What Opportunities Will I Have to Change My Coverage in 2021?

Depending on your circumstances, you may have opportunities to change your Medicare health and drug coverage in 2021.

If you have Extra Help: Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. If you have Extra Help in 2021, you have a Special Enrollment Period (SEP) to enroll in a Part D plan or switch between plans. This SEP is available once per calendar quarter for the first three quarters of the year (January-March, April-June, and July-September). If you use the Extra Help SEP to change your coverage, the change will become effective the first of the month following the month that you make the change. For example, if you use the Extra Help SEP to choose a new Part D prescription drug plan in March, that plan will become effective April 1. If you use your Extra Help SEP in one quarter, you will have to wait until the next quarter to make another change, unless you have a different SEP.

If you enrolled in a plan by mistake or because of misleading information: If you enrolled in a Medicare Advantage Plan or Part D plan by mistake or after receiving misleading information, you may be able to disenroll and change plans. Typically, you have the right to change plans if you:

  • Joined unintentionally: You may have enrolled believing you were joining a Medigap plan to supplement Original Medicare, or you meant to sign up for a stand-alone Part D plan and accidentally joined a Medicare Advantage Plan.
  • Joined based on incorrect or misleading information: You may have been misled, for example, if a plan representative told you that your doctors are in the plan’s network but they are not, or you were promised benefits that the plan does not really cover.
  • Through no fault of your own, ended up or were kept in a plan you do not want: If you tried to switch plans during an enrollment period but were kept in your old plan. You can also make a change if you were enrolled in a plan because of an administrative or computer error.

The steps you should take to disenroll depend on whether you have used services and whether the plan paid for those services.

  • If you used any service since joining the plan (for example, saw a doctor or filled a prescription) and received a denial of coverage, you should request retroactive disenrollment, meaning disenrollment back to the date you enrolled in the plan. Depending on your situation, you may then wish to select Original Medicare (with or without a Part D plan) or a different Medicare Advantage Plan. If you are granted retroactive disenrollment, be sure to ask your providers to re-file claims with your new plan.
  • If you have not used any services since joining the plan, you may want to request a Special Enrollment Period (SEP) to disenroll from your plan. This option may be processed faster than retroactive disenrollment. If your request is granted, you will be disenrolled from your plan at the end of the month in which you made the request. To prevent gaps in coverage, sign up for new coverage immediately after you are disenrolled from the plan you did not want.

To request retroactive disenrollment or a SEP, call 1-800-MEDICARE (1-800-633-4227) and explain to the customer service representative exactly how you joined the plan by mistake.

If you qualify for another Special Enrollment Period (SEP): There are several circumstances in which you may be able to make changes to your Medicare health/drug coverage. For example, you have a SEP if you move outside of your plan’s service area, if your Medicare Advantage Plan terminated a significant amount of its network providers, or if you enroll in certain State Pharmaceutical Assistance Programs (SPAPs).

If you need to make changes to your coverage but you are not sure whether you qualify for a SEP, call your State Health Insurance Assistance Program (SHIP) to learn more. If you do not know how to reach your SHIP, call 877-839-2675 or visit www.shiptacenter.org.

Read More: What Changes Will There Be to Medicare Advantage Plans in 2021?
Learn About: How Does Transition Fill Work?
Return to: Medicare 2021

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