The Annual Open Enrollment has ended. There are 20 Special Enrollment Periods (SEP) that are available to individuals that meet those different SEP criteria. I am going to focus on two opportunities for switching plans, EPIC (Elderly Pharmaceutical Insurance Coverage) & the Five Star Medicare Plan.
EPIC is a New York State Pharmacy Assistance Program that provides secondary coverage when paying for your medications at the pharmacy to those who are 65 or older, New York State resident, within the income guidelines (single person make less than $75,000 or, a married couple make less than $100,000). If you think you qualify for EPIC, please call their Help-Line at 1-800-332-3742. Their customer service will answer your questions and send you an enrollment form. You can also get EPIC applications at your local pharmacy or New York State Office For the Aging office locations. I have them in my office as well.
EPIC has NO set enrollment period, and allows enrollment at any time. EPIC uses your income figures from the previous year.
EPIC will always be secondary to your Part D insurance coverage. If you have a retiree plan or VA coverage, EPIC will not help you pay for prescriptions. EPIC will only be secondary to Medicare Part D plans.
EPIC also has an additional benefit. This additional benefit may be more useful to you than any other benefit EPIC offers. If you are enrolled in EPIC, your membership gives you a Special Enrollment Period (SEP) each year. This means that every year you have 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 calendar year.
You can always evaluate whether or not switching your insurance makes sense. So if you missed the December 7 deadline, you can use your EPIC SEP after December 8 to switch plans and begin 1-1-22, or wait until after January to switch anytime you want during the year if necessary.
In counseling individuals with regard to their insurance, I have many times advised joining EPIC, not because an individual needs the additional drug cost assistance that badly, but because it gives them this SEP which we can use to make an advantageous insurance change.
You have another Special Enrollment Period (SEP) available to you. That is the SEP of the Five Star Medicare Plan. This year we have 17 Five Star plans available. All of these plans are Medicare Advantage Plans, they include ALL the Univera Senior Choice Plans (HMO & HMO-POS), ALL the Independent Health Medicare Encompass (HMO) and Independent Health Passport (PPO), and the Highmark BlueCross BlueShield Forever Blue and Freedom Nation plans (PPO). That is 7 plans offered by Independent Health, 7 plans offered by Univera Senior Choice and 3 plans offered by Highmark BlueCross BlueShield. All of these plans have the Five Star Rating for 2022. This means you can enroll into any of these plans anytime during the remainder of 2021 to begin 2022 and anytime during 2022.
The other 18 SEP’s may be useful to you and your situation as well. I do not have enough space to cover all 18 SEP’s, but realize that missing the December 7 deadline is significant, but it is not catastrophic.
Reach out to the Medicare resources you have available. The www.medicare.gov website is always available to research and review alternative products available. The Medicare hotline, 1-800-MEDICARE, is available to you. There are agencies and programs that can be of help to you to research alternatives, like Office For the Aging, Southwestern Independent Living Center & Senior life Matters. The Medicare Rights Center (www.medicarerights.org or 800-333-4114) could help you as well. There are also insurance brokers who could help with the plans they represent.
You missed the December 7 date, but there may be a solution out there anyway.