Medicare Special Election Period for Low-Income Subsidy Beneficiaries
This article was updated on: 10/16/2017
Are you enrolled in Medicare and receiving Extra Help with prescription drug costs? Also known as the Medicare Low-Income Subsidy, this program helps low-income enrollees with Medicare Part D costs like premiums, deductibles, copayments, and coinsurance. You might qualify for a special enrollment period (officially known as a Special Election Period) to enroll in (or make changes to) your Medicare prescription drug coverage.
You may not realize that if you’re eligible for the Low-Income Subsidy, you may be able to enroll in a Medicare Prescription Drug Plan at any time of the year with a Medicare Special Election Period. Under normal circumstances, most Medicare beneficiaries can only enroll, change plans, or drop coverage during certain times of the year. However, if you get Extra Help, you may be able to make these changes to your Medicare prescription drug coverage without the usual date restrictions. This article explains how this Medicare special enrollment period works.
How do I enroll in a Medicare Prescription Drug Plan?
If you find out you’re eligible for the Low-Income Subsidy program, Medicare may automatically enroll you in its Part D prescription drug coverage and find a plan for you if you don’t already have it. Many beneficiaries I talk to are surprised to find out that you don’t automatically get prescription drug coverage when you sign up for Medicare. Original Medicare, Part A and Part B, covers your hospital and medical expenses, as well as certain medications you take in a hospital or outpatient setting. For example, if you need infusion medications, Part B may cover this treatment at a doctor’s office. However, prescription drug coverage for most medications you take yourself at home aren’t covered. That’s where Medicare Part D comes in.
You have two main choices when it comes to getting Medicare Part D prescription drug coverage. You can stay enrolled in Original Medicare and add a stand-alone Medicare Part D Prescription Drug Plan. Or, you can switch to a Medicare Advantage Prescription Drug Plan, which lets you get your Medicare health and prescription drug coverage through a single health plan. Both stand-alone Medicare Prescription Drug Plans and Medicare Advantage plans are available through Medicare-contracted private insurance companies. And, either way, you’ll still need to continue paying your Medicare Part B monthly premium (unless you qualify for state assistance that covers your premium, such as through a Medicare Savings Program).
Is there a Medicare special enrollment period for prescription drug coverage?
Yes, there is a special enrollment for those with Extra Help, known as a Medicare Special Election Period. Most Medicare beneficiaries are limited to certain time periods when they can enroll in Medicare prescription drug coverage, whether that’s a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. But if you qualify for the Medicare Low-Income Subsidy, you get a Medicare Special Election Period that lets you enroll in Medicare prescription drug coverage, or make changes to your coverage, at any time of the year. Your prescription drug coverage will start the first day of the month after you become eligible for the Medicare Low-Income Subsidy and enroll in a plan.
If you lose your eligibility for Extra Help, you’ll get another Medicare Special Election Period to make changes to your prescription drug coverage. During this Medicare Special Election Period, you can:
- Enroll in a Medicare Prescription Drug Plan.
- Enroll in a Medicare Advantage plan with or without prescription drug coverage.
- Change plans, or switch from Medicare Advantage back to Original Medicare.
- Drop your prescription drug coverage.
If you no longer qualify for Extra Help, this Medicare Special Election Period starts the month you lose your Extra Help eligibility and lasts for two months after that. If you lose your coverage for the upcoming year, you can make changes from January 1 to March 31. Keep in mind that once your Medicare Special Election Period is over and you’re no longer eligible for Extra Help, you’ll need to wait until the Medicare Advantage and Prescription Drug Plan Annual Election Period (October 15 to December 7) to make changes unless you have another situation that qualifies you for an additional Special Election Period. Medicare allows special enrollment outside of the regular annual enrollment periods when you have a qualifying situation, such as moving outside of your plan’s service area or moving into a nursing home.
What is the Medicare Low-Income Subsidy (Extra Help) and when can I enroll?
I’d like to give you a quick rundown on the Medicare Low-Income Subsidy (Extra Help) program. This is a government assistance program for low-income Medicare beneficiaries that helps with prescription drug costs. If you qualify for Extra Help, the government looks at information such as your annual income and resources and tells you whether you’ll qualify for the following year. This article provides more details on eligibility for the Low-Income Subsidy.
How do I know if I qualify for the Medicare Low-Income Subsidy?
If you’re eligible for the Medicare Low-Income Subsidy, Medicare sends you a color-coded notice depending on your situation:
- Purple means you automatically qualify for Extra Help because you’re a dual eligible (receive both Medicare and Medicaid); are enrolled in a Medicare Savings Program; or receive Supplemental Security Income (SSI) benefits.
- Green means you’re automatically enrolled in the Medicare Low-Income Subsidy program because you either get SSI benefits; are enrolled in a Medicare Savings Program; or you applied for Extra Help yourself. Unless you decline coverage or enroll in a plan yourself, Medicare will automatically enroll you in Medicare prescription drug coverage.
- Yellow means you qualify for full Medicaid and Medicare benefits and are enrolled in Original Medicare. You’ll be automatically enrolled in a stand-alone Medicare Prescription Drug Plan if you’re not currently enrolled in a plan. You have the option to decline this coverage or enroll in a plan on your own.
- Orange means you still automatically qualify for Extra Help, but your copayment amounts will change next year.
- Gray means you no longer automatically qualify for Extra Help next year. However, you’re encouraged to apply to see if you’ll continue to qualify.
Remember, you can also apply for the Medicare Low-Income Subsidy even if you don’t qualify automatically. To find out how to apply, contact the Social Security Administration, either online or by phone at 1-800-772-1213 (TTY users call 1-800-325-0778) between 7AM and 7 PM (all U.S. time zones). If you have more questions about Medicare prescription drug coverage or would like help finding plan options that could work for you, that’s what I’m here for.
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