What to Do If You Missed Medicare's AEP

What to Do If You Missed Medicare's AEP

Even with the best of intentions, sometimes life can get in the way of your most organized plans. A family emergency, an unexpected trip, or a crisis at your office may have distracted you from the inevitable deadline to make changes to your Medicare health insurance. Despite that reminder on your calendar, December 7th may have come and gone. If you missed Medicare’s AEP (Annual Enrollment Period) deadline to make changes to your insurance coverage, is there any way to make changes to your insurance, or do you have to wait another full year?

Medicare’s Annual Enrollment Period (AEP) starts on October 15th and ends December 7th each year. AEP is generally the only time during the year that Medicare recipients can make changes to their coverage. For instance, during AEP, you can: 

  • Drop Original Medicare and enroll in a Medicare Advantage plan
  • Drop your Medicare Advantage plan and enroll in Original Medicare
  • Change from one Medicare Advantage plan (with or without prescription drug coverage) to another Medicare Advantage Plan (with or without prescription drug coverage)
  • Change from one Prescription Drug Plan (PDP) to another

Once AEP is over, most Medicare recipients will have to wait until the following year to make any changes – and will have to remain with their current insurance coverage until then.

You missed AEP, is there any chance you can make a change before next October 15th?

If you missed Medicare’s Annual Enrollment Period and wished you had made a change to your coverage, you may still have an opportunity to do so during the following periods.

Medicare Advantage Disenrollment Period (MADP): From January 1st through February 14th, the MADP allows Medicare beneficiaries to drop their Medicare Advantage plan and revert to Original Medicare. If you had a Medicare Advantage (MA) plan with prescription drug coverage, you may be concerned about your loss of Part D insurance. If you take advantage of the MADP, you will also have the opportunity to enroll in a stand-alone Prescription Drug Plan (PDP) to help cover the costs of your prescription medications.

Before reverting to Original Medicare, review your current MA plan, your medical expenses from the last year, and any changes in your health you’ve experienced. Have you used the additional coverage offered by the MA plan, such as vision and dental care, hearing exams, or fitness club membership? Did you reach your MA plan’s out of pocket maximum? While Original Medicare (Part A and Part B) helps cover the cost of many medical expenses, it does not include some of the additional benefits offered by MA plans, and it does not have an annual out-of-pocket maximum.

If you decide to revert back to Original Medicare, please note that Part A and Part B do not include prescription drug coverage. The MADP will allow you to enroll in a stand-alone Prescription Drug Plan, but review and carefully compare your options before making a decision. If you currently take medications necessary to maintain or improve your health, make sure those specific drugs are included in the formulary of any PDP you are considering. The formulary is the list of covered drugs – and it can vary from plan to plan. Most PDPs have tiers of pricing, giving you the option to use generic drugs in lieu of brand names for a lower cost. Some plans allow for mail order delivery of your prescriptions. Some Prescription Drug Plans will require you to visit specific pharmacies and suppliers, so find out all the information you need in order to make the decision that is best for you.

Medicare’s Special Enrollment Period (SEP): You may be able to make changes to your Medicare coverage at another time during the year if you are eligible for a Special Enrollment Period.

How do you qualify for a Special Enrollment Period? If you experience certain events in your life, you may qualify for an SEP. These life events can include, but are not limited to:  

  • You moved outside of your current plan’s service area
  • You moved to an area inside your current plan’s service area, but this area offers access to new plan options
  • You moved back to the U.S. after living outside the country
  • You just moved into or out of a skilled nursing facility or long-term care hospital
  • You were just released from prison
  • You were affected by natural disasters specified by the Centers for Medicare & Medicaid Services
  • You left coverage from your employer
  • You have a new opportunity for coverage through an employer or union
  • Medicare has taken official action (“sanction”) against your current plan or terminates their contract with Medicare
  • You are diagnosed with a chronic illness or condition that qualifies you for a Special Needs Plan (SNP) that serves Medicare beneficiaries with that specific condition

If you qualify for a Medicare Special Enrollment Period, you will likely be given a period of time to make the changes you need to your coverage. For instance, if you move out of your plan’s service area, you will have the month you notify the plan of your move, plus an additional two full months, to switch plans. If Medicare terminates their contract with your plan, your chance to switch will begin two months before and end one full month after the contract ends. 

5-Star Special Enrollment Period: During this period of December 8th through November 30th, you may use the 5-Star Special Enrollment Period once to switch to a 5-star Medicare Advantage Plan, Medicare Cost Plan, or Medicare Prescription Drug Plan if one is available in your area.

What makes a plan eligible for “5-star” rating?  Medicare’s rating of 1-5 stars is based on information from member satisfaction surveys, plans and healthcare providers. The 5-star rating is equivalent to “excellent.” The ratings are updated each fall by Medicare, and can change from year to year.

If you missed Medicare’s AEP (Annual Enrollment Period) and are concerned about your healthcare coverage for the upcoming year, review the eligibility criteria for a Special Enrollment Period (SEP). You may find that you qualify for an SEP and can make changes to your coverage outside of AEP’s October 15th - December 7th timeframe. If you qualify, take the time to research, review, and compare your options carefully. Thanks to online plan comparison tools, it is easier than ever to find the Medicare Advantage Plan that will best meet your specific needs and preferences. You will have access to detailed plan information, including costs and benefits, so you can make an informed decision during your Special Enrollment Period. If you are looking for prescription drug coverage during your SEP, use these online tools to research plan formularies and costs. If you missed AEP and get a second chance to make a change to your coverage, you deserve to find the Medicare insurance that is right for you. 

Related Information:

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10 Benefits of Using a Medicare Broker to Help Pick a Plan