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It’s Not Over ‘Til … The 5-Star Special Enrollment Period? The Medicare Advantage Disenrollment Period? What?

Last fall,  we looked at the Medicare Open Enrollment Period, which ran from 15 October to 7 December, 2011.  During that time, seniors with Medicare were able to make unrestricted changes to their coverage, including Medicare, Medicare Advantage and Part D prescription drug plans.  It’s always prudent to review all coverage options, even if the plan is a perfect fit – either for you or for a loved one – since plans change their prices and benefits each year.

While the 7 December 2011 date was the official end of the Open Enrollment Period for last year, there’s still hope!  You may be able to  change your mind after all! You’ve got two basic options.

First, there is something called the 5-Star Special Enrollment Period (SEP).  What’s that, you ask?  Good question.  Apparently very few of us have ever even heard of this SEP thing, much less used it.

Here’s how it works: The 5-Star Enrollment Period began on 8 December 2011 and goes on through 30 November 2012.  Any beneficiaries have the opportunity to change to a Medicare Advantage or drug plan during this time, so long as the new choices have achieved a 5-star rating.

What’s a 5-star rating?  A 5-star plan is one that has received the highest quality rating (*****)  from the Centers for Medicare and Medicaid Services.  These five stars denote an ‘excellent’ plan.  The range goes from one star, for ‘poor’, on up to the optimal five stars.  The ratings are based on 33 measures taken from a variety of sources, including customer satisfaction surveys and performance evaluations that include patient health outcomes and some other independent reviews and studies.  Obviously, the point is to be sure any beneficiary is appropriately and adequately covered.

Two things to be aware of, though, when using the SEP approach:

  • Seniors can only switch one time per period.
  • Some seniors will not be able to switch at all because there is no 5-star plan in their area.
Now, to the second ‘second chance’: the Medicare Advantage Disenrollment Period (MADP), 1 January 2012 – 14 February 2012

Okay – here’s the deal.  Say you’re really unhappy with the choices you made during the open enrollment period last fall.  If your choices involved a Medicare Advantage Plan, you have a way out.  It’s not perfect, but it’s an option.  If you realize the Medicare Advantage Plan you chose will not do the job, you have the option to switch to Original Medicare during the MADP.

Again, you can make this switch only if you have a Medicare Advantage Plan.  If you already have Original Medicare, you cannot make any changes.

Here’s what you can do during the MADP:

  • You are in a Medicare Advantage Plan now?  You can leave that plan and switch to Original Medicare.
  • If you’ve made the decision to switch to Original Medicare, you have until 14 February to also join a Medicare Prescription Drug Plan to add drug coverage.  This coverage will begin on the first day of the month after the plan gets your enrollment form.  For example, if you switch to Original Medicare and sign up for a Part D plan on 6 February, your coverage will start on 1 March. 

And here’s what you cannot do:

  • Switch from Original Medicare to a Medicare Advantage Plan.
  • Switch from one Medicare Advantage Plan to another.
  • Join, switch or drop a Medicare Medical Savings Account Plan.
  • Switch from one Medicare Prescription Drug plan to another. 

For more information about  these options, check page 79 of the Medicare and You 2012 booklet for details about the SEP; there is help finding a 5-star plan at Medicare.gov.  A good health insurance agent up-to-date with the latest information about Medicare is also a valuable resource.  None of this stuff is thrilling, but you need to do your homework before making any changes – the more you know, the better.

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One response to “It’s Not Over ‘Til … The 5-Star Special Enrollment Period? The Medicare Advantage Disenrollment Period? What?

  1. Pingback: Fitness Benefits Gains Insurers Healthy Elderly, Study Finds « MEDCRUNCH

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