What You Need To Know About Medicare Special Enrollment Periods

Medicare Special Enrollment Periods

Paul Simon claimed there were ’50 Ways to Leave Your Lover’, but what about your Medicare Health Plan?  Most people believe they can only change their Medicare Health Plan during the Annual Enrollment Period (between October 15th and December 7th for Part D prescription drug coverage and Medicare Advantage plans, and the month of their birth for Medicare Supplements).  These are not your only opportunities to change your Medicare plan.

The Center for Medicaid and Medicare Services (CMS) allows for Special circumstances for Special Enrollment Periods (SEP).  Their site lists 25 unique opportunities1 to change plans mid-year, not nearly as many as Paul bragged about but enough to give folks who need to change the opportunity.  In my many years in the Medicare industry, I or my teams have used most of those SEP’s. 

Changing from Medicare Advantage to a Medicare Supplement

Recently, I had a man who had moved from out-of-state.  He was on a Medicare Advantage plan and liked the extra benefits and the copays.  His family wanted him to work with Dr. Coelho in Gilroy who only accepts Medicare Supplements. Generally, once you join a Medicare Advantage plan you change to a Medicare Supplement without qualifying medically. His move entitled him to a Special Enrollment Period for his Part D plan and a Guaranteed Issue for a Medicare Supplement. His premium was significantly higher on the Medicare Supplement vs. the Medicare Advantage plan, but this allowed him to see the Doctor his family preferred.

Yes, You Can Take a Medicare Mullligan

The most frequently used Special Enrollment Period (SEP) is the Medicare Advantage Open Enrollment2. Just like a golfer can take a mulligan when their shot goes awry, CMS offers people on Medicare Advantage Plans the chance to make limited changes between January 1st and March 31st. During this time a beneficiary may change from one Medicare Advantage plan to another (with or without drug coverage) or from a Medicare Advantage plan to original Medicare with a Part D prescription drug plan.

Allow me to share examples of how I have helped folks save money or find a more appropriate plan using the Medicare Advantage Open Enrollment Period.

  • Moved a client from one Diabetes Special Needs Plan to another without a premium, saving her over $600 a year.
  • A client discovered his primary doctor no longer accepted his current plan, he switched to a plan his doctor accepted.
  • An acquaintance called about plans with rebates on his Medicare Part B, he became a client and saved over $1500 a year.

The Medicare Advantage Open Enrollment is an annual opportunity to change plans that may be used once each year.  The Center for Medicare and Medicaid Services (CMS) created this to ensure beneficiaries are in the best fitting plan.

Special Plans for Special Needs

A few years ago, I met a woman with Diabetes who was turning 65 and was worried that she would not qualify for a Medicare Advantage plan due to her health issues.  Pre-existing conditions don’t affect eligibility for Medicare Advantage plans! Many Medicare insurance companies offer Chronic Special Needs Plans (C-SNP) for people with specific health issues. These plans are tailored to meet the unique health needs of people diagnosed with a variety of illnesses such as diabetes, lung issues or heart disease.  Medicare beneficiaries are allowed a one-time opportunity to choose a Medicare C-SNP.

Medicare with MediCal/Medicaid

There are Medicare Advantage Plans created for people with Medicare and MediCal; these plans offer unique benefits that are considered social determinants of health, such as healthy food, pest control or transportation.  Dual beneficiaries have three SEP opportunities throughout the year.  This Special Election Period is available once a quarter for the first three quarters of the year, in the fourth quarter dual beneficiaries may use the Annual Enrollment Period from October 15th to December 7th.

Getting the Most from Your Medicare with Special Enrollment Periods

If you’re not confident you’ve made the right decision for your Medicare benefits for 2022, you may have an opportunity to change. It helps to have a local Medicare Specialist as a guide. Medicare beneficiaries can turn to their local HICAP office (Health Insurance Counseling Advocacy Programs) or find a qualified local Medicare Specialist who understands the local Physicians, Medical Groups, and insurance options.

medicare special enrollment periods

Cheri Brown is a former executive with a national insurance carrier with decades of experience in Medicare sales and training.    Email her at MedicareCheri@gmail.com. Not affiliated with the U. S. government or federal Medicare program. A licensed agent may contact you regarding this insurance-related information. This is a solicitation for insurance.

  1. https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances-special-enrollment-periods
  2. https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan

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