What happens if you miss Medicare open enrollment?

Understanding Medicare Enrollment Periods and Your Options If You Missed the Deadline

Are you one of the millions of seniors planning to enroll or make changes to your Medicare coverage, but missed the Medicare Open Enrollment period? This annual period runs from October 15 to December 7 and allows beneficiaries to make important changes to their Medicare plans. If you missed it, you might wonder whether there’s still any way to enroll or adjust your coverage without waiting another year. Let’s explore your options.

What is Medicare Open Enrollment?

Medicare Open Enrollment, also known as Medicare’s Annual Election Period, allows you to:

• Enroll in or drop a stand-alone Medicare Part D prescription drug plan (PDP)
• Switch from one PDP to another
• Switch from Original Medicare to Medicare Advantage or vice versa
• Switch from one Medicare Advantage plan to another

Any changes you make during open enrollment take effect on January 1 of the following year.

Options If You Missed Medicare Open Enrollment

If you missed the open enrollment period, there are still opportunities to change your Medicare coverage, depending on various factors including the type of coverage you have, your location, and certain life circumstances.

Medicare Advantage Open Enrollment Period (MAOEP)

If you have a Medicare Advantage plan, you have another chance to make changes during the Medicare Advantage Open Enrollment Period (MAOEP), which runs from January 1 through March 31. During this period, you can:

• Switch to a different Medicare Advantage plan
• Switch to Original Medicare (and enroll in a PDP if desired)

However, your eligibility to enroll in a Medicare supplemental insurance (Medigap) plan may depend on factors such as your medical history, location, and how long you’ve been enrolled in Medicare Advantage.

5-Star Special Enrollment Period

If there is a 5-star Medicare Advantage plan available in your area, you can switch to that plan at any time between December 8 and November 30 of the following year. This special enrollment period also applies to PDPs, although only a limited number of plans achieve a 5-star rating.

Medicare Part D Plan Changes

For those with stand-alone Medicare Part D plans, the options to change coverage after December 7 are limited. Unlike Medicare Advantage, there isn’t a specific open enrollment period for PDPs outside of the Annual Election Period.

Terminating PDP Special Enrollment

If your PDP is terminating on December 31, you qualify for a special enrollment period that continues through the last day of February. If you enroll in a new plan by December 31, your new plan will take effect on January 1, ensuring no gap in coverage.

Reducing Prescription Costs

If you realize your PDP doesn’t adequately cover your medications, there are resources available:

• Pharmaceutical Assistance Programs: Some pharmaceutical companies offer assistance programs to help reduce prescription costs.
• Extra Help Program: This program caps the amount you pay for prescriptions. If you qualify, you have a quarterly opportunity to switch to a different plan.

Potential Penalties for Missing Medicare Open Enrollment

Missing the enrollment window could result in a Part D late-enrollment penalty, as this penalty depends on the number of months you go without creditable drug coverage. The longer you go without coverage, the higher your penalty will be.

Special Enrollment Period Eligibility

Several situations can trigger a special enrollment period, allowing you to make changes outside the usual enrollment windows. These situations include:

• Moving out of your plan’s coverage area
• Losing other coverage
• Enrollment decisions caused by a federal employee’s error

If you believe you might be eligible for a special enrollment period, you can contact Medicare at 1-800-MEDICARE for assistance.

Conclusion

Missing the Medicare Open Enrollment period doesn’t mean you’re out of options. Understanding the additional enrollment periods and special circumstances that allow for changes can help ensure you have the coverage you need. For personalized assistance, call our ACA number at 833-942-3776 or our Medicare line at 833-739-1122. We’re available from 6am to 4pm PST every weekday and are ready to help you navigate your Medicare options.

Disclaimer: Please note, this article is meant to provide information and may not reflect the most current changes in the Medicare system. Always consult with a Medicare expert or representative for the latest updates and personalized advice.

Additional Resources

• Medicare Open Enrollment – CMS.gov
• Medicare Open Enrollment Period – MedicareResources.org
• Medicare Advantage Open Enrollment Period – Medicare.gov
• Medicare Star Ratings – CMS.gov
• Medicare Star Ratings Overview – MedicareResources.org
• Medicare Part D Enrollment Guidance – CMS.gov
• Pharmaceutical Assistance Programs – Medicare.gov
• Extra Help Program – SSA.gov
• Medicare Eligibility and Enrollment – MedicareResources.org
• Medicare Part D Late Enrollment Penalty – MedicareResources.org