As I write this article in Mid-March, although things have gotten much better the COVID-19 virus is still with us. Although more people are getting vaccinated and the positivity rate is also lower in many areas of upstate New York, this is not the time to let up.
All the major pharmacies are still vaccinating adults with and without appointments. If you are not up-to-date on your COVID-19 vaccinations please consider doing so. Also, continue to follow the CDC guidelines in terms of wearing a mask, maintaining social distancing and, especially, washing your hands.
Special Enrollment Periods
When you think about making changes to your Medicare prescription drug plan (Part D) coverage or switching Part B plans, the first thing that comes to mind is the annual Fall Open Enrollment period. However, problems or special circumstances do arise during the other ten months of the year.
To accommodate these situations Medicare has created a number of Special Enrollment Periods (SEPs) that fall under the general heading of Special Circumstances. When certain life events happen to you, such as moving or returning to full-time employment, these SEPs allow you to adjust your coverage without penalty.
Each SEP has different rules. There are a number of SEPs that allow you to make changes to your Prescription Drug Plan and, in some cases, to your basic coverage. The rules can be somewhat complicated and vary for each category. So, this article can only touch on a few of the most important options.HIICAP counselors can help with all your SEP questions.
You can also go to the Medicare.gov website and enter the search term “special circumstances” to gain information on all the SEPs. Some of the most common SEPs include:
Changing where you live: If you move to a new address which is out of the service area of your plan you are allowed to switch to a new Medicare Advantage Plan or Medicare drug plan. You can also switch back to Original Medicare. Also, if you currently live in, recently moved into or just moved out of a long term care facility you can make all the changes to your coverage that you can make during the Open Enrollment Period.
Losing your current coverage: The most common example of losing your current coverage is that you no longer have employer or union, including COBRA, coverage. In this case you have two months to enroll in Original Medicare, an Advantage Plan or a Medicare Drug Plan. Also, you can make changes if you are no longer covered by Medicaid.
Having a chance to get other coverage: If your employer or union offers you an opportunity to enroll in their coverage you can drop your current Medicare Advantage Plan or Medicare Drug Plan to enroll in their private plan.
Becoming eligible for Medicaid: If you become eligible for Medicaid you will become what is known as a “dual eligible” with coverage split between Medicare and Medicaid. As a dual eligible you will be allowed to join, switch, or drop your Medicare Advantage Plan or Medicare prescription drug coverage. You should consult a HIICAP counselor about the special rules that allow you to make these changes.
Qualifying for extra help: If you qualify for extra help in paying for your prescription drugs you can change drug plans without waiting for the Fall Open Enrollment. Far too many New York residents who are eligible for extra help have not applied. In some cases, this means a loss of as much as $5,000 a year in assistance in paying for prescription drugs. The coverage limits have changed in recent years to allow for more people to be covered.
If you believe you might qualify for extra help it is important to contact a counselor with the HIICAP program about how to enroll. You can also call Social Security directly at 1-800-772-1213 or go online at www.socialsecurity.gov/i1020 . There is no cost to apply for extra help and it does not affect your current coverage.
Enrolling in other drug coverage that is as good as Medicare: If you qualify for other coverage, such as TRICARE or VA coverage, you can drop your current Medicare coverage and/or Medicare Drug Plan and enroll in one of these military plans. You can do this anytime during the year.
Your plan is sanctioned by Medicare and your coverage is affected: If Medicare takes an official action, known as a sanction, against your Medicare drug plan that has an impact on your coverage you can change plans. This option is determined by Medicare on a case-by-case basis. If you receive a notice from Medicare that your plan has been sanctioned HIICAP counselors can help you in selecting new coverage.
Formally incarcerated individuals: This is a new SEP which allows incarcerated individuals who become newly eligible for Medicare to enroll once released and current Medicare beneficiaries who drop Medicare coverage while incarcerated to re-enroll, starting the day they’re released and up to 12 months later.
All of the above are special cases that may allow you make changes outside of the annual Fall Open Enrollment period. If something happens at other times during the year you should contact your County HIICAP program for assistance. If you have any questions about Original Medicare, Medicare Advantage Plans or Medicare Prescription Drug Plans HIICAP counselors are available Monday through Friday to help you.
Who do I contact in Oneida County with my Medicare questions?
In Oneida County, contact the Oneida County Office for Aging and Continuing Care/NY Connects HIICAP program. Call the HIICAP office directly at 315-798-5456 and select option #2. You will probably be asked to leave a message and your call will promptly be returned. A trained counselor will provide you with the same high-quality service over the phone or they can arrange an in-person appointment at locations in either Rome or Utica.
Other HIICAP Programs in the area
To schedule an appointment with the Madison County HIICAP program, located at 138 Dominic Bruno Blvd in Canastota, call 315-697-5700 and ask for the HIICAP program. The Lewis County HIICAP program, located at 5274 Outer Stowe St. in Lowville, is scheduling appointments between 8:30 a.m. to 4:30 p.m. every weekday. Call 315-376-5313 to schedule your appointment. The Herkimer County HIICAP program is administered by Catholic Charities with offices located at 61 West St. in Ilion. To schedule an appointment between the hours of 8 a.m. and 3:30 p.m. call 315-894-9917. Select #232 from the directory listing.
Each of these programs are stressing that you call and schedule an appointment before coming to any of their counseling locations.
Dr. William Lane is the owner of William Lane Associates, a gerontological firm located in Homer, NY. He writes a monthly column on HIICAP related issues for the OFA. Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.
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