It is one of the most frustrating situations in the world when you want to get something done, get out of a deal, make a change, or get away from an association or affiliation you don’t want.
It’s even more frustrating when it has to do with your money and your health.
When it comes to Medicare insurance plans, first of all, it can just be downright confusing. On top of that, there are so many myths and misconceptions about how it all works. And if you make the “wrong” decision, you could be stuck with it. In many cases, it might be difficult to undo what you’ve just put into motion or replicate what you had before.
These decisions could affect how you approach going to the doctor, pharmacy, and urgent or emergency care. Wouldn’t it help to know all of your options instead of hoping you find one sometime?
We could talk about myriad topics related to this sometimes frustrating and confusing subject, but in this snippet, we’re going to focus on how to change your Medicare plans.
If you’re brand new to Medicare, this information still applies to you. When you inevitably want to change something down the road, maybe something else from this will stick with you, as well.
For those of you already on Medicare or you’ve already made your decision, maybe you just feel like you’re stuck. Not true.
Maybe you feel like your plan covers everything, so there couldn’t possibly be anything that could ever save you money. Usually not true.
Perhaps you think the only time you can make changes is during the Annual Election Period (AEP) in the fall. Again, usually not true.
Medicare is so multilayered, and even the most educated and experienced agent will run into something new. But a knowledgeable agent or advisor can walk you through these situations and find the best solution for your situation.
So let’s demystify some mysteries of Medicare.
When Can I Make Changes?
First of all, the quick answer is, “More often than you would think!” Many people have no idea they can make changes throughout the year. It’s true that some just simply cannot. However, because of recent changes in laws and rules, it is probably rarer that someone can’t enroll in some kind of new plan during the year. Odds are, you may be able to find a reason and ability to change during the year if you just look around and ask someone (like a licensed insurance agent or advisor) who knows what they’re doing.
First of all, let’s debunk this immediately: If you have a Medicare supplement (Medigap, MedSupp, “that plan that pays for almost everything”) and you can answer some simple health questions, you can enroll in another Medicare supplement anytime during the year. Period.
So many companies and agents seem to suggest that a supplement can’t be changed immediately. Consequently, so many people are shocked to learn they can change their supplements in the middle of the year. If you don’t like your Medicare Supplement for whatever reason, feel free to start looking, because you can probably change it. If the rate is jumping up, you don’t like the service, you don’t like the company, etc., no problem as long as you can qualify.
IEP/ICEP-Your Initial Enrollment
First of all, you can always make changes, add plans, and pretty much do whatever you desire when you first come on to Medicare. Whether you are turning 65, coming off of group coverage and over 65, or are totally disabled and qualify for Medicare, this is the time that you have the greatest ability to do whatever you want.
On the effective date, you are entitled to either Part A or Part B, you have the option to enroll in a Medicare Part D Prescription Drug Plan (Remember, “D” is for “Drugs”). You have the ability to sign up for this plan three months in advance for an effective date of your initial enrollment, or if you miss the boat, you have three months to figure it out and enroll for the next month’s effective date. If you do not enroll in some type of drug coverage, when you do later, you will have a lifetime penalty in the form of an extra monthly premium on your drug plan.
When enrolling in Part B for the first time (assuming you also have Part A), this opens up an ability to enroll in a Medicare Supplement plan for six months prior to your Part B effective date, with enrollment dates starting with your Part B effective date and ending six months later. You have the ability to sign up as early as six months (with some companies) before you actually turn on your Part B, as long as you have proof and a Medicare number.
In addition to Medicare Supplement options, Medicare Beneficiaries also can choose a Medicare Advantage (MA/MAPD) plan during their initial enrollment, as well. MA plans follow Part D rules, and Medicare beneficiaries can apply three months before, the month of, and three months after they’re entitled to Part A and B.
Note: Medicare Advantage plans and Medicare supplement plans require enrollment in both Part A & Part B. Prescription Drug Plans (PDPs) only require either A or B.
