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Friday, November 26, 2021  

Seniors Locke-In By DecisionsPublished 7/24/2006

Many seniors are limited to the decision they made regarding their Medicare Part D Prescription Drug Coverage until January 1, 2007. Known as "lock-in", seniors who selected a stand-alone prescription drug plan or a Medicare Advantage Plan with a Prescription Drug Plan, will have to continue to use the services of that plan until New Year’s Day.

Seniors who are "locked in" will have the opportunity to change their prescription drug plan between November 15 and December 31, 2006 for coverage effective January 1, 2007. This is known as the Annual Coordinated Election Period. Individuals who did not enroll prior to May 15, 2006 can enroll from November 15 to December 31, 2006 for coverage to begin January 1, 2007. These individuals will be subject to a 7% penalty per month.

Some individuals who meet very specific guidelines can qualify to change prescription drug plans through a Special Enrollment Period. To change plans, individuals must submit a completed enrollment application to the new plan, which results in an automatic disenrollment from the current plan. For eligible persons, coverage begins on the first day of the month following enrollment. For example, individuals submitting a completed enrollment application to a new plan on July 25, will have coverage by the new plan on August 1st.

Individuals who receive Medicaid or the Medicare Savings Program are qualified to change plans once a month. Individuals who lose Medicaid or the Medicare Savings Program, have a Special Election Period which allows for enrollment in another plan for up to three months without a penalty. Individuals who apply for and are approved for Extra Help after May 15, 2006, qualify for one Special Election Period which starts on the day the individual qualifies for Extra Help or the day coverage was started by the plan. The Special Election Period ends on December 31 of the same year.

Residents of nursing home, a psychiatric ward or an intermediate care facility for the mentally retarded can change plans once a month after living in an institution for more than 30 days. Individuals who leave an institution can change plans one time during the first two months after moving out of the facility. Individuals who move out of the plan’s service area can change plans. If the individual notifies the plan of a permanent move, the Special Election Period begins the month before the move and lasts up to two months after the move. Coverage by the new plan can begin up to three months after the plan receives the completed application.

For individuals who move and fail to notify the plan about a move and have been out of the plan’s area for six months or the plan learns of the move from Medicare or the post office, the Special Election Period begins at the beginning of the sixth month and continues through the end of the eighth month after the move. There are other special circumstances in which individuals may qualify to change plans through a Special Election Period such as losing coverage through no fault of there own, enrolling in a PACE program, contract violations or enrollment errors, or the plan is no longer providing coverage in the area.

Seniors who turn 65 have an Initial Election Period. Individuals have seven months to sign up for Medicare Part D which is three months prior to turning 65, the month the individual turns 65, and three months after the 65th birthday. Individuals may select any plan that is available in the state. For questions on changing Medicare Prescription Drug Plans, call 1-800-503-5190 or 303-333-3482.

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