mr. white has medicare parts a and b with a part d plan. last year, he received a notice that his plan sponsor identified him as a “potential at-risk” beneficiary. this month, he started receiving assistance from medicaid. he wants to find a different part d plan that’s more suitable to his current prescription drug needs. he believes he’s entitled to a sep since he is now a dual eligible. is he able to change to a different part d plan during a sep for dual eligible individuals?
mr. white has medicare parts a and b with a part d plan. last year, he received a notice that his plan sponsor identified him as a “potential at-risk” beneficiary. this month, he started receiving assistance from medicaid. he wants to find a different part d plan that’s more suitable to his current prescription drug needs. he believes he’s entitled to a sep since he is now a dual eligible. is he able to change to a different part d plan during a sep for dual eligible individuals?
Answer: Yes, Mr. White is eligible to change to a different Medicare Part D plan during a Special Enrollment Period (SEP) for dual eligible individuals. Being eligible for both Medicare and Medicaid qualifies him as a dual eligible beneficiary. This status grants him access to a Special Enrollment Period outside of the typical Medicare Annual Enrollment Period.
Medicare provides Special Enrollment Periods for dual eligible individuals to make changes to their Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plans. Mr. White’s situation aligns with this category, as he is receiving assistance from Medicaid and is now a dual eligible beneficiary.
During his Special Enrollment Period, Mr. White can make changes to his Part D plan, such as enrolling in a different Part D plan that better suits his prescription drug needs. This SEP allows him to adjust his coverage based on his current circumstances.
It’s important for Mr. White to review and compare different Part D plans to find one that covers his prescription medications and meets his healthcare needs. He can also consider other aspects like premiums, copayments, and network pharmacies. He may want to reach out to Medicare or a licensed insurance agent for assistance in choosing the most suitable Part D plan for him.