Open Enrollment

Though the Annual Open Enrollment closed December 7th, every January through March, is Medicare Advantage Open Enrollment. Those that are in a Medicare Advantage plan get another opportunity to change plans. If for some reason, you missed evaluating your plans prior to the December 7th Open Enrollment deadline, and you are in Medicare Advantage, you get another opportunity.

At this time, you can switch from your Medicare Advantage Plan (excluding Medical Savings Accounts, cost plans, and PACE) to another Medicare Advantage Plan, or to Original Medicare with or without a Part D plan.

Any changes made are effective the first of the month after the plan gets your requests. If you are considering a change, make sure you:

● Find out what plans are available in your area. You can do this by looking in the back of the Medicare & You 2025 book, reviewing plans on medicare.gov or talking to a SHIP counselor.

● Make sure the plan meets the needs you have. If you are wondering how to pick a plan, we recommend you look at: costs of medications, are your doctors in the network, the maximum out of pocket for health services, then all the extras (hearing, vision, dental, etc).

● Make the change by March 31st. This can also be done on the plan website, on www.medicare.gov, by calling Medicare (1-800-MEDICARE) or working with a SHIP counselor.

If you are not in a Medicare Advantage plan and do not meet the criteria for a Special Enrollment Period, you will not be able to change plans until the next open enrollment period which is Oct 15-Dec 7. We know that many beneficiaries did not look at their Part D plans this past year and are now surprised at costs of medications and premium changes. If you find your medication is no longer covered, you are eligible for a transition fill within the first 90 days of the plan. This is a 30 day fill that will tide you over until you can change medications or get a non formulary request approved.

If your medication copay increased it might be because of a change in the benefit or a change in the medication tier. If this is a hardship, you can request a formulary tier exception request which can lower the copay, if approved. At the beginning of the year, many exception requests that were approved last year may be expiring. This will require that you renew that exception request. Your physician will need to provide a supporting statement as they did before in order to renew the exception request.

These are three plan changes that could impact access to your medication and your costs. It is important to review any changes to your plan now to prevent any gaps in medication needs.  If this creates more questions for you, please reach out to Missouri SHIP to talk it through with a counselor by calling 1-800-390-3330.

Reference: https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan