If You Missed The Medicare Open Enrollment Period

1. Look for Other Drugs: If you missed Open Enrollment and you can’t change your coverage, try to optimize the drugs you’re taking to fit your current plan. PlanPrescriber surveyed people on their website and found that one-in-three (34 percent) took a drug that wasn’t covered by their Medicare plan in the coming year. If these individuals didn’t update their coverage in time, they’d not only pay full price for that drug, but their expenses wouldn’t count toward getting them out of the “donut hole.” If you’re in the same boat this year, don’t despair. The Medicare Modernization Act (MMA) requires every Medicare plan with prescription drug coverage to include at least two drugs in each category and class. Even if your plan doesn’t cover the drug you take, it must cover another drug designed to treat the same problem. Talk to your doctor to find what other drugs exist to treat your illness and discuss the possibility of switching.

2. Annual Disenrollment Period Starts Jan. 1, 2017: Medicare’s Annual Disenrollment Period (MADP) lets you “dis-enroll” (cancel) from a Medicare Advantage plan if it fails to meet your needs. You can also add drug coverage at the same time. In 2017, ADP starts on Jan. 1 and ends on Feb. 14. If you decide to drop a Medicare Advantage plan, you will have the option to enroll in a stand-alone Medicare prescription drug plan so that you don’t lose drug coverage. If you abandon a Medicare Advantage plan you’re giving up benefits such as the network of providers who participate in that plan and a cap on your out-of-pocket spending for medical bills (provided those costs are approved by Medicare). These are two benefits original Medicare doesn’t have. So, before you dis-enroll in a plan, do some homework to be sure you’ll still have the coverage you need.

3. Investigate Medicare Special Enrollment Periods (SEPs): Medicare also provides SEPs for people who need to change their coverage outside of AEP. A person may qualify for an SEP if they move permanently outside of their plan’s service area; become eligible for a low-income subsidy due to a loss of income; receive incomplete information about what qualifies as creditable prescription drug coverage or lose that coverage through no action of their own; if they become eligible for Medicare and Medicaid (“dual eligible”) but lose their dual eligibility status; if they live in, are moving into, or moving out of certain types of skilled nursing facilities; if they receive a retroactive Medicare entitlement determination; or if they qualify for other special enrollment periods that may be authorized by the federal government.

4. Enroll into NYS Pharmaceutical Assistance Program (EPIC): One of the many benefits that NY seniors who enroll into EPIC receive is a Special Enrollment Period to make a change in your insurance coverage ANY time during the course of the year if your current plan is not meeting your needs or if your health changes and you need a different type of health care plan.

If you missed Medicare’s Open Enrollment, don’t feel as though you’re trapped in a plan that doesn’t meet your needs. If the cost of drugs, coverage or key benefits becomes more than you or a loved one can afford, there may be opportunities to make changes. The key is to be proactive. Reach out to the Office for the Aging and ask to speak with a certified Health Insurance Counselor who can help you figure out what those opportunities are and how to take advantage of them.