Special Enrollment Periods (SEPs)

Special Enrollment Periods (SEPs) could offer additional flexibility for Medicare beneficiaries to change their Part D plans outside the regular enrollment period. SEPs are triggered by specific circumstances like losing other coverage, moving, or changes in eligibility, allowing you to adapt your coverage as needed.

AEP and SEPs may differ in the following ways:

• AEP is a fixed annual period.
• SEPs are triggered by life events and provide more personal flexibility.
• With SEPs, you might not have to wait for the annual window if you experience a qualifying event that requires a coverage change.

Qualifying Life Events

Qualifying life events for SEPs include moving, losing other prescription drug coverage, or significant financial changes. Documentation may be required to apply for a SEP, and the application period usually starts from the date of the event and extends to a specified time, giving you enough time to make necessary changes.

These events will likely be designed to ensure that even in the midst of life changes, you could potentially maintain adequate health care coverage and support your health or overall function.

For instance, if you move to a new state, your current plan may no longer be available, prompting a need for a new hospital insurance plan that suits your new location and healthcare needs.

How to Apply for SEPs

To apply for a Special Enrollment Period, provide necessary documentation to validate the qualifying life event, such as proof of residence change, loss of other coverage, or eligibility for special benefits and low-income subsidy.

Knowing the specific requirements for SEPs ensures smooth transition and continued healthcare access. Being proactive and prepared may help avoid gaps in coverage and possibly ensure your healthcare needs are met.

Open Enrollment Period for Medicare Advantage Plans

The Open Enrollment Period for Medicare Advantage plans runs from January 1 to March 31 each year. During this time, you can switch from one Medicare Advantage Plan to another or revert to Original Medicare, which could be beneficial if your healthcare needs or circumstances change early in the year.

To return to Original Medicare, you must drop your Medicare Advantage plan during this period. This allows you to adjust your coverage without waiting for the next Annual Enrollment Period, likely ensuring continuity of care.

Switching to a Different Medicare Advantage Plan

Switching Medicare Advantage Plans during the Open Enrollment Period is straightforward. If you are enrolled in both Part A and Part B, you can make this change without a special reason, allowing you to find a plan that better suits your healthcare needs and preferences.

Whether you’re seeking better prescription drug coverage, additional benefits, or a different network of healthcare providers, this period gives you the opportunity to explore and compare various Medicare Advantage plans. This could potentially ensure that your plan aligns with your health and financial needs for the year.

Dropping Medicare Advantage for Original Medicare

If you drop your Medicare Advantage Plan for Original Medicare, your coverage will start the first of the month after your request. This might be helpful if you move outside your plan’s service area or experience other qualifying events.

Transitioning back to Original Medicare will likely involve navigating different premium structures and possibly higher out-of-pocket Medicare costs, depending on your healthcare needs and coverage choices. Being aware of these potential changes could help you make an informed decision and avoid unexpected expenses.

Comparing Part D Plans

Comparing Part D plans will likely be essential for Medicare beneficiaries. Premium costs for Part D plans may change, so stay informed about potential adjustments. Comparing plans could help ensure you choose one that provides the best balance of cost and coverage for your healthcare needs.

Using the Plan Finder Tool

The Plan Finder tool on our website is invaluable for comparing Medicare Part D plans. This online tool lets you filter plans based on costs, coverage, and pharmacy networks, helping you find the best fit for your Medicare prescription payment plan, drug plans, and make informed decisions.

By entering your zip code into the Plan Finder tool, you can easily compare plans and identify plans that offer the best value and coverage for your needs, empowering you to make choices aligned with your healthcare and financial goals.

Possible Factors to Consider

When comparing Part D plans, members should consider factors like:

• The annual out-of-pocket threshold for 2026 may be set around $2,100
• The annual deductible might be around $615
• Enrollees may pay up to 25% coinsurance for covered Part D drugs during the initial coverage phase

Understanding these potential costs could help you choose a plan that fits your budget.

Additionally, check that your medications may be included in the formulary of any new plan you’re considering. Call one of our licensed agents at 1-866-930-4039 (TTY 711) Mon-Fri: 8am-8pm EST for tailored advice and help with navigating the selection process.