Can I switch plans mid-year?

You can switch plans mid-year under a Special Enrollment Period (SEP) only if you are eligible under certain situations otherwise you would have to wait for an Annual Enrollment Period (AEP) which runs from October 15 through December 7. To qualify for an SEP you would need to be eligible, for instance you move to a new service area or your existing plan no longer offers coverage. You should call Medicare to see whether your specific situation would allow you to switch plans.

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What is “step-therapy”?

Step therapy is a type of prior authorization. With step therapy, you must first try certain less-expensive drugs, like a generic drug, that has been proven effective for most people with your condition, before you can move up a “step” to a more expensive brand-name drug.

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What is a Special Enrollment Period (SEP)?

A Special Enrollment Period (or SEP) are periods outside the Initial Enrollment Period (IEP) or the Annual Enrollment Period (AEP) when you may select a plan or change your current plan in certain circumstances. Examples of situations that may qualify you for an SEP include your losing creditable coverage, moving to a new service area or your existing plan no longer offers Part D coverage. You will need to call Medicare to find out if you are eligible for an SEP.

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What are Medicare Part D Star Ratings? Are they important?

Medicare created the Star Ratings system to help you compare quality and performance among Medicare Part C (Medicare Advantage) plans and Medicare Part D prescription drug plans (PDPs). Medicare determines the ratings each year, evaluating a plan’s performance in more than 50 areas across 4 broad categories. These categories range from customer service to patient safety. Medicare assigns them a rating of 1 to 5 stars. This provides a current and unbiased measurement of a plan’s overall performance.

Star Ratings are an important factor to consider when choosing a plan. They take the guesswork out of selecting a trustworthy plan by telling you if the plan is likely to offer high quality.

In general, you should look for plans with a rating of 3 to 5 stars. At, you can view the details of a plan’s Star Rating to see how well it performs in each category. If the plan you like has low ratings, review the Star Ratings details to make sure it’s a good choice for you.

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Who can I call to discuss my various Medicare options?

You can speak with a licensed insurance broker or agent free of charge. There are also additional resources you can turn to like, the Medicare & You handbook and your State Health Insurance Assistance Program (SHIP). If you are losing employer-provided coverage, your employer may make a broker available to you who can discuss various options.

Many Part D plans offer Medicare advisors who can answer questions about the plan and help you determine if the plan will meet your needs.  Calling the plan before you enroll is a good way to determine how the plan will treat you in the future.

Check out this helpful video for more ideas regarding who you can turn to for help!

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I’m turning 65 later this year. When can I enroll in Medicare Part D?

If you are turning 65 you have an Initial Enrollment Period (IEP) of 7 months to enroll in a Part D plan. You can enroll up to 3 months before the month you turn 65, the month of your 65th birthday, and up to 3 months after the month you turn 65. In general, you can switch plans each year during the Annual Enrollment Period (AEP) from October 15 through December 7.

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What are the benefits of enrolling in Original Medicare and adding a Part D plan vs. enrolling in a Medicare Advantage Plan?

With Medicare, you have many opportunities to choose plans that best suit your needs and your budget. Enrolling in Original Medicare (Parts A and B) and then selecting a stand-alone Medicare Part D plan allows you to choose a prescription drug plan that better meets your prescription drug and financial needs. Some plans offer a broader list of covered medications, cost-saving preferred pharmacy networks and/or convenient home delivery.

A Medicare Advantage Plan with prescription drug coverage can offer the convenience of having all your health and prescription coverage bundled under one provider. However, this convenience may result in less choice and less opportunity to ensure the plan meets all your prescription drug needs.

Whichever plan you choose, it’s important to know that if you don’t enroll in Medicare when you become eligible, you may end up paying more down the road. That is because Medicare’s late-enrollment penalties are not a one-time charge but rather, are penalties that can raise your monthly premium(s) for years or possibly for life. Check this article for more information.

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My employer is no longer providing retiree prescription drug benefits. What should I do?

Medicare offers many individual Part D plans, supplemental insurance plans, and Medicare Advantage plans to provide the prescription drug coverage you need. Additionally, your employer may offer a broker service to help you with choosing a new coverage plan during this transition. Keep in mind that if you have a Health Reimbursement Account (an HRA) with your employer you should find out what you need to do so you don’t lose it.

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