Medicare’s Annual Enrollment Period starts on October 15 and ends on December 7. If you’re 65 or older, this is a crucial time for you. The decisions you make will impact your health care coverage and expenses for the following year, so the stakes are high.
Know Your Options
Medicare enrollees have two main options when it comes to Medicare coverage.
- Original Medicare includes Medicare Parts A and B. If you pick this option, you can also enroll in a private Medicare Part D plan for your prescription coverage. You can also pick a Medicare Supplement Plan, often called Medigap.
- Medicare Advantage is a private alternative to Original Medicare. It combines Medicare Parts A and B and may provide additional benefits as well. A drawback is that the provider network may restrict which doctors you see. Many Medicare Advantage plans include prescription drug coverage. If you enroll in a plan that does not include prescription coverage, you can enroll in a separate Medicare Part D plan. Some Medicare Advantage plans are “free” (but you still have to pay Medicare Part B costs and other out of pocket costs such as deductibles, copays, and coinsurance.) while others have an additional monthly premium.
During the Annual Enrollment Period, you can make the following changes:
- Switch from Original Medicare to Medicare Advantage
- Switch from Medicare Advantage to Original Medicare and pick up a Part D plan
- Switch from one Medicare Advantage plan to another
- Change your Medicare Part D enrollment
It’s important to note that you are not guaranteed enrollment in a Medigap plan during the Annual Enrollment Period. After the initial enrollment period when you turn 65, Medigap applications in most states are subject to underwriting, and you can be rejected.
Review Your Own Circumstances
Consider what may have changed with your own personal situation this past year. Have there been changes to your health impacting which doctors you see and what medications you take? Are you traveling out of the area more frequently than you anticipated? Have your finances changed making your coverage harder to afford? These are all important factors to consider when determining if your current plan continues to meet your needs.
Pick a Plan
If you don’t make any changes to your enrollment, you will continue to be enrolled in your current plan. However, even if you like your current plan, it’s smart to review your options. Plans changes from year to year, and you may find that you’re not happy with these changes. At the same time, new plans may offer benefits that weren’t available in years past. You could be making a mistake if you assume you don’t need to do anything.
- You will receive an Annul Notice of Change (ANOC) from your insurer in September. Read this carefully so you understand any changes being made to your current plan. Changes can include premium changes, changes in cost sharing amounts, updates to the drug formulary which could impact the availability or cost of your prescriptions, network changes which could impact the doctors you see, and benefit modifications. Many Medicare Advantage plans are scaling back on supplemental benefits such as vision, dental, and hearing benefits, gym memberships, and more. If these are important to you, check your ANOC for any changes to these benefits.
- You can use the Medicare Plan Finder to search for plans available where you live. When comparing plans, look at the star rating, the out-of-pocket costs and the benefits provided. Also look at the provider network to see if you’ll be able to stay with your current doctor. You also need to check the drug formulary associated with each insurance carrier and each plan as they can differ greatly. You want to make sure your medications are on the formulary and also should confirm what the out of pocket costs will be for each drug.
Be Sure
Although the Annual Enrollment Period lasts for almost two months, you are only allowed to make a one-time switch. Once you enroll in a plan, you may be stuck with it for a while.
However, there are some ways to make enrollment changes outside of the Annual Enrollment Period.
- During the Medicare Advantage Open Enrollment Period, which lasts from January 1 to March 31, you can switch from Medicare Advantage to Original Medicare. You can also switch from one Medicare Advantage plan to another. You CANNOT switch from Original Medicare to Medicare Advantage.
- Special Enrollment Periods are available for eligible enrollees. For example, you may qualify for a Special Enrollment Period if you move out of your plan’s service area or are diagnosed with a chronic condition.
A local, licensed Medicare agent can help you find and enroll in a plan that is right for you. Agents earn a commission from the insurance company. You do not have to pay them anything. Check Silver&Smart’s Medicare Agent Directory to get started.
