Welcome Medicare Nation! It’s tax season! Today is April 15th and it’s the dreaded tax deadline day! It’s this time of year that people realize they need to make some changes to their Medicare plan. However, many people don’t realize that you can’t just make changes anytime you want to a Medicare Advantage Plan. There are specific times that you can make changes, and then you have to live with them until the opportunity arises to make changes again.
Here’s quick guide to making changes to your Medicare Advantage Plan:
- You make your initial selection of your Medicare Advantage Plan when you enroll at 65.
- During annual enrollment from October 15 to Dec 7th.
- You can dis-enroll from January 1- Feb 14th, but you would have to go on to original Medicare because you cannot switch to another Medicare Advantage Plan at this time.
- You may have a “Special Election” that allows you to change your plan.
That Special Election for Medicare Advantage is what we want to focus on today. There are certain circumstances that can qualify you to have this option.
Moving Your Residence:
- If you move your home and your new location is not in your plan service area. You would need to notify Medicare as soon as possible, because you only have the rest of the current month and the following 2 full months from your move as the Special Election Period.
- If you move to a new address and your plan still is in your service area, but by moving you now have new options available to you that you didn’t previously have, then you would have a Special Election Period to change to one of those previously unavailable plans.
- Snowbirds that live in 2 areas have to determine which of those places is your primary residence. Where you vote and where you pay taxes are going to determine your primary residence.
- If you are out of the country for a period of time and now you are coming back to the US, then that could trigger a Special Election Period.
- If you are moving into a longer term care facility or rehab facility with round the clock skilled nursing care, you would have a Special Election Period when you move into the facility, while you are at the facility and when you move out of the facility.
- If you leave a job, or the union through retirement, etc.
- If you had an involuntary loss of drug coverage that was as good or better than Medicare drug coverage, that triggers an SEP. Or if you have had drug coverage through Medicare Cost Plan and left that job.
- If you lost coverage through the PACE Plan.
- If you had Medicaid and lost eligibility because of the income requirements.
You have a chance to get other coverage:
- If you had coverage from an employer and it was better than Medicare, you could go on it.
- If your employer had better plan coverage and you wanted to get on that plan.
- If you wanted to get into a PACE Plan
When there are plan changes with Medicare Contracts:
- If a provider was sanctioned by CMS, then you would be able to choose another plan.
- If Medicare terminated a contract
Dual Member (Medicare and Medicaid)
- You may get extra help with drug coverage
- May have been on a Medigap plan, changed to a Medicare Advantage Plan and then wanted to change back, you can change to a Medicare Supplement plan during your first year of coverage.
- SNIP Plan - for chronic conditions - may leave Medicare Advantage to go on the SNIP, or yu no longer qualify for a SNIP, so you can choose another plan.
If an error was made by a federal employee when you signed up for Medicare, and you can prove it, you may be granted an SEP.
*****You cannot get an SEP because your Doctor left the network********
If you have a Medicare Supplement - a Medigap plan, you can change plans whenever you want because there is no SEP.
If you have a chronic illness, cancer, cardiovascular disease, a plan does not have to take you after your first year of enrollment. You need to be careful and make sure you are going to be able to get coverage when you change plans. The other company might not take you due to pre-existing conditions and your old plan may not take you back. They can discriminate due to pre-existing conditions.
The price of these plans do change as you age, so keep that in mind.
Part A, B and D - you are on all the time, so you don’t make changes unless it is open enrollment or an SEP.
www.callsamm.com - has all of this information available for you.
Do you have questions or feedback? I’d love to hear it!
I may answer one of your questions on the air!
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Find out more information about Medicare on Diane Daniel’s website!