SEP and Medi/Medi Plans

Let’s talk about Medicare (SEP) Special Enrollment Period and then we will discuss Medi /Medi Plans. There are many SEP circumstances that can happen in your life that would prompt you to change your Medicare Plan but for now we will discuss the most common SEP’s. If you have a Medicare Advantage plan and you move to another service area that would be a reason to change especially if you move out of state. You will want to have a plan that is geared more to that new area in terms of Doctors, Specialists, and Hospitals. If you move to a new service area that is not necessarily out of state but offers other plan options you may want to join that new plan. If you move back to the US after living outside the country you have a 2 month window at that time to enroll in Medicare Advantage or a Prescription drug plan.

Let’s just say you are currently covered under a group plan through your employer or Union, including Cobra coverage, and you already have your card showing Medicare Part A which you received when you turned 65 but now you’ve decided, for whatever reason, to go onto Medicare. That would qualify you for a Special Enrollment as long as you are coming from creditable Medical and Drug coverage. You can delay enrolling in your Part B for as long as you are still covered under your Employers Group plan. You would simply decide when you want your group coverage to end. Once you’ve determined that you would then apply for your Medicare Part B to start the day after your group coverage is expected to end. Once you receive your Medicare card with both Part A and Part B then your agent is ready to help put the other pieces into place and you have many options that your agent can discuss with you. Your new coverage would coincide with your Medicare Part B start date. If you are released from jail you also have 2 month SEP to join a Medicare Advantage or Prescription drug plan. If you lose your current coverage due to no longer being eligible for Medicaid your chance to change lasts 3 full months from the date you are no longer eligible or notified, whichever is later. Conversely if you are newly eligible for the Low Income Subsidy or Medicaid you also have a Special Enrollment in which to change your plan.

See the link for more SEP. https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances-special-enrollment-periods

This is not really considered a SEP but still important to know. Let’s say you signed up for a Medicare Advantage plan when you turned 65 and now you want to go back to Original Medicare and take a supplement. As long as you were in the Medicare Advantage plan for less than 12 months you can switch back to Original Medicare and be guaranteed a supplement. That is really not a function of a SEP but of the 12 month trial rule. Nevertheless it’s important to know that you have this “right to try” option and it seems very few people know this. The first and obvious Special Enrollment and it’s really not considered a SEP is really your IEP or your Initial Election Period. The reason it can be looked at as a Special Enrollment is because you can enroll outside of the general enrollment period. When an individual is turning 65 they have a 7 month window to enroll in Part B, 3 months prior, one month during, and 3 months after they turn 65. Once they receive their Medicare card with Parts A&B their agent is ready to enroll them. The choices are Original Medicare and a Supplement or Medicare Advantage.

Let’s touch on Medi/Medi plans for a moment. We already know that Medicare recipients that also qualify for Medicaid are eligible for a Medi/Medi or a Dual Special Needs Plan. Dual because of being eligible for both Medicaid and Medicare, Special Needs because these folks have lower income and have special financial needs. These folks can change their plan every quarter whereas most people must wait for the Annual Election Period to change plans.

So, if you are newly eligible for Medicaid regardless of the time of year or the FL state Low Income Subsidy, you can change your Medicare Advantage plan to one that accommodates your new LIS or Medicaid eligibility. Medi/Medi recipients always get the best coverage because the copayments are usually Zero across the board for nearly all of the plan benefits and again their ability to change every quarter gives them the edge that they need should they be in a plan that is not working for them. Again, these folks have Special Needs both financially as well as from a coverage standpoint. That is to say they are typically not as healthy as folks on regular Medicare Advantage plans. Call us and find out what your best options are. Whether or not you qualify for any of these Extra Help programs we can help you find the perfect plan.

Call Gary to discuss your best options.