It's been a very busy year and I have not been online as much as I would like. Busy is good however!
During the Medicare open enrollment I was working with a client to get her enrollment modified so that she would have more flexibility. I was working with a wonderful insurance broker named Peter Palmiotto. Peter presented multiple items and our client selected a plan just right for her. We walked together to our respective cars and in our conversation I learned that there are actually times outside of the Medicare enrollment period when Medicare options may be changed. I asked Peter to write a guest blog about this and here is what he has shared. I hope you enjoy the read!
Laura Barish, AltaGolden
How To Change Your Medicare Insurance Year Round
Medicare insurance is a critical part of most seniors’ healthcare, yet can be extremely confusing and frustrating when trying to figure out all your Medicare options. Changing a Medicare Advantage (MA) or Prescription Drug plan (PDP) can be nerve raking and often times can only be changed during the Annual Open Enrollment Period. Yet most are not aware they can change their plans year round if the right conditions are met.
The Centers for Medicare & Medicaid Services (CMS) oversees the Medicare program and allows changes to be made, regardless of the time of year, during what they call a “Special Enrollment Period (SEP).” A SEP is a specific period of time in which you can change, add or drop a Medicare insurance plan. These SEPs are triggered by various events in your life that allow you to shop around without any medical underwriting or lapse in coverage.
There are over 30 different reasons why you may qualify for a SEP, yet most people typically use one of the top 6 reasons we’ll discuss here.
1) Currently Living in a Skilled Nursing Facility: Those living in a SNF may join or switch plans year round. Those discharged from a SNF have up to 2 full months after discharge to join or switch plans
2) Entering Or Leaving a Long Term Care Hospital: Those going into or coming out of a Long-Term Care Hospital have 2 full months after the admittance or discharge date to join or switch plans
3) Moving From A Different County / State: All Medicare Advantage plans will allow you to join, switch or drop your MA plan within 2 full months of your move. You can only switch your PDP plan within 2 full months if you moved to a different state as PDP plans are statewide.
4) Those Receiving Medicare and Medi-CAL: Those that are dual eligible, have both Medicare and Medi-CAL benefits, may join, switch or drop plans year round.
5) Low Income Subsidy Recipient: Those that have, or qualify to have a Low Income Subsidy (LIS) for Part D Prescription Drug Coverage can join or switch plans year round.
6) Loss of Employer or Union Coverage: Employer or Union health insurance coverage ends or is terminated, those affected have 2 full months after the end of prior to coverage in which to join a plan
For those with a Medicare Supplement Policy, also known as a Medigap plan, you may change your plan year round in order to help lower your monthly premium. Be aware that the insurance carrier will put your application through full underwriting review, and your application may be denied based on your health history.
California’s “Hidden Secret” for those with Medicare Supplement Insurance
If you want to lower your monthly Supplement premium but are hesitant to go through medical underwriting, California is one of only two states nationwide that allows you to switch plans without the worry of being denied. This is called the “Birthday Rule,” in which you can switch your Medicare Supplement Insurance Plan to another like-kind plan within 30 days after your birthday without any medical underwriting or possibility of being denied.
As long as your switch occurs within 30 days after your birthday, you are guaranteed to be issued a new policy from any other company offering the same plan. If you currently have a Supplement Plan G, you can only switch to another company and obtain another Plan G. You can lower your coverage (switch from F to G), but you cannot increase your coverage (from G to F). This is the best way to shop around each year to help lower your premium and save money.
For those looking to increase their benefits, lower their premiums or access different doctor networks, using a Special Election Period is a great way to switch throughout the year. Of course, you can always wait until the Annual Enrollment Period each year that occurs between October 15th and December 7th.
For more information or help with your Medicare insurance, please contact San Diego Medicare Options at 888-939-7383.
Peter Palmiotto is the founder and CEO of San Diego Medicare Options, an independent Medicare insurance brokerage firm. Peter makes house calls or can help you over the phone. He is licensed in 5 different states and currently resides in San Diego. He can be reached at 888-939-7383 or for more information visit: www.SanDiegoMedicareOptions.com
A great gift to your parents for starting the new year is the gift of your time--whether it is a phone call, out of town visit, or taking them out to lunch or dinner. I know my mother's favorite gift is being able to have dedicated time with her children and grandchildren.
There is also the great gift of caregiver services (you know I had to get in my AltaGolden plug!). Give us a call if you'd like to discuss if we can help your loved ones in any way. All of our services are customized for each client. Our number is 858-779-9254.
Take care and have a blessed holiday! Laura