Fred Goldenberg: Pleasant surprise: You’ve got a 'do over'

Fred Goldenberg

Remember when you were a kid and you were playing a game and you didn’t like the out-come so you’d yell “Do Over?” Once in a while you’d get your way and you’d get a second chance.

In the world of Medicare and Medicare supplemental coverage, a “do over” is rare.

When you turn 65 you have you Initial Enrollment Period (IEP). There is the Annual Enrollment Period (AEP) that runs between October 15 until December 7 when you can change your Medicare Advantage plan or your Prescription Drug plan.

If you delayed signing up for Part B Medicare coverage, you can sign up from January 1 until March 31, with coverage starting on July 1 (penalty fees will apply). But if you delayed signing up for Part B because you had another source of coverage, like an employer health plan, you get a Special Enrollment period that looks just like your IEP — which it is.

If not already confusing enough, the Center for Medicare and Medicaid Services (CMS) has added the Medicare Advantage Open Enrollment Period (MA OEP) that will occur each year from January 1 through March 31. The following is from CMS and Medicare.gov websites:

— During the MA OEP, you can switch from your Medicare Advantage Plan to another Medicare Advantage Plan or to Original Medicare with or without a stand-alone prescription drug plan. Remember, you can only use this enrollment period if you have a Medicare Advantage Plan.

— If you go back to Original Medicare you’ll only have Parts A & B and will need to add a supplement that will be medically underwritten.

— Before making any changes, make sure you know how changing your health and drug coverage will affect you.

— Changes made during the MA OEP are effective the first of the following month. For example, if you switch from a Medicare Advantage Plan to Original Medicare and a stand-alone Part D plan on February 10, your new coverage will begin March 1.

If you have Extra Help:

— Extra Help is a federal program that helps pay for some or most of the out-of-pocket costs of Medicare prescription drug coverage. If you have Extra Help in 2019, you have a Special Enrollment Period (SEP) to enroll in a Part D plan or switch between plans.

— This SEP is available once per calendar quarter for the first three quarters of the year (January-March, April-June, and July-September). If you use the Extra Help SEP to change your coverage, the change will become effective the first of the month when you make the change. For example, if you use the Extra Help SEP to choose a new Part D prescription drug plan in March, that plan will become effective April 1.

— This is a change to the Extra Help SEP, which previously could be used once per month. If you have Extra Help, these new limits may mean that you are locked into a drug plan at certain times of the year.

If you qualify for another Special Enrollment Period (SEP):

— There are several circumstances in which you may be able to make changes to your Medicare health or drug coverage, like if you move outside of your plan’s service area, if your Medicare Advantage Plan terminated a significant amount of its providers, or if you enroll in certain State Pharmaceutical Assistance Programs (SPAPs).

— If you need to make changes to your coverage but you are not sure whether you qualify for an SEP, call your State Health Insurance Assistance Program (SHIP) to learn more. To contact your SHIP, call 877-839-2675 or visit www.shiptacenter.org

What it boils down to is if you have a Medicare Advantage plan, new or old, and you are unhappy with your choice, but didn’t do anything about it during the AEP you get a “Do Over.”

Why not just make one Open Enrollment Period going from October through March and call it one thing? I don’t know.

But if you’re unhappy with your plan, old or new, you now have a “do over” and that’s a good thing. Call me to see if this makes sense for you.

Fred L. Goldenberg is a Certified Senior Advisor (CSA) and the owner of Senior Benefit Solutions, LLC, a financial services and certified health insurance organization in Traverse City. Questions or comments about this column or interest in our February Medicare 101 classes can be directed to (231) 922-1010 or fred@srbenefitsolutions.com.