Senior Listening

There are four Medicare enrollment periods. In last month’s Senior Listening, I covered two of the four: the Initial Enrollment period and the General Enrollment period. In this month’s edition I will cover Open Enrollment and Special Enrollment Periods.

Open Enrollment: Open Enrollment runs from Oct. 15 to Dec. 7. Any changes made to your Prescription Plan or Advantage Plan throughout this period will start Jan. 1. It is especially important to review your plan’s annual notice of change which you should receive by the end of September. This notice will show any changes to your current plan for the next year.

During this time, you can:

• Join, switch, or drop a Medicare Advantage Plan

• Change your Prescription drug coverage, also called Medicare Part D.

• Enroll in a Prescription drug plan if you go back to Original Medicare if you no longer want to stay on your Advantage Plan.

If you drop your Medicare Advantage Plan during this time and go back to Original Medicare, you will want to review your part D coverage. If your Advantage Plan had drug coverage in it, when you drop it and go back to Original Medicare you will lose your drug coverage so you will need to enroll into a part D plan. If your plan did not have drug coverage and you had a separate plan for drug coverage this is the time to review your coverage to see if there is a better option for you.

Open enrollment is also a good time for Medicare enrollees to review their current Part D or Advantage plan for any upcoming changes like:

• Premiums

• Out-of-Pocket Costs (your cost share may rise even if your premium stays the same)

• Formularies (are all your prescriptions covered by your plan next year)

• Deductibles

• Pharmacies (your pharmacy may no longer be preferred or may be out-of-network) Special Enrollment Period (SEP): Special Enrollment is when you have a qualifying event or circumstance that allows you to enroll outside of the other enrollment periods. When you enroll into a different plan during a SEP your coverage starts the first day of the following month.

Special enrollment time frames allow you to:

• Change from one Medicare Advantage plan to another.

• Disenroll from your Advantage Plan and switch back to Original Medicare.

• Join a Part D prescription drug plan if you are switching back to Original Medicare.

Some common examples that may allow you to have a special enrollment period are:

• You moved out of your Advantage Plan’s service area. It is particularly important that you check with your Advantage Plan if you move, you may end up noncovered or paying out-of-network charges. If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for two full months after you move. If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus two more full months.

• You move out of a nursing home or rehabilitation hospital. Your chance to join, switch, or drop coverage lasts if you live in the facility and for two full months after the month you move out of the facility.

• You were covered by Medicaid and lost coverage. Your chance to change lasts for three full months from either the date you are no longer eligible or the date you are notified you are no longer eligible, whichever is later.

• You had creditable coverage through your or your spouse’s employer and you lose that coverage. Your chance to join lasts for two full months (63 days) after the month your coverage ends to enroll in an Advantage Plan or Part D. You will have eight months from the day your employment ends, or your employer-provided medical coverage ends whichever comes first to sign up for Part B if you delayed enrollment. Keep in mind you will want to sign up before your current health coverage ends or you may have a gap in coverage.

• Your plan changes its contract with Medicare. This may mean your current plan has been “Sanctioned” by Medicare (this usually means the plan is no longer allowed to enroll anyone into their plan). A “Sanctioned” SEP starts when the sanction is