Are you planning to move to a different state and worried about the changes with your Medicare plan?

It’s important to understand that, depending on where you are moving and what type of Medicare coverage that you have, there may be some potential impacts.

Before making any big decisions or relocating, it is essential for Medicare beneficiaries to learn more about options available in their intended location – including possible changes in premiums, deductibles or other eligibility requirements.

In this blog post, we’ll discuss the steps needed to ensure a smooth transition when switching states for Medicare Advantage Plans, Medicare Advantage Prescription Drug Plans, and Part D Prescription Drug Plans.

Understanding the Special Enrollment Period (SEP) for Medicare Advantage Plans When Moving to a New Area

Relocating to a new area can be a significant and life-altering event that necessitates a thorough understanding of how it impacts your Medicare Advantage Plan.

When you move out of your current plan’s service area, you may be eligible for a Special Enrollment Period (SEP) to update your plans to those servicing your new region.

If you are currently planning to move or have recently relocated, you may have the option to switch to a new Medicare Advantage Plan or return to Original Medicare. Most notably, this SEP commences as early as the month prior to your move and extends for two full months after the relocation process is completed.

It is important to keep in mind that proof of qualifying health coverage for one or more days during the 60 days preceding your move is required.

However, individuals returning to the U.S. after residing overseas or those who have recently been released from jail are exempt from providing proof of prior coverage.

What proof might I need to provide to be eligible for this Special Enrollment Period?

When you move and qualify for a Special Enrollment Period (SEP) to change your Medicare Advantage Plan, there are specific documentation requirements that you must meet to prove your eligibility.

These documents are necessary to confirm the occurrence of your life event (in this case, moving) and to verify that you had qualifying health coverage before the move.

1. The first set of documents required is proof of your move.

This could be a lease agreement for your new residence, a utility bill, or an updated driver’s license showing your new address. It’s important to note that the document must show your name and your new address to be accepted as valid proof.

2. The second set of documentation is to confirm that you had health coverage before the move.

This could be a letter from your previous insurance company detailing the coverage you had, an Explanation of Benefits (EOB) statement, or a pay stub showing a health insurance deduction1. These documents should demonstrate that you had qualifying health coverage for at least one day during the 60 days before your move.

In addition to these, if you’re enrolling in a Medicare Advantage Plan for the first time, you might also need to provide your Medicare Number or Social Security number and your current contact details.

It’s essential to submit these documents promptly after your application, as you won’t be able to start using your new coverage until they’ve been received and processed.

The Centers for Medicare & Medicaid Services (CMS) has implemented a verification process to ensure that only eligible individuals can enroll or change plans using an SEP.

3. In some cases, you might be asked to complete and upload Form CMS-L564 (Request for Employment Information), or provide written notification (a letter, fax, or email) from your employer if you’re applying for Medicare Part B during your Special Enrollment Period.

Failure to join a new Medicare Advantage Plan or new Medicare Advantage Prescription Drug Plan during the SEP may result in automatic enrollment in Original Medicare. 

In summary, moving to a new area presents an ideal opportunity to reevaluate your Medicare Advantage Plan and make necessary changes to suit your specific needs in your new location.

Take full advantage of this Special Enrollment Period to ensure you have the most suitable coverage for your evolving circumstances.  It is always a good idea to call 1-800-MEDICARE for the most accurate and up to date information pertinent to your unique situation.

Does my Part D Prescription Drug Plan out-of-pocket expense reset for the year if I move to a new area and pick a new plan?

Medicare Part D Prescription Drug Plans are an integral component of the Medicare program, offering invaluable prescription drug coverage to its beneficiaries.

It plays a crucial role in helping individuals effectively manage the costs associated with their prescription medications, including both generic and brand-name drugs.

The coverage provided under Medicare Part D is thoughtfully divided into four distinct phases, each carefully designed to cater to the unique needs of the beneficiaries.

Let’s explore these phases in more detail:

1. Deductible Phase:

In the initial phase, you are responsible for paying 100% of your prescription drug costs until you reach the deductible limit set by your specific plan. It’s important to note that the deductible can vary among different Part D plans.

For example, in the year 2023, the maximum allowable deductible is $505. During this phase, it is advisable to carefully consider your prescription drug expenses to effectively manage your healthcare costs.

2. Initial Coverage Phase:

After you have met the deductible, you enter the Initial Coverage Phase. During this phase, you are required to pay a copayment or coinsurance, while your plan covers the remaining cost for each covered drug.

It is worth noting that your combined amount, including the deductible, must reach $4,660 in 2023 before you progress to the next phase. This phase provides you with a period of coverage where you can receive your prescribed medications, while your insurance plan shares the financial responsibility.

