INDEPENDENCE BLUE CROSS

Produced branded content for Independence Blue Cross (IBC) detailing the ins and outs of Medicare. Articles were published in the Philadelphia Inquirer.

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PENDING DRAFTS BELOW:

Currently, approximately 19 million adults in the U.S. are enrolled in a Medicare Advantage Plan to cover all of their hospital and medical insurance. These Medicare-approved plans, which are offered by private insurance companies, cover all of the services that original Medicare covers. Additionally, most Medicare Advantage Plans offer preventative care and extra benefits, like vision, hearing, dental care, and health or wellness programs, and include Medicare prescription drug coverage.

However, the plan chosen at the time of initial enrollment is not always the plan that individuals will continue to hold with throughout the year. Oftentimes, certain events can occur in life – like a move or loss of other insurance coverage - requiring the plan holder to change or update their Medicare Advantage Plan or Medicare Prescription Drug Coverage to ensure that they continue to receive optimal health care coverage. These extenuating circumstances may qualify beneficiaries to make changes or join Medicare outside of regular enrollment periods, known as a Special Enrollment Period (SEP).

Below are some of the qualifying life events that permit individuals to enroll in a SEP.

  • You change where you live
    • You moved to an address that isn’t in your plan’s service area
    • You moved to an address that is in your plan’s service area, but the new location offers new plan options
    • You moved back to the U.S. after living internationally
    • You are released from jail
  • You lose your current coverage
    • You are no longer eligible for Medicaid
    • You left coverage from employer or union (including COBRA coverage)
    • You involuntarily lost other drug coverage that’s as good as Medicare drug coverage (credible coverage) or your other coverage changes and is no longer creditable
    • You had drug coverage through a Medicare Cost Plan and left the plan
    • You dropped your coverage in a Program of All-inclusive Care for the Elderly (PACE) program.
  • You have the chance to get other coverage
    • You have the option to enroll in other coverage offered by your employer or union
    • You have or are enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage)
    • You enrolled in a Program of All-inclusive Care for the Elderly (PACE)
  • Your plan changes its contract with Medicare
    • Medicare takes an official action (called a “sanction”) because of a problem with the plan that affects you
    • Medicare terminates your plan’s contract
    • Your Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan’s contract with Medicare isn’t renewed
  • Other special situations include
    • You are eligible for both Medicare and Medicaid
    • You qualify for Extra Help paying for Medicare prescription drug coverage
    • You’re enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility
    • You dropped a Medigap policy the first time you joined a Medicare Advantage Plan
    • You have a severe or disabling condition and there’s a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with your condition
    • You’re enrolled in a Special Needs plan (SNP) and no longer have a condition that qualifies as a special need that the plan serves
    • You joined a plan or chose not to join a plan due to an error by a federal employee
    • You weren’t properly told that your other private drug coverage wasn’t as good as Medicare drug coverage (creditable coverage)
    • You weren’t properly told that you were losing private drug coverage that was as good as Medicare drug coverage (creditable coverage)

Keep in mind that the rules about when you can make changes and the type of changes you can make vary per each qualifying life event. For example, you typically have two full months after your coverage ends or changes to join a new Medicare Advantage Plan or Medicare Prescription Drug Plan. In other special circumstances, however, such as being eligible for both Medicare and Medicaid, you have the option to join, switch, or drop your Medicare Advantage Plan or Medicare Prescription Drug Plan at anytime.

To learn more about these rules, visit the Special Circumstances page on Medicare’s official website. Additionally, be sure to contact a Medicare representative with your health insurance provider to discuss your options and find a plan that works best for you at each and every stage in your life.