If you missed the Open Enrollment Period (OEP), don’t feel trapped! If the cost of drugs, coverage or key benefits becomes more than you can afford, there may be ways to make changes and reduce your out-of-pocket costs. You can reach out to the State Health Insurance Assistance Program (SHIP) at your local Area Agency on Aging for help.
Medicare’s Advantage Disenrollment Period (MADP) runs from January 1 until February 14 each year. During the MADP, you can leave your current Medicare Advantage Plan and switch to Original Medicare. If you switch to Original Medicare, you will also be able to add a Part D prescription drug coverage plan during this time frame.
Medicare Special Enrollment Periods (SEPs)
Medicare 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 your current health insurance coverage, gaining the ability to enroll in new health insurance coverage, or your current Medicare plan changing their coverage.
Research Medicare Supplement Insurance Plans
Medigap plans are sold by private insurance companies and offer supplemental coverage to be used with Original Medicare. Most people purchase a Medigap plan during their individual Medigap Open Enrollment Period. Unlike the annual OEP, the enrollment time frame 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.
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 the ratings every fall. Beneficiaries can switch to a five-star Medicare Advantage Plan, Medicare Cost Plan or Medicare Prescription Drug Plan one time between December 8, 2017, and November 30, 2018. You cannot change to any plans that are not rated five stars, however.
Ways to Utilize Your Drug Coverage
If you missed the OEP and you can’t change your coverage using any of the options listed above, it’s best to try to keep your healthcare costs as low as possible. The Medicare Modernization Act (MMA) 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’re taking, 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.