A non-government resource for the Medicare community
Powered by Q1Group LLC
A non-government Medicare community resource
  • Menu
  • Home
  • Contact
  • MAPD
  • PDP
  • 2023
  • FAQs
  • Articles
  • Search
  • Contact
  • 2023
  • FAQs
  • Articles
  • Latest Medicare News
  • Search

Changing Medicare plans to lower drug costs or increase coverage

Category: Changing Medicare Plans
Published: Jul, 14 2023 01:07:07

If you find that your prescription costs and healthcare needs have changed, you may now be looking for a more affordable alternative to your current healthcare and prescription coverage.

You may wish to explore some of the following Special Enrollment Periods (SEPs) providing you with an opportunity to change plans outside of the annual Open Enrollment Period.

(1)  2023 Insulin-user SEP:  Medicare has created a new Special Enrollment Period allowing people using insulin products a one-time opportunity to change Medicare plans at any time during 2023.  You can read more at: Q1News.com/386.

(2)  Extra-Help SEP:  If you are eligible for Medicare Part D Extra Help, then you are granted a Special Enrollment Period to change Medicare plans once every three months from January through September with coverage starting on the first day of the month after your enrollment.  To learn more, please see: Q1FAQ.com/716.

Important:  2023 Extra Help qualification limits have changed.  You can click here to for more information about the 2023 Federal Poverty Level (FPL) guidelines and qualifying for Extra Help during 2023.

(3)  5-Star plan SEP:  All Medicare beneficiaries have a once-a-year Special Enrollment Period to switch to a Medicare plan with a 5-Star quality rating.

Although 5-Star plans are not available everywhere, you can use our Medicare Advantage Plan Finder (MA-Finder.com) to check availability of 5-Star Medicare Advantage plans in your county.  Here is an example link for ZIP code 33592: MA-Finder.com/33592 – just look for the 5-Star icon next to the plan name (or use the 5-Star search filter).

Unfortunately, in 2023, there are no 5-Star stand-alone Medicare Part D plans (PDPs) available to the general public; however, there are a few employer/union (EGHP) 5-Star PDPs.

You can click here to read more about using the 5-Star Special Enrollment Period.

(4)  Changes in your health - Chronic Illness SEP:  A person who has developed a chronic health condition may use an SEP to join a Chronic Care Medicare Advantage Special Needs Plan (C-SNP).  Again, please see our MA-Finder at MA-Finder.com - and use the “Chronic Condition” Special Needs Plan filter (checkbox in the search area) to see available plans.  For more information about this SEP, please see:  Q1FAQ.com/35.

(5)  Relocation SEP:  A Special Enrollment Period is available to anyone who moves out of their Medicare plan’s “service area” during the plan year.  The service area for a stand-alone Medicare Part D plan (PDP) is a state or multi-state area and the service area for a Medicare Advantage plan (MA or MAPD) is usually a county, partial-county, or ZIP code area.

Important:  When you move to another service area, you may not find the same Medicare Part D or Medicare Advantage plans – and even plans with the same name may not provide the same coverage as the plan in your previous location.  Please be sure to carefully evaluate your plan options before enrolling.  You can use PDP-Finder.com or MA-Finder.com to review plans available in your new location.

(6)  Long-Term Care SEP:  A Special Enrollment Period is also available to people moving into, or out of, a long-term care (LTC) facility.  You can use our long-term care plan comparison tool: Q1Medicare.com/LTC.

Next steps?  For more information about these and other SEPs that may be available to you, please see our Special Enrollment Period FAQ, contact a Medicare representative at 1-800-633-4227, or contact a local SHIP representative.

Question:  Will I be granted a Special Enrollment Period if my Medicare Advantage plan drops my doctor from the plan network?

Maybe.  Medicare does provide a Special Enrollment Period when a Medicare plan makes “significant” changes to the plan’s healthcare provider network. However, the SEP is granted on a case-by-case basis.  To learn more about qualifying for this SEP, please contact a Medicare representative at 1-800-Medicare.

Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs

Ask a Pharmacist*
Have questions about your medication?

» Answers to Your Medication Questions, Free!
Available Monday - Friday
8am to 5pm MST
*A free service included with your no cost drug discount card.

Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.