Availability of Transition Refills
Medicare Part D Plans can change their formularies each year and sometimes people do not realize that a medication is no longer covered or requires authorization until they try to get their medications refilled in the new year. Since the Medicare Open Enrollment Period ended on December 7th, people generally can no longer change their drug plan for coverage starting January 1st. However, if people find out early next year that their Part D or Medicare Advantage plan no longer covers their prescription drug, they should be aware that transition refills (also known as transition fills) are available.
A transition fill typically provides a one-time, 30-day supply of a drug that a Medicare beneficiary was already taking even if the drug is not covered or requires special approval for coverage by their current plan at the start of a new calendar year. This gives the Medicare beneficiary time to talk with her doctor and either seek a formulary exception or prior authorization or switch to a drug that the plan covers. Transition fills will not cover new medications that people are prescribed.
All stand-alone Part D plans and Medicare Advantage plans that include drug coverage must make transition refills available. When someone uses her transition fill, she should be told at the pharmacy that her medication was covered temporarily. Medicare beneficiaries in this situation should also quickly receive a letter from their Part D plan explaining that they have used their transition fill, why their prescription drug is not covered, and what their options are going forward.
Medicare Advantage Open Enrollment Period and Special Enrollment Periods
Although most people on Medicare can only change their health and drug plans during the Annual Open Enrollment Period (October 15th through December 7th), there are some enrollment opportunities that people can use to make changes to their Medicare coverage next year if needed.
Medicare Advantage Open Enrollment Period
One option for making an enrollment change after January 1st is the Medicare Advantage Open Enrollment period, which runs from January 1st through March 31st. This enrollment period allows people who are enrolled in a Medicare Advantage plan on January 1st to switch to another Medicare Advantage plan (with or without drug coverage) or disenroll from their Medicare Advantage plan and return to Original Medicare. Anyone choosing to return to Original Medicare during this period will be able to join a stand-alone prescription drug plan for Part D coverage. Only one change may be made during this period. Any change made during this period will become effective on the first day of the next month.
Special Enrollment Period for Dual Eligibles and people with Extra Help
Dual eligibles (those eligible for both Medicare and Medicaid) and other individuals who are eligible for Extra Help with their Part D costs have a special enrollment period to change their Medicare health or drug plan once a quarter during each of the first three quarters in a calendar year. Changes made during this period will start on the first of the next month.
Other Special Enrollment Periods (SEPs)
There are several other SEPs that exist for various circumstances that people can use to make coverage changes during the year. Common ones include when people move, when people lose Medicaid coverage, or when people lose other prescription coverage and need to enroll in Part D.
A special enrollment period may be available for those who received inaccurate or misleading information while using the Medicare Plan Finder to choose their 2021 Medicare coverage or if they were given misleading information by someone like an agent or broker and ended up enrolled in a plan that does not meet their needs. If you (or a consumer you work with) believe you received misinformation and ended up with Medicare coverage that does not work for you, call 1-800-MEDICARE to explain your circumstances and discuss the availability of a Special Enrollment Period. For more information about Medicare enrollment periods and other SEPs that may be available, see Medicare’s publication on this topic here.
We encourage readers who have questions about using these enrollment periods to make changes to their coverage or who have questions about getting a transition refill to call APPRISE at 1-800-783-7067.