New Medicare Special Enrollment Periods and What You Can Do

Posted on December 10th, 2018 in Industry Updates by Amplicare

Beginning in 2019, there will be a new Open Enrollment Period for Medicare Advantage. This period will run from January 1 – March 31. If any of your patients are enrolled in a Medicare Advantage plan, they have a one-time opportunity during this period to:

Switch to a different Medicare Advantage plan, 


Drop their Medicare Advantage plan, return to Original Medicare (Parts A and Part B), and enroll in a stand-alone Medicare Part D Prescription Drug Plan.1


Medicare beneficiaries are increasingly enrolling in Medicare Advantage Plans instead of Original Medicare with a stand-alone Prescription Drug Plan. The percentage of Medicare beneficiaries on Medicare Advantage plans more than doubled from 16% in 2006, to 33% in 2017 2. Advantage plans differ from original Medicare in that they have limited, sometimes closed doctor networks. Some Advantage plans offer additional benefits, like coverage for hearing, dental, and vision. If patients are unhappy with their current benefits, but missed the opportunity to review their plan options, this new Open Enrollment period offers an extension for patients to find the right coverage.

What this means for you

For pharmacies, this means you have the opportunity to offer knowledge and guidance for your Medicare Advantage patients until the end of March. If patients express frustration or concern about their current insurance plan, check their current enrollment; if they’re enrolled in a Medicare Advantage plan you can help them enroll in a plan better suited to their needs! 

Pro-tip: Consider developing this opportunity into a marketing campaign to increase community awareness and gain new business. A few well-placed flyers and a facebook post can go a long way. 


The Pro’s and Con’s of Medicare Advantage

Medicare Advantage Plan Comparisons 


New Special Enrollment Periods for Dual Eligible Beneficiaries

Beginning in 2019, dual eligible patients (patients on both Medicare and Medicaid) will only be permitted to change their Medicare plan once every quarter from January to September. This is a big change from the previous regulation, which allowed such patients to change plans once a month.


The official policy states, “to ensure that Part D plan sponsors are better able to administer benefits, including coordination of Medicare and Medicaid benefits, we are revising the Special Election Period (SEP) for dual-eligible and LIS beneficiaries from an open-ended monthly SEP to one that may be used only once per calendar quarter during the first nine months of the year.” 3

What this means for you

For pharmacies, this means there are increased limitations on how often you can help your dual eligible patients enroll in a new Medicare plan. Because of this, we recommend focusing on your dual eligible patients with a regular cadence at the beginning of each quarter -- January, April, and July.


Dual Eligibility explained

Best practices for Dual Eligible plan comparisons






Other Articles

Posted on March 21st, 2019 by Amplicare

Fighting the Opioid Crisis with Naloxone

The statistics are staggering: Opioids kill more people in the U.S. each year than the total number of soldiers the country lost in the Iraq...

Continue Reading

Posted on March 12th, 2019 by Admin

Amplicare and Ananda Professional Partner to Automate CBD and Wellness Education for Pharmacies

[Cynthiana, Kentucky], Tuesday, February 12, 2019 – Amplicare, a leading software automation provider for pharmacies, and Ananda Profe...

Continue Reading

Posted on March 7th, 2019 by Corina

Amplicare Introduces New Benefits to Improve Patient Care and Health Outcomes

NEW YORK, Feb. 6, 2019 /PRNewswire/ -- Amplicare, the leading decision automation platform for pharmacies, today announced the addition of t...

Continue Reading


Latest news and updates about the Medicare and pharmacy industries.