There are 20 Special Enrollment Periods (SEP) that are available to all individuals with regard to Medicare coverage. I will focus on two of the 20 SEP’s for switching your insurance plans in 2021, EPIC coverage & Five Star Medicare Part D Plan. We have not had a Five Star Medicare Part D plan since 2013, so this very good news in 2021.
EPIC (Elderly Pharmaceutical Insurance Coverage) is a New York State Pharmacy Assistance Program that provides secondary prescription drug coverage. In order to qualify for EPIC, you be a New York State Resident who is 65 or older, and with an income below $75,000 for a single person and $100,000 for a couple. You can apply for EPIC anytime you meet those criteria guidelines. If you think you qualify for EPIC, please call the EPIC Help-Line at 1-800-332-3742. The customer service will answer your questions and send you an enrollment form or call my office and we can mail you an application.
EPIC uses your income figures from last year. Those figures can be obtained from your tax return, if you file; if you don’t file a tax return, EPIC can use your 1099 tax documents. You still receive these, even if you are not required to file taxes. You must include your net Social Security income (which is not always taxable). I encourage all seniors to review their income every year to see if they qualify for EPIC (if not already covered by EPIC).
EPIC will always be secondary to your Medicare Part D insurance coverage. If you have VA coverage, EPIC cannot help you pay for prescriptions you get from the VA.
In addition to providing secondary prescription drug coverage, EPIC offers all members a Special Enrollment Period (SEP) each year. This means that every year you are enrolled in EPIC you have an additional one time opportunity to switch your prescription drug coverage from one product to another. This can be used at any time during the year, but only once each year.
In counseling individuals with regard to their insurance, I have often advised clients to join EPIC. This is true even when an individual does not need the additional drug coverage, but because EPIC gives them an SEP which they may use to make an advantageous insurance change in the future.
The second SEP available to you all year in 2021, is the Five Star Special Enrollment Period. This year we have three Five Star Insurance plans available to us in our region. The Five Star Plans are all BlueCross/BlueShield of WNY PPO (Preferred Provider Organization) Medicare Advantage Plans; Forever Blue PPO 751 ($204 premium), Forever Blue PPO Value ($145 premium) and Freedom Nation ($25 premium). All three plans include prescription drug coverage.
Whichever of these three plans you choose would replace your current coverage if you chose to use this SEP. You should evaluate your current coverage and compare it to each of these plans. As always, it is important to understand the coverage offered and that your medications are in the formulary of the plan you choose.
Two of the BC/BS PPO plans have the very useful BlueCard network with 43 partnering coverage states, Forever Blue PPO 751 and Freedom Nation. This BlueCard network is a useful tool in planning for travel and second homes.
Having these Five Star Plans means that in 2021 everyone has this Five Star Special Enrollment Period as an opportunity to switch their insurance during 2021 if they need or want to. Like the EPIC SEP, the Five Star SEP can only be used once during a calendar year.
There are 20 Special Enrollment Periods available to individuals during the year. The other 18 SEP may be useful to you and your situation. We are always here to help you evaluate whether or not switching your insurance makes sense.