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Frequently Asked Questions about Medicare Special Election Periods - Healthcare Quality Improvement Campaign %
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Below are the most frequently asked questions about Medicare and the Special Election Periods in which you are able to enroll.

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I Am New to Medicare

I frequently hear, “I am new to Medicare. What do I need to be aware of?” If you are a new Medicare recipient, you may find its rules are quite complex. One reason for the complexity is that Medicare covers a wide range of circumstances and options. In the following paragraphs, I will cover some of those circumstances and briefly explain how they work.

Medicare Choices at Age 65

So, let’s say you are brand-new to Medicare at age 65. You have a choice right off the bat. You can stay with Original Medicare, or enroll in a Medicare Advantage Plan. You will have this choice every year you are enrolled in Medicare, but it’s most critical to decide when you are new to Medicare, because every plan must accept you regardless of your health. This period, called Initial Enrollment Period (IEP), begins three months before you turn 65, includes your birthday month, and lasts another three months. After that, you will have an Annual Enrollment Period (AEP) for Medicare Advantage Plans from October 15 to December 7 every year. 

It’s important to understand that the Advantage Plans don’t take anything away from Medicare, and they add many benefits, such as dental and fitness plans. Not all localities are able to offer these plans, however, because the coverage area must have a substantial network of medical and healthcare providers, by Medicare rules.The Advantage plans are offered by approved insurance companies, following strict Medicare guidelines.

If you enroll in original Medicare, you will want to choose an appropriate Medicare supplement (Medigap) in order to pay for the substantial copays and deductibles of Medicare. The AEP does not apply to Medigap. You can change your plan at any time throughout the year.

I Returned to the U.S. after Living Permanently outside the U.S. I Returned to the U.S. on Aug. 4, 2020

If you turned 65 while living abroad, you probably signed up for Part A, since you usually don’t have to pay a premium for this coverage. So, upon your return, you have three months to enroll in Part B (as well as Part A, if you haven’t done that yet). That would include the months of August, September and October. If you try to enroll after that, you may have to pay a penalty, and you will probably have to wait until January 1 of the following year. 

If you miss the window between January 1 and March 31 of the following year, you are required to wait until the next January, and of course, pay the penalty for late enrollment, because you did not enroll when you first became eligible. You must pay this penalty for as long as you have Part B.

I Recently Obtained Lawful Presence Status in the United States. I Got This Status on September 1, 2020

As soon as you have lawful presence status, you become eligible for Medicare, assuming you are 65 years of age or older, or you meet one of the other criteria – for instance, disability. You should apply within three months of obtaining the status, or you may incur a penalty. So, in your case, be sure to apply for Medicare before November 30, 2020.

I Am Leaving Employer or Union Coverage on November 13, 2020

When you leave employer or union coverage, you become eligible for Medicare, assuming you have reached the age of 65. You have a 7-month window to enroll in Medicare, beginning three months before coverage ends in November, including November, and ending on February 28, 2021 –  three months after your employer or union coverage ends. 

If you are not yet 65, you will need to enroll in a so-called COBRA plan through your employer, which will extend the coverage you now have (for a total of 18 months), If COBRA ends and you are not yet 65, you can obtain a private short-term medical plan through an insurance agent or this website. 

I am moving into a nursing home. My moving date is October 16, 2020. Will Medicare pay?

Medicare will pay for 100 days in a nursing home, provided that your health is improving. Medicare does not pay for custodial care, so if you stop improving, Medicare stops paying for your room and board.

Medicare does pay for medical procedures, doctors’ visits, tests and the like while you are in the nursing home.

The second stipulation for Medicare payment of nursing home charges is that the 100 days must start after a hospital stay of at least 3 days, and the move must be within 30 days of discharge from the hospital.  If you simply move into the nursing home from your residence, Medicare pays nothing for your room and board.

Because your health situation may change unexpectedly, and different medical procedures or medicines may be required, you will have a Special Election Period every month. This will allow your caregivers to keep you up to date with medical care. 

I Currently Live in a Nursing Home 

If you currently live in a nursing home, Medicare will pay for the first 100 days, provided that your health is improving. Medicare does not pay for custodial care, so if you stop improving, Medicare stops paying for your room and board.

Medicare does pay for medical procedures, doctors’ visits, tests and the like while you are in the nursing home.

Because your health situation may change unexpectedly, and different medical procedures or medicines may be required, you will have a Special Election Period every month. This will allow your caregivers to keep you up to date with medical care.

I Am Moving Out of a Nursing Home

If you are moving out of a nursing home, you will need to arrange for the care you need, such as a Primary Care Physician, and possibly Home Care.

You have a Special Enrollment Period in which you are allowed to choose a new Medicare plan.

I Recently Moved Outside of the Service Area for My Current Plan. I Moved on September 3, 2020

You may switch to a Medicare Advantage plan in your new area if one is offered there. If you notify your current plan now, you will have two more months – a total of three months – to choose a new Advantage plan. 

Or, if you decide it is better for you, you can return to Original Medicare. One advantage of this is that you are covered everywhere in the 50 states, so if you move again or travel extensively, you will not have to change plans.

