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My new 2016 Medicare Part D coverage is much more expensive than last year. Can I still change to another 2016 Medicare Part D prescription drug plan?

Category: Enrollment topics
Published: Feb, 16 2016 07:02:35


Maybe, depending on your situation. Most people cannot change their Medicare Part D plan coverage after the December 7th annual Open Enrollment Period (AEP) deadline.  However, if you qualify for a Special Enrollment Period (SEP), you can change your plan outside of the AEP.

You may qualify for an SEP for a number of reasons, some examples include:
  • If you move out of your Medicare plan’s Service Area (State or ZIP Code region).

  • If you move into (or out of) a Long-Term Care facility.

  • If you are enrolled in a sanctioned Medicare plan (see SEP for sanctioned plans), you may qualify for an SEP. To learn more and see if you qualify for this particular SEP, you will need to contact Medicare at 1-800-633-4227.

  • If you are eligible for the low-income subsidy (LIS) or the Medicare Part D Extra-Help program, you can change your Medicare Part D prescription drug coverage at any time during 2016.

  • If you are enrolled in a low-performing Medicare Part D or Medicare Advantage plan (a plan with consistently low quality ratings), you may qualify for an SEP and be able to change plans once, at any time during 2016.

  • You also have the once-a-year opportunity to join a Medicare plan with a “5-Star” quality rating at any time during the year.  (Unfortunately, 5-Star rated Medicare plans are not available in many areas.)

    Important: If you switch to a "5-Star" Medicare Part D prescription drug plan (a plan that only provides drug coverage – PDP) from your current Medicare Advantage plan with prescription drug coverage (health and drug benefits – MAPD), you would be automatically dis-enrolled from your Medicare Advantage plan and would return back to your Original Medicare Part A and B coverage along with your new “5-Star” prescription drug plan.

  • Finally, depending on your circumstances, you may be granted a Special Enrollment Period if you were provided false or misleading information when enrolling into your plan. To learn more and see if you qualify for this particular SEP, you will need to contact Medicare at 1-800-633-4227.

  • Please note that we are no longer in the 2016 Medicare Advantage Disenrollment Period (MADP) that started on January 1st and continued through February 14th and so you no longer have the ability to use the MADP to leave your 2016 Medicare Advantage plan and return to Original Medicare Part A and Part B - with the opportunity to enroll in a 2016 stand-alone Medicare Part D prescription drug plan.








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  • 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.
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  • 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.
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