Here is what you must know if you wish to change Medicare Benefit Plan


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Yes, Medicare’s annual enrollment period ended on December 7th.

No, all hope is not lost when you find that the benefit plan you have chosen for 2021 does not match.

This is because Medicare has a three-month window at the beginning of each year from January 1 to March 31 when you can swap your benefit plan for another or drop it and return to Medicare (Part A Hospital Insurance and Part B Outpatient Coverage)).

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“The most common reason people change is because they change during the [fall enrollment window] without realizing that one of their doctors is off the network or one of their drugs is not on the prescription, “said Danielle Roberts, co-founder of the insurance company Boomer Benefits.

Also from January 1st to March 31st, if you missed your first Medicare registration period and do not qualify for an exemption, you can register during that time. If this is your situation, coverage won’t start until July 1, said Elizabeth Gavino, founder of Lewin & Gavino and independent broker and general agent for Medicare plans.

Of the 63 million or so Medicare beneficiaries, around 25 million are enrolled in a benefit plan that includes Parts A and B, and usually Part D for prescription drugs, as well as extras such as teeth and eyesight.

The upcoming three-month opportunity to change or drop your benefit plan will come just weeks after Medicare’s annual fall registration ends, when a multitude of options were available for those looking to change their coverage.

In contrast, the upcoming window related to the benefit plan has limitations.

For starters, you can only do one switch. This means that the change will generally be locked in 2021 as soon as you switch to another benefit plan or delete it for basic Medicare (unless you meet an exclusion that qualifies you for a specific registration period).

Additionally, you cannot switch from one standalone Part-D prescription medication plan to another in that three month window.

In the fall, if you selected a Part-D plan based on inaccurate or misleading information, anytime during the year you can call 1-800-Medicare to see if your situation allows you to make changes.

In the meantime, deleting a benefit plan in favor of Basic Medicare often means losing drug coverage – which means you have to sign up for a standalone Part-D plan. This is important because if you remain uncovered for 63 days, you face a life penalty for late enrollment that will affect your monthly premiums.

If you switch back to Original Medicare and want to get supplementary insurance (also known as “Medigap”), be aware that you may not be eligible for guaranteed coverage. These guidelines cover all or part of the cost sharing of some aspects of Parts A and B, including deductibles, co-payments and co-insurance. However, they have their own rules for signing up.

If someone is planning to go back to the original Medicare and get a Medigap plan, they should be aware that they will likely have health questions to answer.

Danielle Roberts

Co-founder of Boomer Benefits

“If someone plans to go back to the original Medicare and get a Medigap plan, they should be aware that they will likely have health questions to answer and go through the underwriting,” said Roberts.

She recommends starting the process by applying for the Medigap plan and getting approval before leaving the benefit plan or signing up for a standalone Part-D plan.

“If you sign up for the Part-D plan, you will be removed from the Medicare Benefits Plan, so it’s important to wait for that part as well,” said Roberts. “We encourage people who need to make changes to do so at the beginning of the legislature.”

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