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I Missed Medicare’s 2012 Annual Enrollment Period! What Now?

With Medicare Annual Enrollment ending three weeks early in 2011, some seniors and those caregivers responsible for enrolling or re-enrolling in Medicare that missed the deadline are wondering how their plan will be impacted and what they can do, if anything.

By Ross Blair

On December 7, 2011 Medicare’s Annual Enrollment Period (AEP) for 2012 Medicare Advantage (part C) and Medicare Part D plans ended. These plans often change prices and benefits from year to year, so the AEP was designated to allow people to review and change their coverage, if necessary.

Prior to 2011, AEP ended on December 31st. So, as you can imagine, there was some concern that the new December 7th deadline could sneak up on some people. There was understandable concern that some people wouldn’t hear about the new dates and could wind up missing AEP altogether.

We were concerned too, so two weeks after the AEP started, we surveyed Medicare Part D or C recipients to find out how many knew about the new deadline. And, as suspected, the survey showed that one in five Medicare recipients were unaware of the new dates.

Our hope is that anyone who didn’t know about the date changes when we ran our survey somehow got the news between November 1 and December 7, and updated their drug coverage before the deadline.

But we also know from experience that a fair number of people always miss the deadline, no matter when it is. In the past when the AEP ended on December 31, we’d get phone calls as late as January 10 from people wanting to make a “last minute” change to their coverage for the coming year. And, all too often, we had to give people the news that it can be very difficult to change your Part C or D coverage outside of AEP. It’s not impossible, but it can be difficult.

So, if you or someone you know did miss AEP this year, we created a short list of tips to help you maximize your drug and health benefits in the coming year. And, if you desperately need to change plans, there are some strategies for doing that in here as well.

What to do if you missed the 2012 Medicare Annual Enrollment Period:

  1. Look for Other Drugs: If you missed AEP and you can’t change your coverage, try to optimize the drugs you’re taking to fit your current plan. Among the ten largest drug plans in the country, no single plan covers more than 79 percent2 of all available prescription drugs in 2012. We surveyed people using our website during the last year’s AEP and found that one-in-three (34%) took a drug that wasn’t covered by their Medicare plan in the coming year. So, if they didn’t update their coverage heading into 2011, they’d pay full price for that drug and their expenses wouldn’t count toward the “Donut Hole.” If you’re in the same boat this year, don’t despair. The Medicare Modernization Act (MMA) requires every Medicare plan with prescription drug coverage to include at least two drugs in each category and class. So, even though the plan doesn’t cover the drug you take, it must cover another drug designed to treat the same problem. Talk to your doctor to find what other drugs exist to treat your illness and discuss the possibility of switching.
  2. Ask about Medicare Supplement (MediGap) open enrollment periods: If your MediGap plan isn’t working for you any longer and you can’t enroll in a Medicare Advantage plan outside of AEP, you may be able to change your MediGap plan during select MediGap open enrollment periods. MediGap plans are usually medically underwritten, which means the insurance companies don’t have to accept your application if you’ve been on Medicare Part B for more than three months. AEP is the best time to drop a MediGap plan and switch to a Medicare Advantage plan. But some states and insurance companies have created open enrollment periods for MediGap plans as well. These open enrollments allow you to update or change your MediGap health coverage without medical underwriting. But the rules change from state to state, so if you want or need to make a change outside of AEP, investigate the MediGap open enrollment rules in your state by contacting a licensed agent.
  3. Ask an expert about Special Needs Plans (SNPs): Special Needs Plans (SNPs) are available for people who are low-income, disabled and under the age of 65. There are also fifteen types of SNPs designed specifically for folks with chronic health problems. And, if you qualify for a SNP you can enroll at any time, provided one is available in your area. The SNPs designed for chronic conditions cover the following areas: chronic alcohol and other drug dependence; certain auto-immune disorders; cancer; certain cardiovascular disorders; chronic heart failure; dementia and Alzheimer’s; diabetes mellitus; end-stage liver disease; end-stage renal disease requiring dialysis; certain hematologic disorders; HIV/AIDS; certain chronic lung disorders; certain mental health disorders like bipolar and schizophrenia; certain neurologic disorders; and stroke.
  4. Investigate 5 Star Medicare Advantage plans: New this year, you don’t have to wait for AEP to enroll in a 5-Star Medicare Advantage plan. The 2010 Health Care Reform law created a new ratings system for Medicare Advantage plans that begins in 2012. Plans with the highest rating of 5 stars can enroll people at any time, even after AEP is over. But, the plans are not available everywhere. The easier way to find one near you is to use a Medicare plan search engine, like PlanPrescriber.com or Medicare.gov.
  5. Medicare Annual Disenrollment Period (MADP) Starts January 1: Medicare’s ADP lets you “disenroll” (cancel) from a Medicare Advantage plan if it fails to meet your needs and add drug coverage at the same time. ADP starts on January 1, 2012 and ends on February 14, 2012. If you decide to drop a Medicare Advantage, you will have the option to enroll in a stand-alone Medicare prescription drug plan so you don’t lose drug coverage. But if you abandon a Medicare Advantage plan you’re giving up benefits like the network of providers who participate in that plan and a cap on your out-of-pocket spending for medical bills (provided those costs are approved by Medicare). These are two benefits original Medicare doesn’t have. So before you disenroll in a plan, do some homework to be sure you’ll still have the coverage you need in 2012.
  6. Investigate Medicare Special Enrollment Periods (SEPs): Medicare also provides SEPs for people who need to change their coverage outside of AEP. A person may qualify for an SEP if they move permanently outside of their plan’s service area; become eligible for a low-income subsidy due to a loss of income; receive incomplete information about what qualifies as creditable prescription drug coverage or lose that coverage through no action of their own; if they become eligible for Medicare and Medicaid ("dual eligible") but lose their dual eligibility status; if they live in, are moving into or are moving out of certain types of skilled nursing facilities; if they receive a retroactive Medicare entitlement determination; or if they qualify for other special enrollment periods that may be authorized by the Federal Government.

If you missed the Annual Enrollment Period, don’t feel trapped in a plan that doesn’t meet your needs. If the cost of drugs, coverage or key benefits becomes more than you or a loved one can afford, there may be opportunities to make changes. The key is to be proactive, and reach out to an expert who can help you figure out what those opportunities are, and how to take advantage of them