Decisions aren't always easy when it comes to health coverage. Although information about each choice may be available, it’s common to worry about making the wrong choice. Sometimes words that look good on paper turn out differently in practice. This is why Medicare beneficiaries are offered limited opportunities to change a private drug or health plan after an initial selection.
After enrolling, new coverage generally begins on the first day of the month following the month of selection. The drug plan Annual Election Period runs annually in the fall and is the time to enroll for the first time or change existing Medicare Advantage and Part D coverage. Keep in mind that changing a health plan can also change drug coverage. Anyone may terminate or change enrollment status during the Medicare Advantage Disenrollment Period at the start of the year, which lets members leave an Advantage plan and return to original Medicare.
For general help comparing plan types and how they work together, see Understanding Dental Insurance and Medicare Benefits.
Special enrollment exceptions
- When new private drug plan members discover their plan won't cover a medication they currently take, the plan's transition policy may apply. Medicare drug plans must provide a temporary supply of previously taken drugs for at least 30 days, unless the drug is excluded by law. To continue the prescription, contact your health provider and request that the plan cover the drug as an exception. If the request is denied, you have the right to appeal.
- Beneficiaries who receive government financial assistance for drug costs (Extra Help) can change drug and health plans once per month; individuals living in a qualified institution may also have this option.
- Individuals enrolled in a private Medicare drug or health plan by mistake, or who believe they were misled before joining, may be eligible for a Special Enrollment Period. Anyone in this situation should contact 1-800-MEDICARE for guidance.
- If a Medicare prescription plan changes its covered drug list, current members taking an affected medication may get continued coverage through the end of the calendar year. To continue beyond that, ask your prescriber to request a plan exception; be aware that plans may change formularies during the year.
If you need more background on Medicare choices, plan coordination, and related insurance topics, see Understanding Medicare, Medicaid, and Life Insurance and Understanding Medicare and Medicaid.
To get personalized help, call 1-800-MEDICARE or ask an agent who can review plan options and enrollment windows with you.
Frequently Asked Questions
Can I change Medicare drug plans at any time if I find a medication isn't covered?
Not at any time, but new enrollees can use transition policies for a temporary supply and can request an exception or appeal if coverage is denied.
Who can change plans monthly?
Beneficiaries receiving Extra Help (financial assistance for drug costs) and some residents of qualified institutions may change plans once per month.
What should I do if I was enrolled in a plan by mistake?
You may qualify for a Special Enrollment Period and should contact 1-800-MEDICARE promptly for assistance.
Will a formulary change immediately stop my current prescription coverage?
Plans often provide continued coverage through the end of the year for current users, but you should request an exception from the plan if you need coverage beyond that period.