What to do if you miss Medicare’s Open Enrollment

October 4, 2021

Medicare’s enrollment periods can quickly get confusing. In this article, we’ll go over the Open Enrollment Period. Depending on your policy, there are only certain times of year that you can cancel, switch, or enroll in a new plan. Let’s break them all down:

  • Initial Enrollment 3 months before your 65th birthday – 3 months after your 65th birthday
    • For those newly eligible for Medicare
    • Sign up for Medicare (Part A and Part B)
    • Choose a Medicare Advantage Plan
    • Enroll in a Prescription Drug (Part D) Plan
  • Open Enrollment – Jan. 1 – Mar. 31
    • For Medicare Advantage policyholders
    • Switch to a different Medicare Advantage Plan
    • Switch from a Medicare Advantage Plan to Medicare 
      • If doing this, you can also enroll in separate Prescription Drug (Part D) Plan at this time
  • Annual Enrollment – Oct. 15 – Dec. 7 
    • For all Medicare beneficiaries
    • Switch from Medicare to a Medicare Advantage Plan or vice versa
    • Change your Medicare Advantage Plan
    • Change your Prescription Drug (Part D) Plan
    • Enroll in a Prescription Drug (Part D) Plan

If you missed Medicare Open Enrollment…

The Open Enrollment Period happens annually from Jan. 1 – Mar. 31 and is exclusively for Medicare Advantage policyholders. This is the time of year that you can change your Medicare Advantage plan or enroll in Original Medicare (Parts A and B) instead. If you have a Medicare Advantage plan and missed this enrollment period, you may have to wait until the Annual Enrollment Period (Oct. 15 – Dec. 7) to leave your plan. However, there are a few options you can explore that will allow you to make changes before that time.

See if you qualify for a Special Enrollment Period

If you have a major life event, you may qualify for a Special Enrollment Period. Things like moving out-of-state, retirement, change in marital status, or loss of insurance can qualify for this enrollment period.  You will be able to change plans and enroll in new coverage following a qualifying life event. 

See if you qualify for a Special Needs Plan

If you’re wanting to change health care plans to get a plan that better meets your medical needs, you may want to look into a Special Needs Plan. 

Special Needs Plans are Medicare Advantage plans that cater to people with certain health conditions. These include:

  • Chronic alcohol or drug dependence
  • An autoimmune disorder, such as lupus
  • Chronic heart failure
  • Diabetes mellitus
  • End-stage renal disease needing dialysis
  • HIV or AIDS

Call 1-800-MEDICARE (1-877-486-2048) or your local State Health Insurance Assistance Program to learn whether you could qualify for a Special Needs Plan.

Speak with your doctor about prescription alternatives

Many people change plans during the Open Enrollment Period because their current plan doesn’t cover the drugs they take. If you can’t change your plan, consider changing your prescriptions.

You should never make this decision without medical advice. Because the Medicare Modernization Act requires every plan with prescription drug coverage to cover at least two drugs in any drug class and category, you can likely find something similar to treat your condition at a lower out-of-pocket cost. Speak to your doctor about drug alternatives and make the switch under his or her care.

SmartMatch can help 

Free Medicare consultations, resources, and enrollment services are just a phone call away. SmartMatch makes it easy to find a plan that best fits your unique health care needs and budget. Visit our Plan Comparison tool or call us at (888) 411-7647 to get started.

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