Rare, Special Enrollment Periods
It is not a common occurrence, but there are instances in which there can be special circumstances, during which, a person can cancel enrollment in a Medicare Advantage plan, or switch either a Medicare Advantage or Medicare Part D plan during a period that is not the Annual Enrollment Period.
The Medicare Advantage Plan Discontinued by the State
In 2014, I wrote a blog post about a carrier that was closed by the state regulator. If you were enrolled in a Medicare Advantage plan, and that plan is discontinued because the carrier has ordered that action, then you are entitled to a Special Enrollment Period.
In 2015, certain plans were discontinued because the state insurance regulator ordered it. In this instance, existing members have the right to a Special Enrollment Period.
The Plan is Restricted by the CMS
The CMS is the agency that governs Medicare, and is part of the Division of Health and Human Services. The CMS is also the part of the government that approves the sale of every Medicare Advantage and every Medicare Part D Plan. The implication is that since the CMS is the sole determinant of which plans are granted permission to be sold to Medicare beneficiaries, and it is also the case that the CMS can rescind that privilege, if it is discovered that the plan doesn’t comply with CMS’ extensive set of regulations. Sanctions and fines have been levied in the past, and are currently in effect, to protect Medicare beneficiaries.
If it is the case that this occurs, and your plan is affected, then you may be able to obtain relief. You will need to obtain details from your state insurance regulator, which may allow you to select a different Medicare Advantage plan or a different Medicare Part D plan. That is entirely possible.
A Rare Second Opportunity for Medigap
If you a eligible for a Special Enrollment Period, then you will be able to enroll in subset of Medigap plans. Those plans would be A,B, C, F, K, and L. For those of you that have unknowingly selected a Medicare Advantage plan, and have later discovered that Medigap would be a better fit for you, but you have a medical situation that would restrict your acceptance into a Medigap plan, this is potentially a solution for you. It will be up to the state to determine the exact length that this window will remain open, so it would be highly advisable to find out more about this option, to see if it applies to you.
Regulations are Heavily in Consumers’ Favor
A key objective of Maximize Your Medicare is to attempt to clear up a major misconception regarding Medicare. It is common that Medicare beneficiaries believe that the rules are heavily stacked against the beneficiary. The writer does not subscribe to this notion. Are the rules complicated? Yes, there is great misunderstanding regarding Medicare, the enrollment rules, and the extent of coverage provided by Medicare.
However, that is entirely different from the amount of protection established by the CMS to protect your consumer rights. In fact, the rules protect the consumer in almost every instance. For example, sales presentations made by carriers are pre-approved, the mail is pre-approved, and not even the order of the materials can be altered in any way by the carrier, or anyone representing the carrier in any capacity.
Conclusion
The particular circumstances described here, rare as they may seem, do occur. When the do, the Special Enrollment Periods are there to protect the interest of the Medicare beneficiary. While the path to finding the best solution may involve assistance from an expert or work by the beneficiary, the mechanism to protect a Medicare beneficiary’s rights are strong indeed.