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What to do if you Picked the Wrong Medicare Drug Coverage



Each year, during an enrollment period that takes place from October 15 to December 7, Medicare beneficiaries can make changes to their Medicare coverage. Beneficiaries can switch between Original Medicare and private Medicare Advantage plans, they can switch between Medicare Advantage plans, and they can join or change stand-alone Part D prescription drug plans. These changes go into effect on January 1.


For the enrollment period that just ended this past December, the Centers for Medicare and Medicaid Services (CMS) rolled out a completely redesigned Medicare Plan Finder tool. Medicare beneficiaries can use this online tool to compare plan options, estimate costs, and enroll in plans. In late November 2019, CMS reported that Plan Finder traffic was 14% higher than in 2018.


However, you may have heard about reports of “glitches” with the new Plan Finder. These include inaccurate details about drug prices and pharmacy networks. Some people also reported difficulty sorting search results. Although CMS updated the Plan Finder almost daily, beneficiaries may have signed up for plans before the mistakes were caught. Unfortunately, now that their new coverage has started, some people are learning that the plans they chose do not work well for them. For example, their copays might be higher than estimated on the Plan Finder, or their preferred pharmacy might not be in their new plan’s network.


If you chose a Medicare Advantage plan or Part D plan based on bad information, you may be able to change your plan. CMS has a process for you to request a special enrollment period that would allow you to change your plan. You can call 1-800-MEDICARE and explain that there is an issue with your plan choice. If your choice was based on inaccurate information, you might be granted a special enrollment period to change your coverage.


People who are enrolled in a Medicare Advantage plan already have an opportunity to switch plans. Each year, from January 1 until March 31, beneficiaries enrolled in Advantage plans can change plans or switch to original Medicare and a stand-alone Part D plan.


In addition, some other circumstances will give you a special enrollment period to change plans. For example, people who recently moved to a new area with different coverage options, lost employer-sponsored drug coverage, or were recently released from jail may qualify for a special enrollment period. In addition, someone living in a skilled nursing facility can switch or drop plans. Finally, if you are enrolled in both Medicare and Medicaid, you have additional opportunities for a special enrollment period.


If you have any questions about whether you qualify for a special enrollment period or would like help choosing a new plan, please contact your local Aging and Disability Resource Center. If you have an urgent need for medication, and you cannot fill your prescription because your Medicare plan does not work the way you expected to, please contact the Aging and Disability Resource Center right away.

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