Part D Special Enrollment Periods

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Understanding Part D special enrollment periods

Most everyone knows that when you are about to become eligible for Medicare you should choose a Medicare approved drug plan.  What many people don’t know is that Medicare Part D enrollment is not limited to first becoming eligible for Medicare or taking advantage of the Annual Enrollment Period (AEP) that takes place between October 15th and December 7th.

As a Medicare beneficiary you may be able to take advantage of a Part D Special Enrollment Period (SEP) where you are able to change your Medicare Part D enrollment outside of the Annual Enrollment Period.

Part D Special Enrollment Period explained

You are eligible for both Medicare and Medicaid. Also know as being dual eligible, you are able to join, change or drop prescription drug coverage anytime.

You qualify for extra help paying for your Part D coverage. You have the right to join, change or drop prescription drug coverage anytime.

You are enrolled in a State Pharmaceutical Assistance Program. You can join a prescription drug plan once during the calendar year.

You dropped a Medicare supplement (Medigap) the first time you enrolled in a Medicare Advantage Plan. Within the first 12 months of being enrolled in the Advantage Plan, you can drop that plan, return to original Medicare and pursue Medicare Part D enrollment.

You have a severe or disabling condition and there is a Chronic Special needs Plan available for you condition. You can join a Chronic Special Needs Plan that will  include Part D prescription drug coverage. You can join anytime, but have lost your ability to make additional changes until your Annual Enrollment Period.

You no longer qualify for a Chronic Special Needs plan because you no longer have the qualifying health condition. You can switch plans, but only have 3 months from losing your Chronic Special Needs Plan to do so.

You joined a plan or chose not to join a plan due to an error by a federal employee. You have 2 months from the time you receive the notice of the error to chose another plan or drop prescription drug coverage.

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You were not informed that your other private drug coverage was not not as good as a Medicare Part D Plan. You have 2 months to join a plan from the date that you receive notice of the error from Medicare.


You were not informed that you were losing private drug coverage that was as good as Medicare Part D coverage. You have 2 months to join a plan from the date that you receive notice of the error from Medicare.

You move to a new address that is not in your plan’s service area or, is in the service area, but you have other plan options. If you inform you plan prior to your move, you have one month before the move and 2 months after the move to change you Medicare Part D enrollment. If you inform them after you move, you will have the remainder of the month in which you inform them and an additional two months to make a change.

You move back to the USA after living outside of the country. You have 2 full months after the month that you move back to join a plan.

You reside in, or are moving into or out of a skilled nursing facility or meet the institutional level of care. You can join, switch or drop plans anytime you are confined to a skilled nursing facility or for 2 full months after the month that you move out.

You leave employer group or union coverage, including COBRA. You have 2 full months after the month that you leave your prior coverage to pursue a Medicare Plan or Medicare Part D enrollment.

You involuntarily lose your other drug coverage that is deemed creditable drug coverage or you plan changes and your other drug coverage is now considered non-creditable coverage. You have 2 full months to enroll in a Part D Plan after the month you coverage ends.

You have drug coverage through a Medicare Cost Plan or have a PACE plan and drop coverage. You have 2 full months to enroll in a Part D Plan after the month that you leave your previous plan.

You are no longer eligible for your State’s Medicaid program. You have 2 full months after the month that you are deemed non-eligible, or if you lose your Medicaid coverage for the following year, you can switch between January 1st and January 31st.

You are enrolling in other creditable drug coverage, such as VA or Tri-Care. You are able to drop your Part D anytime.

You have the opportunity to enroll in other coverage offered by your employer or union. You are able to make a change whenever you are offered this coverage.

Your Medicare  Advantage Plan or prescription drug plan is not renewed for the following year. You can make a change between October 1st and January 31st.

Medicare terminates your plan’s contract. You can switch until 1 full month after you plan is terminated.

You are released from jail. Your chance for Medicare Part D enrollment lasts for 2 full months from the month that you are released from jail.

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Keeping it all straight

As you can see it’s not all about having a choice during the AEP. Only by being aware of your Medicare Part D enrollment options can you maximize your opportunity to get the best plan.

The above list of Part D Special Enrollment Periods demonstrates that it is normally when you experience some type of change in your status or the status of you current plan that you can make a change. Visit the Medicare website to learn more.

 

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