If you do choose Original Medicare, then you will want to consider a Medigap plan to cover the copays and deductibles.

However, you may have to wait until the Annual Enrollment Period to enroll in a Prescription Drug Plan.

If you don’t choose another plan during the three months of eligibility, you will be automatically placed on Original Medicare.

I Recently Left a PACE Program on September 14, 2020

Before you left the PACE program, I’m assuming the staff of the program helped you make appropriate arrangements for care. If they did not, it would be wise to contact them and request assistance.

Depending on your financial circumstances and your medical and custodial needs, you have many options for your care, including a PACE program in another locality.

However, if your health has improved and you no longer need the help, you may have to choose new doctors and other providers.

You have a Special Election Period in which you are allowed to choose a new Medicare plan.

You will have two months to select another plan – either Original Medicare, or Medicare Advantage, if one is available in your area. If you choose Original Medicare, you will need a Medigap plan and a stand-alone Prescription Drug Plan.

If you have moved into a long-term care facility, that facility will be providing your medical and custodial needs.

I Recently Involuntarily Lost My Creditable Prescription Drug Coverage (Coverage as Good as Medicare’s) on August 31, 2020

Because you lost your coverage, and it was not your fault, you are eligible to sign up for a new plan. You have the following choices:

  • You can enroll in a stand-alone Prescription Drug Plan through this website, Medicare.gov or an insurance agent.
  • You can enroll in a Medicare Advantage plan, assuming one is available in your locality. This will include prescription drug and medical coverage, plus other benefits such as dental and fitness.

Your Special Election Period lasts for two months after you are disenrolled, or notified of disenrollment, whichever is later.

I Belong to a Pharmacy Assistance Program Provided by My State

That’s great! The pharmacy assistance program will help pay for some medications. Remember, though, that you still need to be enrolled in a prescription drug plan (PDP) through Medicare. Your PDP will pay for some medications, and the assistance program will pay for others – most likely the most expensive ones.

NOTE: If you don’t have a PDP through Medicare, and you sign up later, you will pay a penalty for not signing up when you were first eligible.

I Recently Had a Change in my Extra Help Paying for Medicare Prescription Drug Coverage 

Any change in Extra Help will cause a Special Election Period. What that means is that you have a three month window to choose a different Part D plan. You can enroll through this website, Medicare.gov, or your insurance agent.

I Recently Got Extra Help 

You now have a Special Election Period, in which you can choose a different Medicare Part D Prescription Drug plan. You can choose a Medicare Advantage plan if available in your area, or a stand-alone plan. You are allowed to stay with the plan you have, also, if it fits your needs.

I Recently Had a Change in the Level of Extra Help

This change allows you to choose a different Medicare Part D Prescription Drug plan. You can choose a Medicare Advantage plan if available in your area, or a stand-alone plan. You are allowed to stay with the plan you have, also, if it fits your needs.

I Recently Lost Extra Help on September 1, 2020

First, contact Social Security and file an appeal. There may be an error. 

Now, since you no longer have the Extra Help, you will need to start paying the premium for your Medicare Prescription Drug Plan. You may choose a different plan from the one you have now, because you have a Special Enrollment Period for three months, ending in November. You can choose a Medicare Advantage plan if available in your area, or a stand-alone plan. You are allowed to stay with the plan you have, also, if it fits your needs.

You must also pay the deductibles and copays for your medicine. 

Another possibility is to investigate pharmaceutical company assistance. Click here or further information.

I Was Affected by a Weather-related Emergency or Major Disaster (as Declared by the Federal Emergency Management Agency (FEMA)

Because of this disaster, you will have a Special Enrollment Period of 60 days with the opportunity to choose a different Medicare plan. If you have a Medigap plan, you may access medical care outside of your locality if your provider is not available due to the disaster.

If you need a new Part D Prescription Drug plan, you may enroll in any plan Medicare approves. You may stay with the plan you have if it is still right for you, or you may choose a new Medicare Advantage plan or a stand-alone plan.

I Am Enrolling in a 5-star Medicare Plan.

You may enroll in a 5-star Medicare plan between December 8 and November 30, the Special Enrollment Period only for 5-star plans.

There are some things to watch out for, though: 

  • If you move from an Advantage Plan back to Original Medicare, you will also need to enroll in a stand-alone Prescription Drug Plan (PDP).
  • You may not be able to enroll in a PDP until the Open Enrollment Period beginning October 15 and ending December 7.
  • If you move from Original Medicare to an Advantage Plan, you will be automatically disenrolled from the PDP you now have.
  • You can do this only once a year.
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Frequently Asked Questions about Medicare Special Election Periods

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This site is a non-government resource , providing information in a simple and straightforward way. Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine. The purpose of any insurance communication is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our advertisers sell insurance offered from a number of different Medicare Supplement insurance companies. The trademarks or service marks sold or described herein, or in blogs or advertisements, are owned by the respective trademark owners and nothing herein should be construed as a representation by this site owner or team members.