or not paying their premiums, they will not receive a Special Enrollment Period.
A beneficiary could also qualify for an unlimited number of Special Enrollment Periods if they are part of Medicaid, the Medicare Savings Program, or the Extra Help program. These are all programs through the Department of Social Services and the Social Security Administration that help lower medical and drug costs. Along with the cost savings, these programs would allow the beneficiary to change their plan an unlimited number of times during the year, but beneficiaries must financially qualify for these programs.
Special Enrollment Periods are important safeguards that help make sure Medicare beneficiaries are not left without coverage due to circumstances that are beyond their control. That is why being informed is crucial. Not knowing when a Special Enrollment Period is available could leave a beneficiary stuck without coverage and with the risk of accruing massive medical bills.
If you have questions about Medicare’s Special Enrollment Periods and if you qualify for one, contact SHIIP, the North Carolina Seniors’ Health Insurance Information Program, at 855-408-1212 to speak with a trained counselor or to request a free brochure.
SHIIP is part of the North Carolina Department of Insurance and assists people who have questions regarding Medicare, Medicare Part D, Medicare supplement, Medicare Advantage and long term care insurance. SHIIP also helps citizens recognize and prevent Medicare billing errors and possible fraud and abuse through the N.C. Senior Medicare Patrol program.
Trained SHIIP counselors are available for free, unbiased counseling appointments in all 100 North Carolina counties. Learn more at www.ncshiip.com.