For Medicare Folks: What Lies Beyond December 7th?
By Dave Trout
December 7th marks the end of the Medicare Annual Enrollment Period.
During this time period, if you have a Medicare Advantage Plan (Part C) or a Medicare Prescription Plan (Part D) – you may change to another plan which better suits your needs.
If you are on a Medicare Supplement plan in addition to Medicare A & B - you can change over to MAPD. “Window shopping “ opened on Oct 1, 2024 and enrollment got under way on October 15th.
THIS YEAR – Mother Nature dealt us a cruel blow with a devastating hurricane, September 27th. Everyone in our beautiful western North Carolina mountains were affected. Our normal routines went by the wayside as we worked to recover. Who had time for a thoughtful review of their options?
When a natural disaster like this occurs, CMS – Center for Medicare/Medicaid Services will declare a Special Enrollment Period – SEP.
The technical specifics: SEP for Government Entity-Declared Disaster or Other Emergency .42 CFR 422.62(b)(18)
An SEP exists for individuals affected by a disaster or other emergency declared by a Federal, state, or local government entity who were unable to, and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.
This means for the next several months Beyond Dec 7th – you have the SAME enrollment options as you would have from October 15th to December 7th.
SO you may - Change and Review your MAPD or Part D Rx plan – or - leave Traditional Medicare for a MAPD.
The individual insurance companies have the option of how they will respond to SEP declarations. Most of our companies have extended enrollment until at least the end of February. This is especially important for folks with stand-alone Part D Rx plans where we have seen so much change in benefits, formularies and premium.
In addition, 2025 marks the third year of “The Return of Open Enrollment”... sounds like a bad film noir.
Medicare realized that many seniors may have “something happen” – new doctors, change in health, updated RX – during these enrollment months and into the first of the year. If you have a MAPD plan ( not a stand-alone Rx plan), you have one and only one opportunity to change from January 1st to the end of March.
Finally, there are Dual Plans for folks with both Medicaid and Medicare. These have extended enrollment periods throughout the year. We also have C-SNP – Chronic Disease Special Needs Plans for folks with either heart or diabetes; these allow for end round enrollment.
AND FIVE STAR. Medicare evaluates how well a plan is working to benefit those Medicare beneficiaries enrolled – Star Rating. Plans which are at the top of their service metrics are awarded this distinction.
You may enroll anytime during the year. One company, in particular, has achieved this - three years in a row. Quite a feat.
One of these plans has one of the lowest MOOP-Maximum Out of Pocket for Medical Expenses; another features a very strong “ Part B Giveback “. This puts money back on to Social Security retirement benefit.
So, while it may be after December 7th … the store is still open.
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