Medicare: What is ‘lock-in’?
“Lock-In” marks the end of the Medicare open enrollment season. For Medicare Advantage plans this ended on Dec. 31. For those leaving Advantage plans and going back to original Medicare that period ended on Feb. 15.
The lock-in period is when, for better or for worse, you must stay with your plan election and wait until the next open enrollment for 2012 which will begin on Oct. 15 and end on Dec. 7.
Which is great news for anyone who has had to work through the holidays in selecting or selling a Medicare program.
You may only change plans in your lock-in period under special circumstances. These circumstances create a “Special Election Period” or “SEP.”
One well known fact is that people who are enrolled in both Medicare and Medicaid may change their plan enrollment any month of the year regardless of the lock-in period.
Other causes for a SEP are: Moving from one plan service area to another. This move can be from one county or one state depending on how the plan’s services are defined.
A member that becomes qualified (or disqualified) for Medicare’s “extra help” for prescription drugs – also known as Low Income Subsidy – can make a plan change at the time they become qualified or disqualified.
People in an employer group that choose to go on Medicare or lose their employer coverage can have a special enrollment when they leave their employer’s plan. This can be at age 65 or later as long as they have had drug coverage at least as good as what Medicare offers. Coverage that is as good as Medicare’s is called “creditable coverage.” If you are an employee you can ask your health insurance broker or human resource department and they can tell you if it is creditable.
Also, every year employers must provide a “Notice of Creditable Coverage” prior to the beginning of the annual open enrollment.
These are only a few of the many circumstances that create a Special Election Period. For more information on whether your situation qualifies contact Medicare directly at 1-800-Medicar.
Betsy Vipond is CEO of The Senior Health Advisor and has been in insurance for over 32 years. She specializes in Medicare products. Call her at 800-603-0901.
