Question: I did not switch my insurance by the December 7 deadline and that may have been a mistake. What chance for change do I have?

Answer: The Annual Open Enrollment has ended. There are 20 Special Enrollment Periods (SEP) that are available to individuals that meet those different SEP criteria. I am going to focus on two opportunities for switching plans, EPIC (Elderly Pharmaceutical Insurance Coverage) & those whose plan is no longer offered in 2026.

EPIC is a New York State Pharmacy Assistance Program that provides secondary coverage when paying for your medications at the pharmacy to those who are 65 or older, New York State resident, within the income guidelines (single person make less than $75,000 or, a married couple make less than $100,000). If you think you qualify for EPIC, please call their Help-Line at 1-800-332-3742. Their customer service will answer your questions and send you an enrollment form. You can also get EPIC applications at your local pharmacy or New York State Office For the Aging office locations. You can reach out to me and I can forward one to you. You can also apply online at health.ny.gov/health_care/epic/application_contact.htm.

EPIC has NO set enrollment period which allows you to enrollment at any time. EPIC uses your income figures to determine your eligibility, so you will need to have detailed information about your income.

EPIC will always be secondary to your Part D insurance coverage. If you have a retiree plan or VA coverage, EPIC will not help you pay for prescriptions. EPIC will only be secondary to Medicare Part D plans.

EPIC also has an additional benefit. This additional benefit may be more useful to you than any other benefit EPIC offers. If you are enrolled in EPIC, your membership gives you a Special Enrollment Period (SEP) each year. This means that every year you have EPIC you have an additional one time opportunity to switch your prescription drug coverage from one product to another. This can be used at any time during the year, but only once each calendar year.

You can always evaluate whether or not switching your insurance makes sense. So if you missed the December 7 deadline, you can use your EPIC SEP after December 8 to switch plans and begin 1-1-26, or wait until after January to switch anytime you want during the year if necessary.

In counseling individuals with regard to their insurance, I have many times advised joining EPIC, not because an individual needs the additional drug cost assistance that badly, but because it gives them this SEP which we can use to make an advantageous insurance change.

Another opportunity you may have applies to those individuals whose plan has been discontinued for 2026. There are MANY in western New York who are in this situation. When your plan has been discontinued you have additional time to make you next year selection. You can enroll in any plan you wish by December 31 and your coverge will begin 1-1-26. If you miss that deadline you have until February 28th to make a new choice, but in this situation your coverage would not begin until the first of the following month you make your enrollment. So this isn’t the best scenario for you.

The other 19 SEP’s may be useful to you and your situation as well. I do not have enough space to cover all 20 SEP’s, but realize that missing the December 7 deadline is significant, but it is not catastrophic.

Reach out to the Medicare resources you have available. The www.medicare.gov website is always available to research and review alternative products available. The Medicare hotline, 1-800-MEDICARE, is available to you. There are agencies and programs that can be of help to you to research alternatives, like Office For the Aging, Southwestern Independent Living Center. The Medicare Rights Center (www.medicarerights.org or 800-333-4114) could help you as well. There are also insurance brokers who could help with the plans they represent.

You missed the December 7 date, but there may be a solution out there anyway.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.