As most Medicare recipients know, October 15 to December 7 is the Medicare Annual Election Period. During this time, you may make changes to your Medicare Advantage or Medicare Prescription Drug plan. Any changes made during this time will take effect on January 1.
You can read or download the Medicare booklet titled Understanding Medicare Part C & Part D Enrollment Periods from the Resources page on my website. Unfortunately, the Medicare booklet offers little or no explanation of what is involved in these changes, so here’s what you can expect, in plain English.
During Medicare AEP you are allowed to make the following changes:
• Change from original Medicare to a Medicare Advantage Plan.
If you have original Medicare or original Medicare along with a Medicare Supplement and a Part D prescription drug plan, you may switch to a Part C Medicare Advantage plan.
• Change from a Medicare Advantage Plan back to original Medicare.
This is a little trickier. You can easily switch to Original Medicare but I recommended that you also enroll in a Medicare Supplement plan to cover the gaps in Original Medicare. Unless you are eligible for a special enrollment period, you will have to pass through medical underwriting. If you do not meet the insurance company’s medical requirements they may charge you a higher premium or even refuse to offer you a Medicare Supplement plan. Do not cancel your Medicare Advantage plan until you are sure you have been accepted by your new Medicare Supplement plan. You will also need to add a prescription drug plan
• Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
This one is straightforward. If you live in an area where there are multiple Medicare Advantage plans, you can switch from one plan to another without any medical underwriting. You can switch plans as many times as you like between October 15 and December 7, and the last plan you switch to on or before December 7 will be the one that takes effect on January 1.
• Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
If you switch to a plan that has drug coverage and you did not have creditable drug coverage before, you may have to pay the Part D late enrollment penalty.
• Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
If you switch to a Medicare Advantage plan without drug coverage in most cases, you are not allowed to purchase a stand-alone prescription drug plan and therefore you would be without prescription drug coverage.
• Join a Medicare Prescription Drug Plan.
During open enrollment, you may join a prescription drug plan. if you did not have creditable coverage, you will be subject to the Part D late enrollment penalty.
• Switch from one Medicare prescription drug plan to another Medicare prescription drug plan.
While it may not be necessary to change your drug plan, now is the time for you or your agent to run your list of prescription drugs through the Medicare Plan Finder at the Medicare.gov website. Drug plan premiums and their formularies may change yearly. By checking your drug plan every year, you ensure that you are receiving the most value for your money.
• Drop your Medicare prescription drug coverage completely.
If you drop your coverage and you do not have other creditable drug coverage and would like to re-enroll the following year, you will be subject to the Part D late enrollment penalty.
Notes:
Medical Underwriting Refers to the process insurance companies use to decide, whether to accept your application for insurance, what premium you will pay for that insurance and whether or not to add a waiting period for any pre-existing conditions. Medical underwriting is based on your medical history.
Medicare Supplements (Medigap) You do not have to wait for Medicare Open Enrollment to make changes to your Medicare Supplement plan. You may make changes year round but as mentioned above unless you qualify for a special enrollment period you will have to go through medical underwriting and can be denied coverage. Never cancel an existing Medicare Supplement until you are sure the new company has accepted you.
Medicare Advantage Plan You can join a Medicare Advantage Plan even if you have a pre-existing condition, except for end-stage renal disease (ESRD), for which there are special rules.
Creditable Drug Coverage Is prescription drug coverage (for example, from VA or former employer) that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.
Enrolling in or changing Medicare plans can be an overwhelming task. The options are many and the jargon can be confusing. Whether you are new to Medicare and looking for someone to explain things in plain English or have had a Medicare plan for years and think you may be paying too much, I am here to help. I make the complex simple by shopping the plans and rates for you.
I specialize in Medicare products for seniors and represent all Medicare Supplement Plan types.
Call or email me now. There is never a fee for my services and you are under no obligation to use them.
Medicare Explained in Plain English
