The American Red Cross is currently experiencing its worst blood shortage in over a decade. According to the American Red Cross, this blood crisis forces health care providers to choose who receives blood transfusions and who must wait. And because blood cannot be manufactured or stockpiled, more is only available through the generosity and kindness of those who volunteer to donate. This January, also National Blood Donor Month, consider making your blood donation appointment and helping ease the blood crisis.

Dear Marci,

I mistakenly enrolled in the wrong Medicare Advantage Plan and did not realize until the plan became effective in 2022. When can I change my coverage now?

-Susan (New York, NY)


Dear Susan,

I’m sorry to hear that! Depending on your circumstances, you may be able to change your coverage. Let’s discuss a few possibilities:

You can make certain changes during the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1 through March 31. Those enrolled in a Medicare Advantage Plan (like yourself) can switch to a different Medicare Advantage Plan or to Original Medicare with or without a stand-alone Part D plan. Changes made during his period are effective the first of the month after you make the change. You can use Medicare’s Plan Finder tool to compare plans and call 1-800-MEDICARE to request the change.

If you enrolled in a Medicare Advantage Plan or Part D plan by mistake or after receiving misleading information, you may be able to disenroll and change plans. Typically, you have the right to change plans if you:

Joined unintentionally: You may have enrolled believing you were joining a Medigap plan to supplement Original Medicare. Or, you meant to sign up for a stand-alone Part D plan and accidentally joined a Medicare Advantage Plan.
Joined based on incorrect or misleading information: For example, if a plan representative told you that your doctors are in the plan’s network but they are not, or you were promised benefits that the plan does not really cover.
Through no fault of your own, ended up or were kept in a plan you do not want: If you tried to switch plans during an enrollment period but were kept in your old plan. You can also make a change if you were enrolled in a plan because of an administrative or computer error.
Depending on the circumstances, this change may be retroactively effective.

You may be eligible for a Special Enrollment Period (SEP) in which to change your coverage. SEPs allow you to change your health and/or drug coverage outside normal enrollment periods. For example, if your Medicare Advantage Plan left your area or if you moved out of your plan’s service area, you would have an SEP to switch to another MA Plan or to Original Medicare. Those enrolled in certain cost assistance programs, such as Extra Help or the Medicare Savings Program, are eligible for other SEPs. Read about other circumstances that might trigger an SEP on Medicare Interactive.

And of course, you can wait for Fall Open Enrollment Period to make changes to your coverage for next year. Fall Open Enrollment Period occurs each year from October 15 through December 7, with your new coverage starting January 1.

I hope this helps you correct your coverage for 2022. Best of luck!

-Marci

January is Cervical Health Awareness Month. Cervical cancer is preventable with vaccination and appropriate screening, so it is important that we raise awareness of the preventive care that supports cervical health. The CDC lists two tests to help prevent cervical cancer or to find it early: Pap smears and HPV tests. A Pap Smear looks for cell changes on the cervix that might become cervical cancer if not treated, while the HPV test looks for the virus that can cause these cell changes. Medicare Part B covers these tests if you meet the eligibility requirements. Schedule your preventive visit today and take charge of your cervical health!

I have been enrolled in the same Part D plan for years. Today I learned that it’s no longer covering a prescription I have been taking. Am I eligible for a transition fill while I figure out what to do next?

-Ralph (Nallen, WV)


Dear Ralph,

A transition refill, also known as a transition fill, is typically a one-time, 30-day supply of a drug that you were taking:

Before switching to a different Part D plan (either stand-alone or through a Medicare Advantage Plan)

Or, before your current plan changed its coverage at the start of a new calendar year

Transition refills are not for new prescriptions, though. You can only get transition fills for drugs you were already taking before switching plans or before your existing plan changed its coverage.

The following situations describe when you can get a transition refill if you do not live in a nursing home (there are different rules for transition refills for those living in nursing homes):


1. Your current plan is changing how it covers a Medicare-covered drug you have been taking. If your plan is taking your drug off its formulary or adding a coverage restriction for the next calendar year for reasons other than safety, the plan must either:

Help you switch to a similar drug that is on your plan’s formulary before January 1

Or, help you file an exception request before January 1

Or, give you a 30-day transition fill within the first 90 days of the new calendar year along with a notice about the new coverage policy.



2. Your new plan does not cover a Medicare-covered drug you have been taking.

If a drug you have been taking is not on your new plan’s formulary, this plan must give you a 30-day transition refill within the first 90 days of your enrollment. It must also give you a notice explaining that your transition refill is temporary and informing you of your appeal rights.

If a drug you have been taking is on your new plan’s formulary but with a coverage restriction, this plan must give you a 30-day transition refill free from any restriction within the first 90 days of your enrollment. It must also give you a notice explaining that your transition refill is temporary and informing you of your appeal rights.

In both of the above cases, if a drug you have been taking is not on your new plan’s formulary, be sure to see whether there is a similar drug that is covered by your plan (check with your doctor about possible alternatives) and, if not, to file an exception request. (If your request is denied, you have the right to appeal.)

Remember: All stand-alone Part D plans and Medicare Advantage Plans that offer drug coverage must provide transition fills. When you use your transition fill, your plan must send you a written notice within three business days. The notice will tell you that the supply was temporary and that you should either change to a covered drug or file an exception request with the plan.

I hope this helps you determine if you are eligible for a transition fill at this time! Best of luck.

-Marci

For many people, the start of the new year is a time to reflect on what we’ve learned and set new goals as we look ahead. You might evaluate your physical and mental health and think of the changes you want to see in the coming year. Making big changes can be tough, though, and habits can be challenging to break. As you think of what you would like to accomplish in 2022, Mayo Clinic Health System reminds us that S.M.A.R.T. goals can help set us up for success:

Specific: Eating healthier sounds like a good goal, but what does it really mean? Aim for specific goals instead, like eliminating soda or eating three servings of vegetables a day.
Measurable: Make your goal one you can measure. Sleeping at least 8 hours a night is a goal you can track. A goal of sleeping more is not so easy to track.
Attainable: Avoid aiming too high or too low.
Realistic: Choosing realistic goals that you can meet with reinforce your efforts and motivate you to keep going.
Trackable: Choosing specific, measurable goals means you can track your progress over time. Write your efforts down or track them electronically so you can see how far you’ve come!