What Happens If You Miss Medicare’s Annual Enrollment Deadline?

Each year, Medicare's Annual Enrollment Period (AEP) (Also known as the Medicare Open Enrollment Period) gives seniors the opportunity to enroll in a Medicare Advantage or prescription drug, change an existing plan, move to a new one or dis-enroll.
The AEP typically lasts about two months. But what if you miss the deadline? Does it mean you can't make any changes until next year? Changing your Part C or D coverage outside of AEP is difficult, but it's not impossible.
Here are a few tips to help you maximize your drug and health benefits in the coming year, and a few strategies for switching your plans outside of the enrollment period.
What to do if you missed the 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 percent of all available prescription drugs (as of 2012). PlanPrescriber surveyed people on their website and found that one-in-three (34 percent) took a drug that wasn't covered by their Medicare plan in the coming year. If these individuals didn't update their coverage in time, they'd not only pay full price for that drug, but their expenses wouldn't count toward getting them out of 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. Even if your 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. The specific rules vary by 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 younger than 65. There are also 15 types of SNPs designed specifically for people with chronic health problems. If you qualify for a SNP you can enroll at any time, provided one is available in your area. 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: As of 2012, 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. Plans with a 5-star rating can enroll people at any time, even after AEP is over, however these plans are not available everywhere.
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. You can also add drug coverage at the same time. In 2015, ADP starts on January 1, 2015 and ends on February 14, 2015. If you decide to drop a Medicare Advantage plan, you will have the option to enroll in a stand-alone Medicare prescription drug plan so that you don't lose drug coverage. If you abandon a Medicare Advantage plan you're giving up benefits such as 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.
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 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 as though you're 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. Reach out to an expert who can help you figure out what those opportunities are and how to take advantage of them.

Doctor reembursement

The “doc fix” is a temporary solution to curb Medicare spending on physician services under the Sustainable Growth Rate method employed by the Centers for Medicare & Medicaid Services.
Monday’s passing of the bill averts the 24% reduction in physician Medicare reimbursement that would have occurred on March 31, delaying the cuts for one more year.
Of note is the fact that Medicare reimbursement rates are not being reduced for other healthcare service providers to pay for this bill, Jefferies analysts write in their report. Rather, Congress is proposing to fund this bill by raising sequestration cuts to a 4% rate in the first half of 2024.
For hospital operators, SNFs and Healthcare REITs, Jefferies says the doc fix bill is a “positive,” as it should give investors more confidence in the near-term earnings of these facilities that will not be impacted by a major reimbursement cut.

Single Payer Health Product

You know the facts:

• The United States is practically alone among developed nations in adhering to an immoral (and ineffective) for-profit health insurance regime.

• 48.6 million Americans — almost one of every six of us — is uninsured.

• 45,000 Americans a year — 123 a day — die because they don’t have health insurance.

• The private health insurance industry eats up $350 billion a year in administrative costs, waste and profits.

• A single-payer, Medicare-for-all system would cut drug prices by 40% or more.

• Inflated medical bills are the number one cause of personal bankruptcies in the United States.

• The majority of doctors and the American people support a single-payer, Medicare-for-all system.

How Medicare Open Enrollment Can Save -- or Cost You Hundreds By Ross Blair, September 14, 2012 Text Size: -+ 0 Comments Follow This Print Email Share on facebook_like Whether you're approaching age 65 or already enrolled in Medicare, you should take advantage of the annual enrollment period (AEP) – a once-a-year opportunity to review Medicare Advantage and prescription drug plans coverage options and see whether you are enrolled in the most cost-effective plan for your needs. Research by PlanPrescriber.com shows that a large majority of Medicare beneficiaries could have saved hundreds of dollars last year by reviewing just one element of their coverage: their prescription drug plan. While it may be easy to come up with other things you'd rather do this fall, taking time now time now to review all aspects of your coverage options could really pay off. AEP is coming early again this year, a month earlier than usual, running from Oct. 15 to Dec. 7. Though Medicare beneficiaries have eight weeks to select their coverage, last year 42 percent of people waited until the last nine days to apply, according to research by PlanPrescriber.com. However, this is not a decision you want to rush or put off until the last minute. Last year, federal officials extended the Dec. 7 deadline for three days for certain people because of influx of last-minute sign-ups. You can avoid the rush this year and start comparing plans Oct. 1 to prepare to enroll Oct. 15. We've compiled some important tips for people on Medicare to help ensure they pick the best Medicare Advantage or prescription drug coverage for their specific needs. Understand the basics before filling in the gaps Understanding Medicare can be challenging, but it's important to understand what Original Medicare (Parts A and B) cover before weighing other options. Once you understand the basics, you can compare products designed specifically to fill some of the different gaps in Medicare. They include: Medicare Part D stand-alone prescription drug plans, which cover the cost of most prescription drugs; Medicare supplement plans, which cover portions of the deductibles, coinsurance and out-of-pocket costs not covered by original Medicare; and Medicare Advantage plans, which bundle together the Part D drug benefit with some additional coverage for deductibles, coinsurance and out-of-pocket costs. Each type of supplemental coverage has different guidelines for when you can enroll, change and cancel your coverage. Prescription drug plans can change every year so check the benefits for 2013 If you get coverage through a Medicare Advantage or prescription drug plan, know that most plans change their pricing and benefits each year. You can use an online tool to see whether and how your prescriptions drugs will be covered in 2013. According to a study by PlanPrescriber.com, the average person could have saved $654 in 2012 by changing their coverage to a plan that covered their drugs at the lowest possible cost. Factor in costs like copays and deductibles At first glance, it may appear best to go with the plan with the lowest premium. However, you are still responsible for out-of-pocket costs. Also consider such costs as doctor's office copayments and deductibles. Those expenses can add up, meaning the plan with the lowest premium could cost you more in the long run. If you're turning 65 during the enrollment period, happy birthday and know the deadlines Hundreds of thousands of people will turn 65 during this year's annual enrollment period. If you're already getting Social Security benefits, you will be contacted a few months before you become eligible for Medicare and given the information you need. Most people are enrolled in Medicare Parts A and B (Original Medicare) automatically. While you're celebrating, keep in mind that other types of coverage have different deadlines that are important to remember: •Part D prescription drug plans. You must enroll during the annual enrollment period. •Medicare Advantage. You have three months to sign up after you enroll in Medicare Part A and Part B benefits. Otherwise, you'll have to wait for next year's annual enrollment period. •Medicare Supplement insurance (Medigap). The Medicare Supplement Open Enrollment Period is six months, beginning the first day of the month in which you are both age 65 (or older) and enrolled in Medicare Part B. If you miss the Medicare Supplement Open Enrollment Period, your application could be declined if you have a pre-existing medical condition or you may be charged more for coverage. Finally, remember that there's no reason to enroll without help. Qualified professionals can help you understand your options and select a plan. You can get help through your State Health Insurance Assistance Program (SHIP), websites like www.PlanPrescriber.com, licensed health insurance agents who are certified to sell Medicare, or by calling 1-800-Medicare.

