Medicare’s Open Enrollment period is over, yet some people may have some options for changing coverage. This article provides a Q&A to review these options, including for people whose Medicare Advantage and/or Part D plan is terminating December 31, 2015.
Even though Medicare’s Open Enrollment is over, can I still enroll in a new plan if my Medicare Advantage/Part D plan is terminating? Did I miss the boat?
Yes, if your MA or Part D plan is terminating December 31, 2015, you have a Special Election Period (SEP) to enroll into a new plan between Dec 8 and Feb 29. Your plan should have mailed notice of its termination by Oct 2nd explaining your rights, including this SEP. Any plan change you make is effective the first of the following month. You can enroll into a new plan only once during this SEP. See our section on When Medicare Advantage Plans Terminate Coverage for more info.
Do I have a right to buy a Medigap policy if my MA or Part D plan is terminating?
In California, if your Medicare Advantage plan terminates, you have a guaranteed issue right to buy a Medigap policy. But if your stand-alone Medicare Part D plan terminates, you do not have a guaranteed issue right to buy a Medigap policy. A guaranteed issue right means you may buy a Medigap policy without health screening, without a waiting period and at a similar price charged for other people your age. You can buy plan A, B, C, F (including high deductible plan F), K, L, M or N. Note: If you are younger than 65 and have Medicare solely because you have End Stage Renal Disease (ESRD), you do not have this right.
You may apply for one of these guaranteed issue Medigap policies anytime after the MA plan notifies you of its termination. You have up to 123 days after your Medicare Advantage plan benefits actually end to apply. See our website section on guaranteed issue rights for more info.
What if my planis NOT terminating, but I missed Medicare’s Open Enrollment andneed to make a change? Are there other timesI can switch my Medicare Advantage and/or Part D plan?
Below is a summary of some of the other times and situations beneficiaries can change their coverage.
Medicare Advantage Disenrollment Period (MADP)
If you’re in a Medicare Advantage plan, you can disenroll from your plan and return to Original Medicare anytime between January 1 – February 14. You are also given a Special Election Period (SEP) to enroll in a Part D plan during this 6-week period. But you may not enroll in a Medicare Advantage plan at this time.
Your MA plan disenrollment becomes effective the first day of the following month. We encourage you to enroll in a Part D plan at the same time you disenroll from your MA plan in order to avoid any gap in drug coverage. For example, if you disenroll from your MA plan on January 28 and enroll in a Part D plan on February 1, you would return to Original Medicare on February 1, but wouldn’t have drug coverage until March 1. Alternately, if your MA plan has drug coverage (a Medicare Advantage Prescription Drug Plan – MA-PD), enrolling into a new stand-alone Part D plan will automatically disenroll you from your MA plan.
5-Star Medicare Advantage or Part D Plan Special Election Period
If there is a Medicare Advantage or Part D plan in your area with an overall plan performance rating of 5 stars, and you’re otherwise eligible to enroll in the plan, you have a Special Election Period to join that plan. Medicare posts plan performance ratings each fall on their website and the ratings apply for the following calendar year. Your SEP is from December 8 through November 30. Your new coverage will become effective the first day of the following month. You can use this SEP to enroll in a 5-star plan only once during the SEP. See Medicare’s Plan Finder Tool to search for 5-star plans in your area.
Ongoing Special Election Period Right for People with Extra-Help
If you are eligible for the Part D Extra Help (that helps pay your Part D expenses), you can change your Medicare Advantage and/or Part D coverage on a monthly basis. Those eligible for Extra Helpinclude people who have full Medi-Cal or a Medicare Savings Program (Qualified Medicare Beneficiary, Specified Low Income Medicare Beneficiary or Qualifying Individual). If your income is at or below 150% of the Federal Poverty Level, you may qualify for Extra Help if you also meet the resource requirement. You can apply for Extra Help online at the Social Security website, or contact your local Health Insurance Counseling and Advocacy Program (HICAP) for help with the application.
Other Special Election Periods (SEPs)
You may have a SEP to switch your Part D or Medicare Advantage plan in the following situations:
- If you move out of your plan’s service area
- Your plan violates its contract with Medicare (including marketing misconduct)
- You are in a plan with a low-rating (less than 3 stars) or
- You move in or out of a nursing facility.
See our list of events that trigger such a SEP for more information.
If you have any questions with this information and your Special Election Period rights, please contact your local Health Insurance Counseling and Advocacy Program (HICAP) for free, individual and unbiased counseling at 1-800-434-0222.