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Medicare Special Enrollment Periods

While Medicare Annual Enrollment Period is only for several weeks out of the year (October 15 to December 7), there are certain events that qualify beneficiaries for enrolling in Medicare coverage outside of that time period. Chances to make a change to coverage are called Medicare Special Enrollment Periods (SEP). There are different rules that govern what beneficiaries can do depending on the type of qualifying event.

The most common qualifying life events that result in a special enrollment period are the following:

Change of residency

Sometimes, moving living locations results in a special enrollment period because the new residence is no longer in range for the coverage that the previous plan provided. When this happens, the beneficiary must notify the plan’s carrier. If the beneficiary notifies, then they will have about a two month window to make adjustments to their coverage, like choosing a new plan. If they do not choose another Medicare Advantage plan, they will be enrolled in Original Medicare when they are disenrolled from their previous plan.

Loss of current coverage – Medicare Special Enrollment Periods

This most often occurs when a beneficiary is enrolled in Medicaid and then is no longer eligible due to changing life circumstances like increased income or loss of disability status. The beneficiary can then switch to Medicare Advantage, drop the Medicare Advantage plan and return to Original Medicare, or drop the coverage that they previously had without making other changes. This will result in a lapse in coverage.

Opportunity for other coverage

A beneficiary can drop their Medicare Advantage plan and/or Part D plan if  an opportunity for other coverage arises.  Offers include as an insurance plan offered by or subsidized by a union or employer.  This special enrollment period can occur whenever the beneficiary is offered alternative coverage.

Plan changes its contract with Medicare

Sometimes, Medicare takes an official action called a sanction to protect beneficiaries. If sanctions occur, the contract the insurance carrier has with Medicare will be different and those differences will affect the plans that beneficiaries are enrolled in. If this happens, the beneficiary can enroll in a different Medicare Advantage plan offered by the same or a different carrier.

Other special circumstances – Medicare Special Enrollment Periods

There are multitudinous other circumstances that may result in a special enrollment period for beneficiaries. Some of them could be being eligible for both Medicare and Medicaid, qualifying for the Extra Help Pharmaceutical prescription drug coverage, qualifying for a Special Needs Plan and choosing that coverage instead, and the list goes on.

Regardless of the specifics of the beneficiary’s circumstances, a qualifying life event that results in a special enrollment period is an opportunity to get better, more comprehensive and appropriate care.

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Medicare Annual Enrollment 2023

As we get closer to the end of the year, many people start thinking about the Medicare Annual Enrollment 2023.  During this time of the year, you can make changes to your Medicare coverage for the upcoming year.   It is important to note; each year Medicare plans change.  Some plans add benefits to a plan or change the way they cover a medication.  Whether you’re a first-time Medicare beneficiary or have been on Medicare for years, you should check your plan each year to stay informed about the changes that may effect your coverage for the following year.

When is Annual Enrollment 2023:

Medicare Annual Enrollment begins October 15, 2022 and ends on December 7, 2022.  During this time, you’ll be able to make changes to your Medicare coverage for the upcoming year.

What changes can I make during  the Medicare AEP

1. Beneficiaries of  Original Medicare may change to a Medicare Advantage plan.
2. If you are on a Medicare Advantage plan you can change to Original Medicare.
3. You may decide to enroll in a PDP (Part D, prescription drug plan).
4. You can also change from one Medicare Advantage plan to another.
5. Some people switch from one PDP plan to another.
6. Other individuals may choose to drop their Part D coverage altogether.

Things to consider before changing your Medicare coverage:

1. Each year you should review your healthcare coverage. Many people find it invaluable to enlist the expertise of a licensed insurance agent for this.  Because there are so many plan options it can get confusing.  Make sure you understand your current coverage so it will be easier to compare it with the best plan choices for next year.
2. Think about your health care needs especially if they have changed.   If possible, try to consider what you may need in the upcoming year.
3. If you are on a Medicare advantage plan, be sure to check that your health care providers will still be in-network.  Providers and facilities (hospitals, labs, out patient clinics) do make changes during the year and if you skip this step, it could be very costly.
4. Members of PDP plans need to carefully check their plan’s formulary.  Private insurance companies do change these each year and something that is covered this year may not be next year.  It is possible there is a prescription drug plan that is a better fit for you for next year.
5. If possible, it is a good idea to look at the total cost of this year’s plan (plan premium, deductibles, co-pays and co-insurance) to see if you can save money next year. It is important to think about your budget as well as your healthcare needs.

There are many resources to help you learn more about the Medicare Annual Enrollment 2023:

1. Visit the Medicare.gov website: The official Medicare website provides information about all aspects of  Medicare.
2. State Health Insurance Assistance Programs (SHIPs): SHIPs offer free, personalized Medicare counseling and assistance.  These programs can also provide valuable information on programs for those with a limited income.
3. Medicare and You Handbook: The Medicare and You Handbook is a comprehensive guide to Medicare that is updated each year and mailed to all Medicare beneficiaries.
4. Call a local insurance agent.  Make sure the agent is licensed and appointed to sell the most competitive plans in your area.  If you find a reliable and knowledgeable agent, this will help narrow down the choices for you to make an informed decision.

The Medicare Annual Enrollment 2023 is an important time of year for Medicare beneficiaries to review and make changes to their coverage. By staying informed and considering your health care needs, you can make the best decisions for your health and budget.

Please note;  any changes you make during the Medicare Annual Enrollment period will not take effect until January 1, 2024.

There are other enrollment periods that yo may be able to take advantage of during the year.

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