Annual Election Period-Medicare: The Birthday Rule

As many seniors know, on October 15th you can pick a new Medicare Advantage Plan or change your current standalone drug plan. You have until December 7th to make a change which will become effective on January 1st.

In Clark County Nevada there are 55 different options you can choose from and that is a daunting task for anyone. The best suggestion is to speak to a knowledgeable Medicare insurance broker to help you sort out your options. I am volunteering for that task as I have been working in the Medicare space for over 15 years.

The simplest way to start is to look at your current plan and decide what you like and what you do not like. Then covey that to your broker and ask him/her to help you find a plan more suited to your specific needs.

The broker should review with you your medications as well as Doctors to ensure your new plan accommodates your specific needs.

With so many choices, it is difficult to find the best plan for you but with the medications and the doctors, it should be relatively easier. Our job is to help you determine if your current plan meets your needs or not and the Annual Election Period is the time to make any changes for 2021.

Currently, there are 7 different insurance carriers offering about 55 different plans. Some of those plans are for seniors with special needs like diabetes, heart issues, and COPD. These plans are specifically for those with these medical conditions. Basically, these plans address those special needs with certain medications needed at significantly lower pricing. There is also a Kidney special needs plan available for 2020 but for 2021 all plans will help with this disease. Kidney dialysis was not available on the regular MAPD plans except with a special kidney plan. That restriction for 2021 will go away and all plans will offer coverage.

There are also about 30 different drug plans available in Clark County. My suggestion is to provide a list of your medications so your broker can shop for the best plan for you. Even if your medications have not changed it is a good idea to review your current plan and see if there is something less expensive or that covers your current medications better. Sometimes better means lower cost of a change from a tier 3 drug to a tier 2 drug thus saving significant prescription dollars.

Once you have done reviewing your current plan and any potential new plans you can make an intelligent decision on a new plan or remain on your current plan.

Medicare Supplement clients can change their plans but may have to qualify medically to obtain a new plan. As a member of NAHU (National Association of Health Underwriters), we are working with the NV legislature to try and implement a birthday rule. Meaning during the month of your birthday and probably the month after you can change your supplemental plan without having to prove you are insurable. In other words, guaranteed issue. There are hurdles to overcome so no official word until the legislature meets in early 2021.


Len Barend, Broker.

The Barend Agency Inc.


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