Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

 Question:

I couldn’t change my insurance for 2025 due to a recent State of Emergency declaration, but I believe I should have made a change. Am I still able to make a change?

Answer:

There are many rules that apply to Original Medicare and the insurance products that go along with that coverage. One of the most important rules to understand is the time period when you are allowed to change your insurance coverage. That usually occurs during the Annual Open Enrollment Period, which is October 15 to December 7 each year. There is also a Medicare Advantage Open Enrollment Period which is open right now, from January 1 to March 31 each year.

There are also more than 20 different Special Enrollment Periods (SEP) available to allow coverage changes due to new situations and concerns.

One very broad SEP is “you experience an ‘exceptional circumstance.’” The most common of these “exceptional circumstances” is a State of Emergency declaration, often due to natural disasters, weather emergencies, or similar situations. This State of Emergency declaration created a situation where some individuals were unable to make the necessary adjustment to their insurance coverage when they could have made the change, and are therefore given extra time to make that decision. The State of Emergency declaration creates an additional Special Enrollment Period (SEP) that runs for a specific period of time. That period of time is defined in the State of Emergency declaration and applies to those individuals who were impacted by the situation.

In the past, individuals who wanted to make a change using the State of Emergency SEP could do so with any broker, insurance website, the medicare.gov website, or over the phone. However, beginning in 2025, now you can ONLY use this SEP by talking with the customer service department of Medicare, using the 1-800-MEDICARE phone number.

This change in how the State of Emergency SEP will be accessed was designed to protect individuals with Medicare and additional Medicare insurance products. Over the years, Centers for Medicare Services (CMS) has found that many seniors were receiving phone calls and mailings that prompted them to change their insurance in a way that may not have been in their best interest. A Medicare-eligible individual would receive a phone call, answer that phone call, and find that it was a salesperson talking to them about a different insurance product than what they were currently enrolled in. Later, the individual discovers that just by talking with this salesperson and answering some questions, they had been enrolled into a different insurance product. Sometimes the individual knew this was happening and sometimes they did not realize that is what happened until after they received the new cards in the mail, or it even took until they ran into problems with their insurance at the pharmacy or a doctor’s appointment.

To me, this new rule is a positive change for those of us that work with Medicare eligible individuals. This SEP protection allows those individuals to change their insurance when they qualify for the State of Emergency SEP, but protects them from = being misled by those salespeople who would try to use the SEP to change their coverage.

When using this State of Emergency SEP, you can still change your insurance, but you can only do so by working through the 1-800-MEDICARE helpline. Their customer service will help you to understand the products available to you, and determine if this SEP is appropriate for what you want to change.

As I mentioned, there are more than 20 SEP’s that are available all the time for those individuals who qualify for special situations. All of those other SEP’s can be handled as usual, with an insurance broker, a company website or the medicare.gov website.

So if you feel you have been impacted by a State of Emergency declaration in your area, or you have questions about your Medicare coverage, you can call 1-800-MEDICARE to find out more. You can continue to work with a broker or the websites as well. But if you determine you want to make a change using the State of Emergency SEP, instead of one of the other 20 available, you simply call 1-800-medicare, to make the change.

I am pleased with this added protection for those with Medicare. It is my hope that we will see fewer repeated phone calls trying to convince you to change your insurance. I hope we see fewer individuals who get changed, when they had no intention of changing their insurance, but simply answered their phone. I hope this new protection leads to a more stable insurance situation for those on Medicare.

At Lawley Medicare Solutions, our Medicare and Individual Health Consultants are dedicated to helping you make the most informed decisions about your healthcare needs. We offer personalized service and expert advice tailored to your unique situation. Contact us today by phone or email to schedule a consultation and ensure you’re getting the best coverage for your needs.

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LAWLEY HAS A TEAM DEDICATED TO MEDICARE INSURANCE!

Our licensed Medicare & Individual Health Insurance team can help clients understand the details of Medicare insurance plans, assist with choosing the right benefits and coverage, and provide guidance when life events that affect health coverage occur. For questions, concerns, or to reach Lawley Medicare Solutions, call 716.849.8223.