What You Need to Know About the Medicare Special Enrollment Period

Things happen that are out of your control.

Changes come that you couldn’t have predicted and you have to re-adjust your sails.

When it comes to your Medicare coverage, the shifts in life circumstances can have a big impact on your coverage.

There’s good news, though.

Medicare allows some wiggle room for those unexpected events by having a Special Enrollment Period  –  or SEP.

There are some rules and guidelines that govern what you can and cannot do.

You should also know why it’s to your benefit to work with an independent insurance agent.

But first, let’s review what you need to know about the special circumstances that affect your coverage.

You’re moving

Making a significant move isn’t normally a decision you make overnight, so you’ll likely have time to figure out what you need to do in terms of your coverage before you go.

Of course, there may be circumstances that require you to make very quick decisions. Either way, you’ll have to weigh your options.

Options

You can switch to a new Medicare Advantage Plan or Medicare Prescription Drug Plan. Your other option is to go back to Original Medicare Coverage.

Timing

The timing of the swap depends on when you alert your carrier to your move.

  • If you notify your carrier before the move, you have from the month before the month in which you move, until two months after you move. For example, if you tell your carrier in May that you’ll be moving in June, the period to make changes begins in May and continues through August.
  • If you inform your carrier after the move happens, your window to make changes begins that month and will continue for two more months.

Of course, the earlier you can take care of your changes, the better. But know that you have options if you don’t let your carrier know about your move until after it happens.

You lose your current coverage

Several scenarios could cause you to lose your coverage. These include a job loss through which you were covered, losing your drug coverage or voluntarily leaving the plan.

Whatever the reason is for your loss of coverage, it’s good to know that you still have choices.

Options

You can join a Medicare Advantage or Medicare Prescription Drug Plan.

Timing

Your specific circumstances may have an effect, but a general rule is that you have two full months after the month you lost coverage in which to secure a new plan.

You have the chance for coverage other than Medicare

You may have an opportunity to secure other coverage. Your employer may offer it, you could be enrolled in a PACE (Programs for All-Inclusive Care of the Elderly) plan or you might be eligible for coverage through an organization such as the VA (Veterans Administration).

Options

In any of these scenarios, you’ll have to drop your Medicare coverage in order to enroll in one of the other plans.

Timing

If your alternate option for coverage is through an employer, you wouldn’t make the switch until the new policy kicks in.

If you’re switching for one of the other reasons, you can drop your coverage at any time.

Medicare changes their contract with your plan

Medicare can terminate their contract with your plan at any time. While it’s a frustrating development, you have choices.

Options

You will need to explore the different available Medicare Advantage and Medicare Prescription Drug Plans to find the one that offers coverage that’s closest to what you had. It’s best to have the help of a professional who knows all the ins and outs of the various plans.

Timing

The timeframe in which you can make your change will vary, depending on the reason that your plan’s contract with Medicare was terminated.

  • If the reason was Medicare placing a penalty on the carrier, your situation will be handled on an individual basis.
  • If Medicare terminated the contract, you’ll have a window that begins two months before the termination and goes until one month after.
  • If Medicare doesn’t renew their contract with your plan, the period in which to change starts on December 8 and runs through the end of February.

Whatever the reasons that you need to make a change in your Medicare coverage, it can come with confusion.

Getting the guidance of an expert insurance provider will make the process much easier.

Working with an independent agent

As you’re working through the changes that you need to make in your coverage, you can certainly go through Medicare.gov.

But, be prepared:

  • You’ll talk to a different representative every time you call.
  • You won’t meet face-to-face.
  • You won’t get a personal touch.
  • You won’t have a go-to person who’s responsible for helping you after you sign up.

On the other hand, you’ll find that working with an independent insurance agent will provide you with a much different experience.

A much better experience.

Check out the advantages of working with someone on a more personal level.

1.There’s no fee involved

No matter who you buy your Medicare policy from the cost will be the same.

In other words, you’re getting really great, one-on-one advice without having to pay extra for it.

2. Agents help you understand your options

Consider the fact that their business runs on positive word-of-mouth recommendations. They want you to have a good experience.

Not only do they truly care about you, they also have in-depth Medicare knowledge, and they know how to explain it to you in a way you’ll understand.

They have the specialized ability to take all of your needs into consideration and match you with a plan that meets them.

3. You have an advocate

Once you’re all signed up your agent doesn’t say, “See ya!”

They’re in it for the long-haul with you – as long as you need them to be. They’re people who can take the time to sit down with you, face-to-face, and go over your questions.

Plus, every year you have the opportunity to switch your plan. You can sit down with the same person, year after year, and discuss what’s changed in your life – physically or financially.

4. They’re neutral

Independent insurance agents are impartial. They don’t have loyalties toward any one company, so they’re careful to match you with the policy that will best meet your specific needs.

The bottom line

Life can turn on a dime.

You can’t predict what will happen in the future, but it gives you peace of mind to know that when changes come, you have options for your Medicare coverage.

Whether you move, have an opportunity for different coverage or lose coverage for some reason, an independent insurance agent can work with you to find a solution that works for you.

Are you facing a change that will require you to reevaluate your Medicare coverage?

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