Revising Medicare Drug/Health Plans

Decisions aren't always easy to make when it comes to health coverage. While the information concerning each choice may be present, it's still easy to worry about making the wrong choice. Sometimes words that look good on paper wind up being something completely different in reality. This is why Medicare beneficiaries are offered the opportunity for a second-chance decision in regards to choosing a private drug or health plan. These changes aren't available at any time for everyone. However, there are some special exceptions in a few cases. There are only specific windows of opportunity for everyone during the year, so it's important to take advantage of them.

After enrolling, the new coverage begins on the first day of the month following the month of selection. The drug plan's Annual Election Period lasts from October 15th through December 7th. It's possible to enroll for the first time or change existing Advantage and Part D coverage during this time. It's important to keep in mind that changing a health plan may also result in a change in drug coverage. Anyone is allowed to terminate or change enrollment status between January 1st and February 14. This is called the Medicare Advantage Disenrollment Period. Members of an Advantage Plan may go back to original Medicare during this time.

There are several instances in which plan members can make changes that don't comply with regular enrollment rules. These exceptions include the following:

  • When new private drug plan members discover that their plan won't cover a specific medication they're currently taking, they may use the transition policy outlined in the plan provisions. Medicare drug plans are required to give new members a supply of any drug they previously took before joining for at least 30 days. This rule applies to all drugs that aren't excluded from Medicare coverage by law. In order to continue getting this prescription, contact a health provider. Ask for a special request for the plan to cover the drug as an exception. If the request is denied, individuals have the right to appeal the decision.
  • Beneficiaries receiving financial assistance from the government for drug expenses can change drug and health plans once per month. Individuals living in a qualified institution may also do this.
  • Individuals enrolled in a private Medicare drug or health plan by mistake can use the Special Enrollment Period to make changes. Individuals who feel they were deliberately misled before joining may also take advantage of this time period. Anyone who meets these requirements should call 1-800-Medicare.
  • If the Medicare prescription plan makes changes to the drugs they cover, members who discover this may ask for an exception. Individuals who are currently taking the medication using the plan will receive continuous coverage through the end of the calendar year. Individuals who want to stay on the prescription beyond that point should contact a personal physician to ask for a plan exception. Be aware that Medicare drug plans reserve the right to change their covered drug lists at any time.

To obtain more information regarding health or drug plan changes and procedures, visit the Medicare Rights Center's official Web site, which is found at http://www.MedicareRights.org. This site also has information about exception policies and drug transitioning.