You say you thought Medicare open enrollment was over? Well, technically, you’re correct: the window in which to make wide-ranging changes in your Medicare coverage closed over a month ago. But there’s actually a second open enrollment period happening right now, affecting the roughly 27 million Medicare beneficiaries that are enrolled in Advantage Plans.
As reporter Sarah O’Brien explains in this recent CNBC article, anyone who has discovered their MA plan is not ideal can change plans between now and March 31 – but there are some limitations you need to be aware of.
Medicare Open Enrollment Offers a Do-Over
It’s a familiar story: year-to-year changes in Medicare Advantage plans can take us by surprise, especially if they’re buried in the fine print of the annual notice you get in the fall. Now in January, you go to fill your prescription as usual and find out that your medication isn’t covered anymore. Are you stuck for an entire year with an inadequate plan?
The good news is that you don’t have to be stuck with those changes, as long as you act between January 1st and March 31st. During this period, you have the ability to switch between different Medicare Advantage plans. You can also drop your MA plan and go back to basic Medicare, if you choose.
The Medicare Advantage structure—which currently serves about 26.9 million beneficiaries of the nearly 64 million enrolled in Medicare—can be a bit of a dizzying landscape to navigate, thanks to varying deductibles, copays, and lists of covered drugs and services (like dental and vision). Still, for the next several weeks, if your current plan isn’t doing the trick, you can fix it. But there are limits.
This Open Enrollment Period Offers Limited Options
O’Brien writes, “The current opportunity to change or drop your Advantage Plan arrives just weeks after the close of Medicare’s annual fall enrollment, when a variety of options were available for those who wanted to modify their coverage. In contrast, this Advantage Plan-related window comes with restrictions.” For example, one important consideration is that you can only change once during this period. So do your research and choose wisely. Once you’ve made your choice, that’s the one you’re sticking with for the remainder of the year until the next open enrollment period this fall
Another limitation prevents beneficiaries from switching from one standalone Part D drug plan to another. But even with drug plans, there may be exceptions – such as, if you feel you chose (or kept) your Part D plan based on faulty or misleading information. If this is something you need help with, O’Brien includes the number for Medicare (1-800-Medicare ) and encourages those concerned to call and ask if their situation will allow for a change.
If You Plan to Switch Back to Original Medicare, Be Careful
There are particular warnings for those dropping MA for basic Medicare. O’Brien cautions that “dropping an Advantage Plan in favor of basic Medicare often means losing drug coverage — which means you would have to enroll in a standalone Part D plan. This matters, because if you go 63 days without the [drug] coverage, you could face a lifelong late-enrollment penalty that gets tacked on to your monthly premiums.” She adds, “That charge is 1 percent of the national base premium ($33.37 for 2022) for each full month you go without drug coverage.” Doesn’t sound like much but it can add up, and it never goes away.
If, after dropping Medicare Advantage, you intend to get a supplemental policy, also known as Medigap, be aware that companies issuing these plans can subject you to underwriting requirements, so be certain that you can be approved for Medigap before you cancel your existing Advantage Plan. You may not qualify for guaranteed coverage unless you live in one of four states – Connecticut, Massachusetts, Maine or New York – with laws that guarantee your right to coverage. The Medicare website also lists other circumstances that might affect your right to buy a Medigap plan.
“These policies either fully or partially cover cost-sharing of some aspects of parts A and B, including deductibles, copays and coinsurance,” O’Brien explains. “However, they come with their own rules for enrolling.” As with everything in healthcare, an ounce of research can save you a whole heap of trouble. Make sure you feel completely comfortable before you sign on the so-called dotted line.
Miss Your Initial Medicare Enrollment Deadline?
There’s one other group to whom this open enrollment period applies: people who didn’t enroll in Medicare when they were supposed to. “If you missed your initial Medicare enrollment period and don’t qualify for an exception, you can sign up during this window,” O’Brien explains. For those in this group, your medical coverage won’t start until July 1st.
Medicare has a list of qualified exceptions listed here on the official Medicare website. The list is long, so we strongly advise getting some good advice before deciding which situation applies in your particular case. In Washington State, this information from the State Insurance Commissioner is a good place to start.
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(originally reported at www.cnbc.com)