Once a Medicare beneficiary is on Medicare and established, the next most common opportunity to make changes is during this period. Anything related to Medicare Parts A to D can be adjusted during this time frame. In theory, during this time period, you can make 75 changes to your drug plan during this time. However, whichever one stands last on December 7 is the one that sticks and goes effective January 1.
This time period means anything drug plan-related can be changed. Anything Medicare Advantage-related can be changed. Yes, Mrs. Jones, that drug plan that you signed up for in 2006 could be adjusted every year if you wanted to. So often, beneficiaries sit on their Medicare drug plans for their entire life. You don’t have to! There are generally 25–35 PDP options in your area each year with no health questions or requirements!
This isn’t a ploy to just get you to change, but it’s really just an opportunity: If one of your medicines costs you way too much, your premium has shot up, the company you’re with has merged plans or changed names, one or more of your medicines is not covered, or some other reason not mentioned, you have choices! This can sometimes save thousands of dollars. No joke.
In addition to drug plans, Medicare Advantages are now a completely guaranteed issue. Until January 1, 2020, anyone with ESRD (End Stage Renal Disease) could not enroll in a Medicare Advantage plan outside of their initial enrollment or SEP. Now MA/MAPD is a guaranteed issue, meaning they ask zero health questions.
And yes, during this time, you can also adjust your Medicare Supplement plan. It’s a great time to do it all at once because it’s all connected. But just don’t feel trapped like you can’t make a change during the year.
This is a newer enrollment period (2019), so many do not know this even exists. MADP (Medicare Advantage Disenrollment Period) was similar to this, but it only ran from January 1-February 14. It was clunky and confusing to implement, so they tweaked it for the better and gave people a real chance to figure out their plan and make an informed decision about a change.
OEP was created because of the whirlwind of AEP. Many beneficiaries get on a new plan and immediately decide they absolutely hate it. Well, OEP is a great tool that anyone on an MA/MAPD can use to get out of that bad deal. During the first quarter of the year (January 1-March 31), anyone on a Medicare Advantage can come off of their plan and choose to go on another Medicare Advantage or purchase a standalone prescription drug plan.
This is huge. If you are on a Medicare Advantage and didn’t know this, you now have three more months per year to decide what you want to do, or more importantly, make a change from a hasty decision that you previously couldn’t undo in earlier years.
Not sure if you’re on a Medicare Advantage? 40 percent of Medicare-eligible persons are on these plans, and that number continues to grow.
In addition to all of these random times throughout the year to enroll, did you know there are still possible options for you to enroll in a new plan? Absolutely.
A SEP is just an acronym that essentially means certain people qualify because of certain circumstances in their life.
The most common SEP would be Low-Income Subsidy/Medicaid. Roughly 1-in-4 enrolled in Medicare qualify for LIS or Medicaid. Many more probably could get it and don’t realize they may qualify. Regardless, anyone on LIS or Medicaid can change their plans once a quarter. Because of such a tight situation financially, they are allowed much more flexibility to change than someone who lives a little more comfortably each month.
Another very common SEP would be moving out of the plan service area. If you move out of your county of residence, you are fairly likely to trigger a SEP for moving. If you move out of state, you definitely do. When you move, if you are no longer able to use the plan that you signed up for in the state you signed up in, it’s time to change plans.
When you move and receive a SEP, you are now completely open to enroll in any plan you want again within state and company guidelines. This means if you were on a Medicare Advantage with cancer or some other chronic illness, no problem. You can now get a supplement. Of course, if you moved from Buford, Wyoming, to New York City, or vice versa, your Medicare and general healthcare options are going to be completely different.
You can’t control your options available when you move, so, therefore, you have a new opportunity to enroll in whatever you want at that point!
So no big deal, if you want that MedSupp you’ve always dreamed of, just move out of the area and you’re good to go!
The other extremely common SEP would be coming off of group coverage. Say you’re 70 and you’re finally done working. You’ve been on your group coverage and with hanging the boots up comes losing your insurance. Well, it’s not your fault that you’re motivated. You would qualify for a Special Election Period and you can then enroll into any plan you want, given that your plan at work was creditable coverage, you were not enrolled in Part B, and sometimes other factors play a role, as well.
