When it comes to healthcare, your needs rarely stay the same. It is, therefore, important to regularly review your Medicare package to evaluate whether it’s suitable regarding cost, coverage, and convenience.
Each year Medicare designates an Open Enrollment Period during which you are free to review your coverage and make any necessary changes to your plan. You have the opportunity to disenroll, enroll or change your:

  • Original Medicare Plan (Part A & B)
  • Medicare Advantage Plan (Part C)
  • Prescription Drug Plan (Part D).

The Open Enrollment Period runs for two months from October 15th until December 7th, with your new coverage beginning on the 1st of January. However, what happens if your circumstances change well before October, and your Medicare Part D plan is no longer suitable? In most situations, Medicare only allows changes during the Open Enrollment Period. Fortunately, though there are some exemptions:

Special Enrollment Periods

Special Enrollment Periods (SEP) will enable you to make changes to your Part D plan outside of the annual Open Enrollment Period. SEPS are granted for specific life events, such as moving address, getting married, having a child or entering a long-term care facility.

Continuous Special Enrollment Periods

If you’re eligible or enrolled in both Medicare and Medicaid, you are granted a continuous Special Enrollment Period allowing you to switch plans at any time. Changes commence the first day of the month after you enroll in a new plan. Individuals on the Medicare Part D Extra Help or Low-Income Subsidy (LIS) are also eligible for a continuous Special Enrollment Period.

Medicare Advantage Disenrollment Period

If you receive a Medicare Advantage Plan, you are permitted to change your Part D drug coverage during the Open Enrollment Period as well as the Medicare Advantage Disenrollment Period (MAPD), which begins January 1st and ends February 14th each year. To change your prescription drug coverage you must first change your Medicare Advantage to an Original Medicare, and then take out a stand-alone Part D drug plan. Those who want to keep their Medicare Advantage Plan should not use the MADP.

Difficulty Affording Medicare Part D Premiums

In the event, you can no longer afford your Medicare Part D premiums, and you are having difficulty qualifying for a Special Enrollment Period, we recommend applying for Medicare’s Extra Help program. Under the Affordable Health Care Act, the Extra Help program can assist Medicare beneficiaries, with limited resources and income, to make payments on their Medicare prescription drug plan. If you simply stop paying your premiums, you will remain liable for any outstanding debt and may be involuntarily disenrolled from your entire Medicare plan.

Your Options

Most Americans who want to change their Medicare Part D plan outside of the Open Enrollment Period you will need to qualify for a Special Enrollment Period. You can access a complete list of qualifying life events and a quick questionnaire to see if you qualify for a SEP on the healthcare.gov website. Even if you don’t qualify now, an event may be just around the corner.