Each year, Medicare’s annual Open Enrollment Period (OEP) gives seniors the opportunity to enroll in a Medicare Advantage Plan (Part C) or prescription drug plan (Part D), change an existing Part C or D plan, or disenroll and revert to Original Medicare (Parts A and B).
The Open Enrollment Period lasts from October 15 until December 7 each year, but what happens if you miss the deadline? Do you have to wait until the next year’s OEP to make changes to your coverage? Fortunately, seniors can change their coverage outside of the annual OEP under a few different circumstances.
Here are some tips to help you maximize your drug and health benefits in the coming year and a few strategies for switching your plan outside of the fall enrollment period.
Ways to Change and Maximize Coverage Outside of Medicare Open Enrollment
- The Medicare Advantage Open Enrollment Period
There used to be a Medicare Advantage Disenrollment Period (MADP) that ran from January 1 until February 14 each year during which beneficiaries could drop their Medicare Advantage Plan and switch to Original Medicare. But in 2019, the Centers for Medicare & Medicaid Services (CMS) did away with the disenrollment period and replaced it with a Medicare Advantage Open Enrollment Period (MAOEP) that runs annually from January 1 to March 31.
During this new MAOEP, beneficiaries who already have a Medicare Advantage Plan can switch to another advantage plan or disenroll from their current plan and revert to Original Medicare (with the option to enroll in a Part D prescription drug plan). Keep in mind that, if you abandon a Medicare Advantage Plan, you’re giving up benefits, such as the network of providers who participate in that plan and a cap on your out-of-pocket spending for approved medical bills. These are two benefits that original Medicare doesn’t provide. So, before you disenroll, do some research to ensure you’ll still have the coverage you need and can afford.
- Investigate Medicare Special Enrollment Periods (SEPs)
Medicare also provides SEPs for people who need to change their coverage outside of the OEP due to certain qualifying life events. While there are some additional guidelines for SEPs, the basic qualifying events include moving to a new address, losing current health insurance coverage, gaining the ability to enroll in new health insurance coverage and a current Medicare plan changing their coverage. For a full list of all SEPs and their rules, visit Medicare.gov.
- Research Medicare Supplement Insurance (Medigap) Plans
Medigap Plans are sold by private insurance companies and offer supplemental coverage to be used in conjunction with Original Medicare. Most people purchase a Medigap plan during their individual Medigap Open Enrollment Period. Unlike the annual OEP, the enrollment timeframe for Medigap is different for each person. It automatically begins the month that a person is BOTH age 65 or older AND enrolled in Medicare Part B. Your Medigap Open Enrollment Period lasts for six months, and during this time, private insurance companies cannot charge more for, deny or restrict your coverage based on medical underwriting and pre-existing conditions. This is not the case after your six-month enrollment period ends, except in certain guaranteed-issue circumstances. You may try to buy a Medigap policy outside of your enrollment period, but insurers may charge more for a policy or refuse to sell you one if you do not meet their medical underwriting requirements.
- Look for Five-Star Medicare Plans
The 2010 Health Care Reform law created a star rating system for Medicare Plans (one being poor and five being excellent in terms of quality and performance), and Medicare updates its ratings every fall. Beneficiaries can switch to a five-star Medicare Advantage Plan, Medicare Cost Plan or Medicare Prescription Drug Plan once per calendar year between December 8 and November 30. You cannot change to any plans that are not rated five stars, however. Beneficiaries can use the Medicare Plan Compare tool to search for high-rated plans.
- Find Ways to Better Utilize Your Drug Coverage
If you missed the OEP and you can’t change your coverage using the techniques above, it is best to try to find ways to minimize your healthcare costs. One of the best ways is to optimize your prescription drug regimen to better fit your current coverage. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 requires every Medicare plan with prescription drug coverage to include at least two drugs in each category and class. Even if your plan doesn’t cover the drug you take, it must cover another drug designed to treat the same problem. Talk to your doctor to find what other medications exist to treat your illness and discuss the possibility of switching to a generic version or a drug that is part of your plan’s formulary. If you and your doctor decide that you cannot take an alternative drug due to limited effectiveness, adverse effects, or other issues, consider filing an exception request with your plan for coverage of your preferred medication(s).
If you missed the Open Enrollment Period, don’t feel as though you’re trapped in a plan that doesn’t meet your needs. If the cost of drugs, coverage or key benefits becomes more than you can afford, there may be opportunities to make changes and reduce your out-of-pocket costs. The key is to be proactive. Reach out to the State Health Insurance Assistance Program (SHIP) at your local Area Agency on Aging for help figuring out what opportunities are available to you and how and when to take advantage of them.