There are still other SEPs available as well. For example, coming in and out of a nursing home, coming out of jail, your plan is discontinued, trial right (coming off of a Medicare Advantage after previously being on a supplement since qualifying for Medicare), or natural disaster.
With a combination of COVID and natural disasters in the past year and a half, a good portion of the country has had disaster relief options for flooding, hurricanes, tornadoes, and the global pandemic in the form of SEPs for their Medicare enrollment.
So How do I Physically Change Plans?
There are plenty of methods to enroll. If you know exactly what you want, you can go straight to the companies you want and get signed up. You can go to Medicare for your drug plan. If you’re incredibly savvy, doing this on your own may be no problem, and you have every right to do that. You can generally do a paper application, a phone application, or you can do it on a computer. If that’s you and you’ve got this, have at it. We won’t stop you and we wish you the best.
However, a word of caution. Every insurance agent or advisor worth their salt has helped someone after they tried to do it themselves because they made a crucial mistake that an expert would never make. What we would highly suggest is to consult with someone who knows what they’re doing. It costs you no more to write it with an agent or advisor than doing it on your own.
Statistics say a vast majority of people prefer to work with someone, they have no clue where to start, or they’re some combination of both. If you’re in that vast majority, find an agent that is well-versed in Medicare and will talk to you about everything you need to know and isn’t rushing you out the door for the next one.
Any insurance agent fully licensed in Medicare has gone through hours of training and retraining and likely has done it in the real world for multiple years. It’s difficult to replace that type of experience, but if you feel up to it, go for it!
What if I Really Can’t Change My Plan?
Maybe you’re one of the very few who can or shouldn’t change their plans. There are some people like that, without question, especially at certain times of the year. Perhaps you’re getting later in the year and you’ve hit the dreaded “donut hole”. There are ways to mitigate or eliminate costs. What if you’re stuck in a plan for at least a few months or the entire year and your medicine is not covered? There are exceptions that can be filed in most cases with your plan to get the medicine covered.
What if you’re not healthy enough to change supplements? Have you tried Medicare Advantage or looked at your options? Have you looked at your drug plan to see if you can save on your medicine? Have you applied for extra help? These are all moves that can be done without changing plans.
Also, something I touched on slightly but didn’t emphasize above is a “trial right”. Hopefully, this is a much more well-known tool to most insurance agents, but I know we were some of the first ones to really use it significantly in our market. But a “trial right” is a one-time opportunity in your life to “try” a Medicare Advantage. If you have always been on a supplement since turning 65 or since coming off the group, you likely qualify to take an opportunity to go on a Medicare Advantage and then hop off within a year and go back to a supplement. Some companies will allow you to come to their company even if you weren’t with them before. Again, who is going to know these tricks besides someone that works with them day in and day out?
There are so many tricks and tips out there. You may be able to find many ideas by Googling (or using your search engine of choice), but not all are easily accessible and in one place.
So What’s the Point?
Don’t give up!!!
Medicare is a multi-layered beast. There are so many theories, beliefs, myths, and legends about Medicare. If you’re at that age or approaching it, you’ve probably heard friends or family talk about this plan or that plan. The truth is, everybody’s different. Different people have different incomes and different budgets. Don’t fall into the trap of trusting a neighbor or family member’s word without doing your own research. Your situation is not theirs. They may have options you don’t and vice versa.
Although it seems like a brick wall, an army you can’t fight, an impossible task, and whatever other comparison you want to make, Medicare is also more fluid than you think. It can be played to your advantage if you let it and know how to work it. You usually can find a way out of your current predicament if you look around.
Now, of course, you may be the rare exception that cannot improve their situation in any way, policy change wise. However, the vast majority of people can find a way to improve their scenario, even if it doesn’t involve immediately changing a plan.
Don’t give up hope! You’re not stuck forever. You’re not eternally stuck in neutral. There is always a better solution. The key is finding it and activating it.