I have Medicare now, but I need help |

If something is wrong today, call today

Whatever month you’re reading this.

The common wisdom is that Medicare changes happen in the fall and everything else waits. That’s the version most people have heard, and it’s the version a fair number of agents will give you. It’s also wrong often enough that assuming it costs people real money.

Two reasons not to wait

A lot of problems aren’t enrollment problems at all.

A denied claim, a bill that looks wrong, a prescription your plan suddenly won’t cover, a prior authorization that got refused — none of that is fixed by changing plans. Those run through appeals and exceptions, and they have their own deadlines that start ticking the day the notice is dated. Waiting doesn’t help. It just burns the clock.

And when it is an enrollment problem, there are more exceptions than people realize.

Medicare has a long list of situations that open a window outside the usual dates: moving, your plan leaving the area or losing its contract, entering or leaving a nursing home, qualifying for Medicaid or drug cost assistance, losing other coverage, being given bad information by a plan or an employer, and more. They aren’t obvious, they aren’t advertised, and they’re easy to miss.

We’ll be straight with you: not every situation has one. Part D drug plans are the hardest case — the exceptions there are narrower, and if you simply want a different drug plan, the Annual Election Period in the fall really is the main time to change one.

That’s not the end of it, though. If a specific medication is the problem, the fix usually isn’t a new plan anyway. It’s a formulary exception or an appeal with the plan you already have, and that can be filed any time of year.

If drug costs are what’s biting, there are federal and state assistance programs a lot of people qualify for and never apply to, because nobody mentioned they exist. That’s not an enrollment window either. That’s an application, and it can be filed most any time.

Sometimes the honest answer is that October is your next opportunity to switch. It’s still a question worth asking rather than assuming, and asking costs you a phone call.

What counts as an issue?

Anything about your coverage that bothers you. That’s the whole test.

Costs that climbed, a doctor who left the network, a drug that isn’t covered the way it was, a denied claim, a bill that looks wrong, a plan leaving your area, a move, a benefit you didn’t need before and need now. If it nags at you, it counts.

Two worth naming, because people often don’t recognize them as issues at all: if you’re stretching a prescription to make it last, and if you have Part A but never enrolled in Part B.

And if you simply haven’t looked at any of this in years — nothing has lapsed, and you haven’t done anything wrong. You just have a plan chosen for a version of your life that may have moved on. That’s a review, not a repair.

The fall window, briefly

The Annual Election Period runs October 15 to December 7. It’s open to everyone on Medicare, and changes take effect January 1. It’s the one time of year anybody can change a drug plan for any reason at all, which is why it matters more than its reputation suggests. If you’re currently in a Medicare Advantage plan, you get a second window from January 1 to March 31.

Supplements work differently — you can apply any time of year, but outside certain protected windows the insurance company can ask health questions and decline you. That one is worth a conversation before you do anything.

Also worth knowing: if you’re on an Advantage or drug plan, your insurer mails you an Annual Notice of Change every September showing what’s changing January 1. Supplement holders don’t get one, because supplement benefits don’t change.

Call us

Today, if something’s wrong — 281-894-7540. Don’t wait for a window that may not turn out to apply to you.

We’ll tell you what your options actually are right now — including when the honest answer is that we need to wait, and what to do in the meantime.

If your plan is still the right one, we’ll tell you that too. No obligation, and our services are always free to you.

Not connected with or endorsed by the United States government or the federal Medicare program.

Real Clients. Real Help.

Linda L.- Magnolia, Texas

“Just wanted to let everyone know how great you were I needed to change my Medicare health insurance and he went the extra mile for me I would highly recommend him.”

Mark H.- Magnolia, Texas

“Justin is genuinely committed to doing the right thing. He’s honest and has proposed what makes sense for me and my business partner. ”

B.F.- Houston, Texas

“Justin cares for his clients. He took the time to find out my needs & concerns. As a result found exactly what I wanted. I would recommend him to anyone.”

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I have Medicare now, but I need help