Medicare Options During Open Enrollment

October 29, 2013
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The following guest blog has been provided to us by Kevin Lawrence. Mr. Lawrence is a Senior Health Insurance Representative and was kind enough to share information with our readers about when an Individual is allowed to make changes to their Medicare Plans. Since we are currently in the Open Enrollment Period where individuals are allowed to make changes to their Part D and Medicare Advantage Programs (please see previous blog) we thought it would be helpful to know of other instances an individual would be allowed to make changes to their insurance plans. If you should have any questions, please feel free to reach out to Mr. Lawrence at 516-524-8863 or

IS IT TIME FOR A CHANGE, WHAT ARE MY OPTIONS?…Special Enrollment Periods (SEP) for Medicare Advantage Plans and Medicare Part D Drug Plans.

There are specific timeframes when you can join, change, or leave Medicare Advantage Plans and Part D Drug Plans, KNOWING THOSE TIMES CAN MAKE IT AN EASY TRANSITION FOR YOU!

*Initial Enrollment Period (IEP). This is when you first become eligible for Medicare. An example is when you TURN 65.

*Annual Enrollment Period (AEP) From October 15ththrough December 7th.We are currently in this season. During this period, you can change, drop, or enroll in a different Medicare Advantage or Part D Drug Plan.

*Medicare Advantage Disenrollment Period. January 1st through February 14th. This period allows you to drop your Medicare Advantage Plan and return to Original Medicare with or without a stand alone Medicare Part D plan. You can not change to another Medicare Advantage Plan during this period.

*Other than these periods, you can only change your health coverage or Part D Plan through a SEP.

The following are examples of the SEP’s along with a brief description of each of them.

1. You choose to change or you lose employer/ union coverage through current or former employment.

2. You are institutionalized. You move into, or are released, from a qualified institutional facility. These types of facilities include a skilled nursing, nursing homes, psychiatric hospital, etc. When you move into the facility, you can change your private health or drug plan. In addition, you have two months to change your private health plan or drug plan when you are released from the facility.

3. You enroll in a State Pharmaceutical Assistance Program. This SEP can only be used once per year. You can join a private health or drug plan for the first time or change your private health plan or drug plan. You may not drop drug coverage during this SEP.

4. You have Extra Help, Medicaid, or a Medicare Savings Program. This SEP allows you to enroll, change or disenroll from a private health or drug plan. If you have Medicaid or a Medicare Savings Program, you have the ability to change your plans monthly as long as you maintain qualified levels.

5. You permanently change your address. If you move outside of your plan’s service area.

6. You are eligible for a Special Needs Plan (SNP) or lose eligibility for your current SNP. If you have a chronic condition, you can change to a chronic care SNP at any time.

7. Your plan no longer offers coverage. If your plan will not offer coverage for the following year, they must inform you by October 1st. The SEP for this situation includes the AEP time and continues on to the last day of February of the following year. If your plan coverage is terminated during the year, you can switch to another plan at that time.

8. You want to enroll in a five star MAPD or Part D Drug Plan.

9. You are enrolled in a consistently underperforming Medicare Advantage Plan. You will receive a letter from The Center for Medicare and Medicaid Services (CMS) in October that your plan has been ranked lower than three stars for three consecutive years. You will have the rest of the calendar year as well as the following year to change to a plan that is rated higher than three stars.

10. Your current plan violated a material provision of the contract. If CMS determines that a violation has occurred, you will be able to choose another private health plan or go back to original Medicare and pick up a Part D Plan.

Knowing your SEASONS of ENROLLMENT will assist you in the transition from your current plan to a Medicare Health Plan. It is important to review your needs to find the most comprehensive, suitable and affordable Health Plan for you.


….A way to start is to put a list together of your current Doctors, Prescriptions and other important needs you may have. Comparing plans is important so that you have the coverage you are looking for. There are many carriers and types of plans to choose from like HMO’S AND PPO’S, REVIEW YOUR LIST to see if your Doctors participate in that plan as well as your Prescriptions being covered. So some due diligence is necessary to give you the coverage and peace of mind you are looking for.

Stay Healthy and Happy!

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