Medicare Open Enrollment occurs every year from October 15th through December 7th. It is an opportunity for all existing Medicare Beneficiaries to make a plan change for the next year. It is important because drug formularies change, premiums change, and many insurance companies bring new plans to the market with better features and benefits to take advantage of. However, this is not the only time in the year a change can be made. It happens to be the most publicized and marketed, but we agents are busy all year long assisting Medicare Beneficiaries with enrollments. Here is how………
Are You Diabetic?
If you are diabetic and you take a covered insulin product, CMS has instituted a special enrollment guideline where you can make a change to your Part D plan anytime through the end of 2023 if your insulin copay wasn’t what you were told or quoted. There were some issues updating the formularies in the Medicare system to accurately price covered insulins in some cases. If this sounds familiar or like you may be affected, call your local agent to discuss.
Do You Get ‘Extra Help’?
Extra Help or also known as Low Income Subsidy is an assistance program through Medicare for low-income individuals to help cover prescription drug costs. Beneficiaries who qualify for this program are entitled to make changes to their plan one time each quarter of the year. If you don’t have Extra Help, but think you may qualify, your local agent should be able to help you apply for the Extra Help, which then opens up an enrollment period for you to change plans as well. This can be done any time of year. [For more information about Extra Help specifically, see previous blog - https://www.cdi-cares.com/blog/what-is-extra-help-could-you-qualify]
Are You Moving?
If you have moved or plan to move out of the area or gain a new permanent residence, you have a Special Enrollment Period to change plans. You will need to change your Part D or Advantage Plan within 60 days of your official address change with Social Security. The plans are all zip code specific and thus need reevaluated if you move. The pharmacy networks, formularies and hospital networks may contract differently in different areas of the state and in different states. So, you’ll want to change plans anyway. As always, use a local independent agent who knows and understands the market and health systems. If your agent is not licensed in a state you relocate to, ask them for a referral. Agents know agents! You will be in good hands.
Are You in a Nursing Facility?
If you or the loved one you are responsible for is in a nursing facility either long term or even for a short-term stay, a plan change can be made anytime of year. You can change plans when you enter or leave the Nursing Facility Rehab. If staying long term, a Medicare Beneficiary can change plans anytime throughout the year. These are special circumstances that are viewed as an important way to help manage health and chronic conditions that may be constantly changing.
Are You Test Driving an Advantage Plan?
The very first time you enroll in an Advantage Plan, whether it’s when you first became Medicare eligible or you made the switch to Advantage for the first time during Open Enrollment, you get a one year ‘test drive’. This is formally called the ‘Trial Rights’ period. At any point during that first twelve months on an Advantage Plan, a Medicare Beneficiary can change their mind and go back to Original Medicare and add a Supplement and stand-alone Part D plan. During this Trial Rights period, adding a Supplement is considered guaranteed issue and effective the first of the next month. Be sure to seek the assistance of a local agent to ensure you qualify for that change, and they will do all the work applying for the right plan and drug coverage.
Guess What, There’s More…..
There are several more scenarios where you can make changes throughout the year. There are additional Special Enrollment Periods for different situations and another Open Enrollment Period. Just know that if you have concerns about your new or current plan, do not think you can’t do anything about it until next October. Call your agent for guidance. That is what we are trained for and here to do!
CDI can help you through this entire maze. We can meet in person or virtually. Reach out if you would like more information. Email carrie@cdi-cares.com or check out www.cdi-cares.com for a contact page and other helpful blogs.
QUOTE OF THE DAY:
“Change is painful, but nothing is as painful as staying stuck somewhere you don’t belong.”
– Mandy Hale