To regulate traffic for new entrants to Medicare and renewal candidates, Centers for Medicare and Medicaid Services have set in stone rules of the road for both types of candidates that all contracted insurance carriers have to abide by, and so do these candidates as well. They are :
When you are new candidate to Medicare
When you are about 3 -4 months short of your birth month, you will get a much awaited ‘red-and-blue’ card from Social Security Administration. Check that start date of Part A and Part B is there on it. If not, call Social Security or Medicare.gov and sign up for Part B and Part D. You need all three components of Medicare insurance, viz. Part A, B, and D.
About 3 months before your birth month, you can shop for buying a Medicare Advantage plan. If you have done your homework well, your Plan begins on the first of your birth month. It is time for celebration. Even if you have missed or delays by as much as 3 months, after your birth month, you are still entitled to enroll in Medicare Advantage plan. Your insurance begins on the first of following month. If you have missed even this, wait for ‘Open Enrollment’ season to begin, as it does for renewal candidates.
When you are a candidate for renewal, change or modification of your Medicare Advantage Plan
Mark your calendar to change or modify your current the Medicare Advantage plan:
October 15 – December 7: This is open season for to make changes to your current Medicare Advantage plan: 1) with the same carrier, 2) switch carrier and enroll in a new plan, 3) drop Medicare Advantage plan and switch to another plan like Medicare Supplement or, 4) revert back to Original Medicare and add standalone Prescription Drugs Plan, You do have to give any reason to switch your plan. If you want to continue with the same plan and carrier you are enrolled with, you do not have to do anything; you will be re-enrolled automatically in the same plan for next year. All changes with take effect on January 1st.
January 1 – March 31: This Open Enrollment Period is available to currently enrolled Medicare Advantage members to make following changes to their current plan:
– Switch your current Medicare Advantage plan to another Medicare Advantage plan, with or without drug coverage.
– Disenroll from current Medicare Advantage plan and switch back to Original Medicare, with or without standalone Prescription Drugs Plan.
– Members enrolled in standalone Prescription Drugs Plan are not eligible to make changes.
What if you run into Special Events?
When there are circumstances and events in your life that compel you to make changes to your Medicare health coverage, Medicare accommodates you to initiate and make changes to your existing Medicare health plans. In parlance of Medicare, such ‘Qualifying Events’ trigger Special Enrollment Period [SEP]. It is best to call Medicare at 1-800-633-4227 and find out if you can have this Special Enrollment Period [SEP] approval to make changes. Make note of the reference number that you get and its applicability timeframe within which you can initiate changes in your health coverage plan. Such qualifying events are categorized as follows: Read on…
Changes in where you live: If you have moved out of service are of your current plan; moved back to the U.S. from living abroad; moved to or moved out of an institution like nursing facility, etc.
Losing current coverage: This could be due to a number of reasons like you lost your Medicaid coverage, you are not eligible for Extra Help any more, you left coverage from your employer or union, you lost your drugs coverage that was as good as Medicare standards, etc.
Changes in Your Current Plan: If either the carrier pulls out plan from its service area, or the plan terminates with Medicare, you may initiate for new enrollment option with Medicare by calling 1-800-633-4227.
Changes Due to Special Situations: There may be circumstances that compel you to make changes to your Medicare health plan. Some typical changes in your situation can be:
You become eligible for both Medicare and Medicaid.
You qualify for Extra Help paying for Medicare prescription drugs coverage.
You are enrolled in State Pharmaceutical Assistance Program [SPAP] and you lose this eligibility.
You have severe or disabling medically chronic condition that and there is a Medicare Chronic Care Special Needs Plan (SNP) available that will serve you better.