Medicare Killers

The Republican Party is now firmly committed to replacing Medicare with what we might call Vouchercare. The government would no longer pay your major medical bills; instead, it would give you a voucher that could be applied to the purchase of private insurance. And, if the voucher proved insufficient to buy decent coverage, hey, that would be your problem. Moreover, the vouchers almost certainly would be inadequate; their value would be set by a formula taking no account of likely increases in health care costs. Why would anyone think that this was a good idea? The G.O.P. platform says that it “will empower millions of seniors to control their personal health care decisions.” Indeed. Because those of us too young for Medicare just feel so personally empowered, you know, when dealing with insurance companies. Still, wouldn’t private insurers reduce costs through the magic of the marketplace? No. All, and I mean all, the evidence says that public systems like Medicare and Medicaid, which have less bureaucracy than private insurers (if you can’t believe this, you’ve never had to deal with an insurance company) and greater bargaining power, are better than the private sector at controlling costs. I know this flies in the face of free-market dogma, but it’s just a fact. You can see this fact in the history of Medicare Advantage, which is run through private insurers and has consistently had higher costs than traditional Medicare. You can see it from comparisons between Medicaid and private insurance: Medicaid costs much less. And you can see it in international comparisons: The United States has the most privatized health system in the advanced world and, by far, the highest health costs. So Vouchercare would mean higher costs and lower benefits for seniors. Over time, the Republican plan wouldn’t just end Medicare as we know it, it would kill the thing Medicare is supposed to provide: universal access to essential care. Seniors who couldn’t afford to top up their vouchers with a lot of additional money would just be out of luck. Still, the G.O.P. promises to maintain Medicare as we know it for those currently over 55. Should everyone born before 1957 feel safe? Again, no. For one thing, repeal of Obamacare would cause older Americans to lose a number of significant benefits that the law provides, including the way it closes the “doughnut hole” in drug coverage and the way it protects early retirees. Beyond that, the promise of unchanged benefits for Americans of a certain age just isn’t credible. Think about the political dynamics that would arise once someone born in 1956 still received full Medicare while someone born in 1959 couldn’t afford decent coverage. Do you really think that would be a stable situation? For sure, it would unleash political warfare between the cohorts — and the odds are high that older cohorts would soon find their alleged guarantees snatched away.

To the Editor: Re “Truth and Lies About Medicare” (editorial, Aug. 19): As a former chief executive and actuary of an insurance company that once sold both individual and group health insurance, I am particularly mystified by the effort to push Medicare participants into the individual health insurance market. I thought that we wanted to reduce — or at least control — the cost of health insurance, but individual health insurance is by far the most expensive alternative. Depending on the size of the vouchers, the government itself may save money, but the entire system will pay more. Someone has to pay for the costs of individual underwriting, marketing and so on, and those expenses will fall on the elderly themselves. You are also correct in assuming that there is likely to be anti-selection, with the healthier people going to the insurance companies, leaving the sickest and most expensive people in the Medicare plan. It is certainly true that health insurance needs reform and that President Obama is far from having all the answers, but the Romney-Ryan plan will increase the country’s health care bill with little or any of the increase going to more or better health care. STEPHEN BROWN Brewster, Mass., Aug. 19, 2012 The writer is a former chairman and chief executive of John Hancock Financial Services. -- Howard McGowan MaldenSenior

                  The improved Medicare-for-all approach would
eliminate the greatest waste in the health care system: the needless
costs imposed by the private health insurers. These firms impose
hundreds of billions of dollars of excess cost on us via their
excessive profit-taking and executive compensation, their marketing
expenses, their vast bureaucracies devoted to denying care, and their
imposition of massive paper-pushing obligations on actual health care
providers.
                        It is not for lack of policy justification or
moral force that Americans continue to suffer from a malfunctioning
health care system. Our failure to have adopted improved Medicare for
all is due entirely to the political power of the health insurance
industry.
                        That political power can be overcome, however,
by a grassroots movement that musters enough of its own strength. The
country cannot survive the ongoing reign of the private health
insurance industry, and it will not.
Public Citizen Health Care for all