Medicare Q&A

Medicare Q&A
Q: I applied for the Extra Help program because I cannot afford the costs of a private Medicare prescription drug plan. I haven’t heard back if I got it, but it’s almost May 15. Will I be able to enroll in a Medicare prescription drug plan after May 15 if I get Extra Help? Will I have to pay a penalty for waiting?

A: Yes, you will be able to enroll in a Medicare private drug plan after May 15 if you are found eligible for Extra Help, the federal assistance program that helps with the costs of Medicare drug coverage (Part D). But you may still have to pay a premium penalty.

If you currently have Medicare, you have just two more weeks during your Initial Enrollment Period (IEP) to enroll in a Medicare private drug plan. If you do not enroll in the Medicare drug benefit by May 15 of this year and do not have drug coverage from another source that is at least as good as Medicare’s (creditable), you may have to pay a premium penalty if you decide to enroll at a later date.

Once your IEP ends, you may only be able to enroll in or change your Medicare drug plan during the Annual Coordinated Election Period (between November 15 and December 31 of every year).

Under certain circumstances, you may get a Special Enrollment Period (SEP) to enroll in or change drug plans. If you apply for and get Extra Help after your Initial Enrollment Period, you get a SEP that begins when

1. Social Security notifies you that you have qualified for Extra Help. Your SEP to enroll in a drug plan begins on the date on the letter from Social Security (not the day you receive it). If you do not choose a plan yourself, you will be automatically enrolled in a Medicare drug plan; or

2. Medicare automatically enrolls you in a drug plan. Your SEP to change plans begins the day your coverage starts—if you do not know when your coverage begins, call the plan. You have until November 14 of the same year to make your election.

Note: You can also qualify for this SEP if you qualify for Extra Help because you have Supplemental Security Income (SSI). People with Medicaid or in a Medicare Savings Program can change drug plans once a month.

If the plan you want to enroll in does not have your Extra Help eligibility on file, you will need to show the plan proof that you got Extra Help. You can use the award letter from Social Security or the letter from Medicare stating that you automatically qualified for Extra Help and were assigned to a drug plan. If you do not have either of these letters, you can ask the plan to call Medicare to confirm your eligibility or ask the plan to check the sheet that Medicare sends to plans twice a month that lists people newly qualified for Extra Help.

If you qualify for a SEP because you get Extra Help and you did not have creditable coverage, you will have a premium penalty if you enroll after June 30 (after that you will have been without drug coverage for more than 63 days before your new Medicare drug plan coverage begins). The premium penalty is 1 percent of the average national premium (which will likely go up every year) for every month you delayed enrollment.

However, if you have full Extra Help (depending on your income and assets, you may qualify for either “full” or “partial” Extra Help—see the chart in Resources below), your penalty will be 20 percent of the regular premium penalty and you will only have to pay it for five years. Others have to pay the penalty for as long as they are enrolled in the Medicare drug benefit.

You can find a list of other circumstances that make you eligible for a SEP in Spotlight on Resources below.

Enrollment Tips:

· If you want to switch from one plan to another, it is better to just enroll in your new plan. You will be automatically disenrolled from your previous plan.

· The rules are the same whether you are in a stand-alone drug plan (PDP) or a Medicare private health plan (HMO or PPO).