After buckling down and getting into the nitty gritty, you did it. You decided on a new Medicare Advantage plan. You checked your formularies. You put those copays head-to-head. You are ready, Freddy. Now all you have to do is pick up the phone and call your agent before December 7, which was…yesterday. Oh no! AEP is over, and you (and your “money guy”—he does real estate, financial advising, health insurance, life insurance, and dog grooming, it’s really convenient) dropped the ball. You’re stuck with this lackluster plan until this time next year.
Ope.
Don’t worry, there are plenty of other ways you can get your plan changed.
There’s still hope
Certain circumstances may allow beneficiaries like yourself to make changes to Medicare plans outside of the Annual Enrollment Period (AEP). These circumstances are known as Special Enrollment Periods (SEPs). SEPs are specific situations that may qualify you for a period to change your Medicare plan outside of AEP. Each situation is triggered by different events and opens up a new window of opportunity for change.
Moving to a new ZIP Code
If you move to a new address that is not in your current plan's service area, you are entitled to a Special Enrollment Period. We suggest you let Medicare know in advance that you’re hitting the road: this ensures you will get a full month before you move and two months after you move to decide what plan you want to change to. If you don’t tell Medicare until after you move, you only get the two months after moving to make a decision. Say you like your plan, and the only change you were looking for was of scenery. If it’s still available in your new stomping grounds, you don’t have to change plans if you don’t want to.
Moving can also be defined in this situation as leaving a structured facility, like a skilled nursing facility or incarceration.
Leaving your employer
If you lose your employer-sponsored health insurance, no matter if it was due to retirement, getting laid off, or getting let go, you are entitled to some time to get your health care affairs in order. Unless this also happens to be around the same time you are turning 65, you will have two months to sign up for another Part D plan to replace your employer coverage, and 8 months to enroll in Part B coverage. COBRA is an option, too, but recall that this coverage is capped at 18 months and may no longer be supplemented by your employer.
Medicaid status
When your income dips below a certain level, you now qualify for Medicaid. If this happened recently, it creates a special enrollment period. Why? You will now have additional options for coverage: Dual Eligible Special Needs Plans, also known as D-SNPs, are on the table. These plans are designed for those with lower incomes and come with additional perks, such as embedded Part D and a specialized care coordinator. Usually, someone in this situation would check what other programs they might be eligible for with their local Social Security office to ensure they are saving the most money possible. Don’t fret if you will only qualify temporarily: you also get two months from the time you are notified you are getting the boot to find new coverage.
Help with payments means more chances to change PDPs
If you qualify for Extra Help, the federal program designed to help those with lower incomes pay for prescription drug plans, you have the option to switch prescription drug plans every three months. So know for sure if you take a generic or name brand, and keep that in mind when you are shopping around, particularly if you might be switching medications soon. The switch when you are prescribed a new drug or are switched from a brand name to a generic might save you some serious dough.
Certain health diagnoses
This might not be as well-known a reason, but if you are diagnosed with certain health conditions, a Special Enrollment Period is triggered. This allows you to enroll in a Chronic Condition Special Needs Plan, or C-SNP. Specific qualifications will apply here, and you will have to get a note from your doctor (or if you are eyeing that Humana C-SNP, they will check in with your doctor on your behalf), but it does give you the opportunity to switch to a plan supporting someone with your condition.
Life changes can bring coverage changes, too
Certain life events such as marriage, divorce, or the death of a spouse may qualify you for a Special Enrollment Period if those changes are either allowing you to enroll in something new or eliminating your access to a plan.
Need some help?
You missed the deadline, but it’s okay! You know who else missed the deadline? Your one-stop-shop agent. Sounds like it’s time to get a new agent who is ready to take some Action. Get in contact with an Action agent today and get yourself signed up with a plan that’s right for you—just don’t miss that deadline again. We can assure you that your Action Benefits agent won’t!