Today I spent the day monitoring phone calls from my company’s Medicare Part D plan enrollment call center. Several seniors who called to enroll in our plan said they were very confused about the Open Enrollment deadline, especially those people who are eligible for both Medicare and Medicaid.
To help clear up some of this confusion, here is some basic information about when you can enroll in a Part D plan or switch Part D plans. In a nutshell:
• Most people can enroll in a Part D plan when they first become eligible for Medicare and then once a year after that during Open Enrollment if they want to switch plans.
• People who receive both Medicare and Medicaid can enroll when they first become eligible and then once a month after that if they want to switch plans.
Enrolling for the first time: Turning 65 or new to Medicare
If you are new to Medicare, it’s important to enroll in a Part D plan as soon as you become eligible (during your Initial Enrollment Period) to avoid paying any late-enrollment penalties. When first eligible for Medicare, you have a full 7 months to enroll in a Medicare Part D plan:
• Up to 3 months before you turn 65
• During the month of your 65th birthday
• Up to 3 months after you turn 65
If you join a prescription drug plan during the 3 months before you turn 65, your coverage will start on the first day of your birth month. If you join during or after your birth month, your coverage will begin on the first day of the next month.
Here are 3 examples to show you when your coverage will go into effect:
Let’s assume your 65th birthday is May 3, 2012. That means your Initial Enrollment Period is from February 1 – August 31, 2012 (3 months before to 3 months after your 65th birthday).
1. If you join a Part D plan before your birth month (February 1 – April 30, 2012)
Your coverage will begin the first day of your birth month: May 1, 2012
2. If you join a Part D plan during your birth month (May 1 – May 31, 2012)
Your coverage will begin: June 1, 2012
3. If you join a Part D plan after your birth month (for example, July 1 – July 31, 2012)
Your coverage will begin: August 1, 2012
When you can switch Part D plans
If you are already enrolled in a Part D plan, you can generally switch plans only once a year during Open Enrollment (also called the Annual Election Period). Open Enrollment runs from October 15 through December 7 for the 2012 plan year. Outside this time period, you may make other changes during the year only if you qualify for a Special Enrollment Period (SEP).
For example, you may qualify for an SEP for the following reasons:
• You lose creditable coverage (that is, coverage as good as or better than Medicare) through no fault of your own (for example, your former employer or union stops providing coverage for retirees)
• You move to a new permanent address that is not in your current plan’s service area
• Your current plan no longer offers Part D coverage
• You receive Medicaid or get Extra Help with Part D costs
• You are enrolled in a State Pharmaceutical Assistance Program (SPAP)
Dual Eligibles can switch plans once a month
If you have both Medicare and Medicaid, you are considered a “dual eligible” individual. “Dual eligibles” may change plans once every thirty days. You can ignore the Open Enrollment dates and the December 7th deadline because they do not apply to you.