Aging Connection: January 2008 - Ohio Department of Aging

Aging Connection

January 2008

Changing Medicare Private Health or Drug Plans

Sometimes, a consumer will find, after he or she picked the Medicare private health or drug plan that seemed the best choice, that the chosen plan doesn't work at all. Is there anything he or she can do to switch to a new plan after the deadline?

According to the Medicare Rights Center, the answer is: "It depends."

The Medicare Rights Center offers this advice for consumers who find themselves in this situation:

The Ohio Senior Health Insurance Information Program, a service of the Ohio Department of Insurance, can answer Ohioans' questions about Medicare.

1-800-686-1578

Changing Medicare health plans: Everyone with Medicare is allowed to change health plans one time between Jan. 1 and March 31. The new health plan coverage starts the first of the month after you make the change. Note that you cannot add or drop Medicare private plan drug coverage (Part D) during this time. So, for example, if you have a Medicare private health plan without drug coverage, you can switch to another Medicare private health plan without drug coverage or to Original Medicare alone. You will not be allowed to purchase drug coverage until November 2008.
Changing Medicare private drug plans: Most people can add, drop or change drug plans just once a year, from November 15 through December 31, with coverage effective January 1. However, you can change your drug coverage from January 1 to March 31, if you switch from one Medicare private health plan with drug coverage to another.
Some notable exceptions: People who have Extra Help - federal assistance that helps pay for the costs of the Medicare drug benefit - or who live in qualified institutional facilities (like nursing homes), are allowed to change health or drug plans once a month.
If your drug is not covered: If you are a new member of a Medicare private drug plan and discover that your new plan does not cover a medicine you've been taking, your new plan is required to provide at least a 30-day supply of that drug without restrictions, such as prior authorization or step therapy. This temporary arrangement allows you to work with your doctor to change to similar covered drug or to request a permanent exemption. This policy does not apply to drugs that are explicitly excluded by law from Medicare coverage, however.
Changed formularies: Medicare prescription drug plans can change the drugs they cover (their formularies) at any time. If you are already taking a drug through the plan, you should continue to be covered until the end of the calendar year. However, if you lose coverage, you may need to ask the plan for an exception.
Special Enrollment Periods: Both Medicare private health plans and drug plans have Special Enrollment Periods, which allow you to make changes under certain circumstances. For example, if you were enrolled into a Medicare private health or drug plan by mistake or were misled into signing up, you can call 1-800-MEDICARE and you may be able to dis-enroll retroactive to the date you first enrolled in the plan.

To learn more about changing health and drug plans, drug transition and exception policies, special enrollment periods and how to begin the appeals process, visit www.medicarerights.org/help.html.

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