3. Coverage Gap (Donut Hole) Phase:

Once you and your plan have spent $4,660 on covered drugs, you enter the Coverage Gap, also known as the “Donut Hole.” Here, the cost-sharing mechanism changes, and you pay no more than 25% of the cost for both brand-name and generic drugs until your out-of-pocket costs reach $7,400 in 2023.

It is important to be aware of this phase to effectively plan for and manage your medication expenses, especially if you regularly rely on certain prescription drugs.

Moving to a new area may require you to change your Medicare Part D Prescription Drug plan if your current plan’s service area does not cover your new location. The good news is, the money you’ve already spent on covered drugs during the year would still count even if you switch plans due to moving.

In 2023, once you and your plan have spent $4,660 on covered drugs (the combined amount plus your deductible), you enter the coverage gap.

During this phase, you’ll pay more out-of-pocket for your prescriptions until you reach the catastrophic coverage phase.

If you move when you’re in the donut hole phase, your out-of-pocket costs (up to the point of your move) should still count towards reaching the catastrophic coverage phase in your new plan.

However, it’s crucial to note that the specific drugs covered and the cost-sharing amounts might be different in your new plan. Therefore, it’s always a good idea to check the formulary of your new plan to ensure your medications are covered and to see what the copayment or coinsurance costs will be.

Remember, you may be eligible for a Special Enrollment Period (SEP) when you move out of your plan’s service area, which allows you to enroll in a new Medicare Part D Prescription Drug plan. This SEP starts as early as the month before you move and continues for two full months after you’ve moved.

It’s always advisable to inform your current plan about your move as soon as possible to ensure a smooth transition to your new plan.

4. Catastrophic Coverage Phase:

After your out-of-pocket costs reach $7,400, you leave the Coverage Gap and enter the Catastrophic Coverage Phase. In this phase, your financial responsibility is reduced to a small coinsurance amount or copayment for the rest of the year for your drugs.

This phase provides a level of protection from high medication costs, ensuring that you can continue to access necessary medications without facing overwhelming financial burdens.

Understanding these different phases of prescription drug coverage can empower you to make informed decisions about your healthcare and effectively manage your medication expenses throughout the year.

Relocating to a new area can have implications on an individual’s Medicare Part D Prescription Drug Plan. If a beneficiary moves out of their Medicare drug plan’s designated service area, it becomes necessary for them to join a new drug plan in their new location.

This is mainly due to the fact that Medicare Part D Prescription Drug Plans (PDPs) and Medicare Advantage Plans with prescription drug coverage (MA-PDs) typically have regional networks of pharmacies, and the formularies, or the list of drugs covered by the plan, can vary depending on the region.

It is important to note that when changing Medicare Part D Prescription Drug plans due to a move, the progress made through the phases of your Part D Prescription Drug Plan remains intact.

However, it is highly recommended to review and carefully understand the formulary of the new plan, as the coverage of specific drugs may differ.

In summary, relocating to a new area may necessitate adjustments to one’s Medicare Part D Prescription Drug Plan. While the progress made through the Part D phases carries over seamlessly, it is essential to familiarize oneself with the nuances of the new plan’s policies. Staying well-informed and comprehending these changes is of utmost importance to ensure the maintenance of effective prescription drug coverage in your new location.

Moving to a new area doesn’t need to be stressful when it comes to your updating Medicare Advantage Plan, Medicare Advantage Prescription Drug Plan, or Part D Prescription Drug Plan. As long as you meet the eligibility requirements for the Special Enrollment Period, you can view several different options and pick the one that best meets your needs without hassle

Additionally, if you move to a new area, it’s important to remember that your Part D Prescription Drug Plan out-of-pocket expense will not reset for that year, but rather will go towards whatever plan you select instead.

Now that you have a better understanding of this Special Enrollment Period and how it works with your current coverage plans, why not make sure you are getting the most out of your insurance?

It may be useful to speak with a licensed health insurance sales agent to help navigate the complexities of coverage options.  Get your questions answered by calling Apollo Insurance Group at (913) 279-0077 for a free plan comparison with no obligation to enroll.  Calling this number will direct you to a licensed insurance agent.

Sources

“Special Enrollment Periods”

“only with a Special Enrollment Period”

“Special Enrollment Period (SEP) – Glossary”

“11219-understanding-medicare-part-c-d.pdf”

“New to Medicare? | NC DOI”

“Drug coverage (Part D)”

“Costs in the coverage gap”

“How Part D works with other insurance”

“Joining a health or drug plan” 

“Part D late enrollment penalty” 

“What documents do I need to submit for an SEP?”

“Exceptional Circumstances for Medicare Special …”

“Send documents to confirm a Special Enrollment Period”

“Fact Sheet: Special Enrollment Confirmation Process”

“How to Apply for Medicare Part B During Your Special …”

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