Ok, you missed your Medicare Open Enrollment Period, now what?
Medicare’s Annual Election Period or AEP runs from October 15 to December 7 every year. This is the time of year where people enrolled in the Medicare program can make changes from Original Medicare to a Medicare Advantage, or from Medicare Advantage to back to Original Medicare plus add a Medicare Part D Prescription Drug Plan. You can also change from one Medicare Advantage or Prescription Drug plan to another for the coming year. Furthermore, you can enroll in a Part D Prescription Drug plan if you didn’t when you became eligible, keep in mind there could be a late enrollment penalty.
Open enrollment is a great time to change to a Medicare plan that better meets your needs. But what happens if you miss open enrollment for health insurance? Don’t worry. We’re here to help.
Act During The Medicare Advantage Disenrollment Period
Depending on what you wanted to do during open enrollment, you may still be able to achieve it during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14. During this period, you can:
- Change from a Medicare Advantage Plan to the Original Medicare plan
- Enroll in a standalone Part D Prescription Drug Plan
Healthy Note: You will lose some benefits by unenrolling from Medicare Advantage. For example, you may no longer have a cap on out-of-pocket expenses for Medicare-approved health care costs.
Investigate Medigap Plan Open Enrollment Periods
People commonly switch from Original Medicare to Medicare Advantage during the open enrollment period for better coverage. While this option is off the table outside the open enrollment period, you might be able to find a Medigap plan that provides the coverage you really need in the interim.
Medigap has its own open enrollment periods, which vary from state to state. Some periods also depend on certain circumstances. For example, in California you can get a Medigap plan without underwriting within six months of losing Medi-Cal benefits, getting fired, retiring, losing your military health coverage, or moving outside your Medigap Benefits area. Consult your local State Health Insurance Assistance Program to see whether you could enroll in a Medigap plan or change your existing one.
See Whether You Qualify For A Special Needs Plan
People typically want to change health care plans to get a plan that better meets their medical needs. You might be able to do this at any time if you qualify for a Special Needs Plan.
Healthy Note: Special Needs Plans are Medicare Advantage plans that cater to people with certain health conditions. These include:
- Chronic alcohol or drug dependence
- An autoimmune disorder, such as lupus
- Chronic heart failure
- Diabetes mellitus
- End-stage renal disease needing dialysis
- HIV or AIDS
Call 1-800-MEDICARE (1-877-486-2048) or your local State Health Insurance Assistance Program to learn whether you could qualify for a Special Needs Plan.
You can enroll in a Special Needs Plan by mailing a paper application to the plan or via the Medicare website or hotline. Some plans also have online enrollment.
Speak With Your Doctor About Changing Your Drugs
Many people change plans during the open enrollment period because their current plan doesn’t cover the drugs they take. If you can’t change your plan, consider changing your drugs.
You should never make this decision without medical advice. But the Medicare Modernization Act requires every plan’s Drug Formulary with prescription drug coverage to cover at least two drugs in any drug class and category. This means that there’s probably something that could treat your condition just as well as your existing medication at less cost to you. Always speak to your doctor about alternatives and make the switch under his or her care.
Find a 5 Star Medicare Advantage plan
Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. A plan can get a rating between 1 and 5 stars. A 5-star rating is considered excellent. These ratings help you compare plans based on quality and performance. Medicare updates these ratings each fall for the following year. These ratings can change each year.
You can only switch to a 5-star Medicare Prescription Drug Plan if one is available in your area.
You can only use this Special Enrollment Period once during the time frame below.