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What Happens When Your Healthcare Needs Change Outside of Medicare’s Annual Election Period?

Posted by Russell Scott
Estimated Reading Time 1 minute 18 seconds

What Happens When Your Healthcare Needs Change Outside of Medicare’s Annual Election Period?

As we age, our healthcare needs can change quickly. A new diagnosis, an unexpected hospitalization, or the need for specialized care may raise questions about whether your current Medicare plan still fits your needs. But what can you do if these changes happen outside of the Medicare annual enrollment period?”

Typically, Medicare enrollment is limited to specific times of the year, like the Medicare Annual Enrollment Period in the fall. However, certain life events may qualify you for a Special Enrollment Period (SEP), which allows you to make changes to your plan outside of the standard timeline.

You may qualify for a SEP if:

  • You move to a new address that is outside your current plan’s service area
  • You lose other health coverage
  • You enter or leave a skilled nursing facility
  • Your plan changes its contract with Medicare

But if your healthcare needs change, such as needing new medications, more frequent doctor visits, or access to specialists, you may not automatically qualify for a SEP. This can feel frustrating, especially if you are suddenly paying more out-of-pocket.

In these cases, it is important to:

  • Review your current plan’s coverage and out-of-pocket costs.
  • Explore other resources, like Medicaid or prescription assistance programs
  • Plan ahead for the next enrollment period to switch to a plan that better suits your evolving needs

Even when plan changes cannot be made immediately, you can still take proactive steps to manage costs and get the care you need. Talk with your provider about generic medication options, local clinics that offer income-based services, or alternative therapies that are covered under your current plan.

If your healthcare needs have changed and you are unsure of your next steps, connect with a licensed insurance agent to review your options. We can help you understand your options and prepare for the right time to update your Medicare coverage.

Russell Scott
OKMedicareHelp.com // info@okmedicarehelp.com

I was born and raised in Tulsa, Oklahoma. I played rugby for Oklahoma State University where I graduated with a degree in Finance and a minor in Accounting. Since then I have married, had three children Rory (6), Sydney (5) and Reince (3) and have built a career in the insurance industry.

One thing I don't take for granted is getting the privilege to meet with individuals and independent agents every week to discuss insurance needs in today’s ever-changing benefits environment. The companies that our agency has chosen to represent have become leaders in their markets and our vision is to develop a strong, capable distribution force to bring their insurance products to the public.

Legacy Insurance Advisors' mission is to sell and service all forms of health and life insurance by representing the best carriers in the industry, by maintaining a superior client base, by partnering with and retaining the most qualified professionals, and by providing all agency personnel with the training and tools available to give the very best possible service to our clients and companies. Our agents, managers, and staff are committed to educating and empowering our policyholders. We will provide guidance and expertise while managing our clients’ risk. Because of Legacy Insurance Advisors’ access to multiple providers in nearly every line of insurance, we will customize plans to fit our clients’ wants and needs.

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