Medicare’s Annual Enrollment Period runs from October 15th to December 7th every year. This time period is known by several names including Open Enrollment, Fall Open Enrollment, and Medicare Annual Enrollment Period (AEP).

During this enrollment period you can make any of the following changes:

  • Switch from one Medicare Advantage plan to another Medicare Advantage plan
  • Disenroll from a Medicare Advantage plan and return to Original Medicare A and B
  • Switch from Original Medicare to a Medicare Advantage plan
  • Enroll, disenroll, or switch Medicare Part D plans

While it’s still a few months away, there are some things you can start to consider now, to be better prepared when Open Enrollment arrives.

New to Medicare

Open Enrollment is for those already enrolled in Medicare. If you are new to Medicare and are enrolling for the first time, your first opportunity to sign up is your Initial Enrollment Period. This is the seven month period that begins three months before the month of your 65th birthday and includes the month of your birthday and the three months following. If you miss this enrollment period, you may have to pay late penalties. The penalties will continue to increase with time.

There are some exceptions to this rule. For example, if you or your spouse are still actively working past 65  and are covered by an employer’s insurance you may be able to delay signing up for Medicare without being penalized. You will have Special Enrollment Period when your employer coverage ends.

Assess Your Current Coverage

Before you decide if you should make any changes during Open Enrollment, it’s important to take time to assess how well your current coverage is working by asking yourself these questions:

  • Are your out of pocket expenses such as premiums, deductibles, copays and coinsurances what you thought they would be? Have their been any surprises?
  • Have there been any changes in your health that require you to see new doctors or take new prescriptions? Has this caused any issues?
  • Are you paying for benefits you aren’t using and don’t need?
  • Are there benefits you don’t have, that in retrospect you wish you did, such as dental, vision and hearing?
  • Are you traveling more than you anticipated? Has this impacted your access to doctors or prescriptions?
  • Have your finances changed? Are you having trouble affording your coverage?

If you answer yes to any of these questions, your plan might no longer be the best fit. Open enrollment is the time to review what other coverage options are available to you. Any changes made during Open Enrollment are effective January 1, 2025.

Here’s what you need to know about changing plans:

If You Are Enrolled in a Medicare Advantage Plan and Want to Switch to Another Medicare Advantage

In 2024, the average Medicare beneficiary has access to 43 Medicare Advantage plans. This means if your current plan is not a good fit, there are many other plans in your area to choose from that may offer the benefits you need at a cost you can afford. It could be worth your while to shop around.

Medicare Advantage plans change every year. Even if you are happy with your current coverage, it’s important to know what is changing for 2025. Each September your insurance carrier will send you an Annual Notice of Change letter detailing all the changes to your coverage for the upcoming year. You should take the time to review this notification carefully. Changes can include differences in costs such as premiums, deductibles, copays and coinsurances, as well as changes to the provider network and drug formulary. If you find any of these changes have a negative impact, you should consider changing plans.

If You Are Enrolled in Original Medicare and Want to Switch to a Medicare Advantage Plan

There are several reasons why you might find a Medicare Advantage plan to be a better fit than Original Medicare. Many Medicare beneficiaries like the simplicity of Advantage plans. They are often considered more affordable. Also known as Part C, Advantage plans roll Part A, B and Part D prescription drug coverage into one plan with one monthly premium. (You will still pay your monthly Part B premium in addition to the Advantage plan premium). Many beneficiaries like the annual out of pocket maximum that puts a cap on potential out of pocket costs.Advantage plans offer additional benefits not covered by Original Medicare such as dental, hearing, vision, gym memberships, and more. All Medicare Advantage plans have their own unique provider network and drug formulary, so you need to review each plan to make sure your doctors, hospitals, and prescriptions are included. Some services may require preauthorization so if you have any ongoing treatments or procedures you will want to know if there are any restrictions or special requirements.

If You Are Enrolled in a Medicare Advantage Plan and Want to Switch to Original Medicare

Coverage with Original Medicare is very different from Medicare Advantage but there are several reasons why it might be appropriate and beneficial to switch. Here are some important differences to be aware of:

  • Original Medicare does not have provider networks like Advantage plans, which means you have a greater choice in healthcare providers. You can see any doctor, specialist or hospital that accepts Medicare. This is often preferred by individuals who travel a lot outside their local area, or those with chronic health conditions who want no limitations on the doctors or hospitals they use for treatment.
  • Original Medicare has no prior authorization or referral requirements that can limit or delay your access to care.
  • Original Medicare does not cover all your medical expenses .There are deductibles, copays and coinsurances as well as no annual out of pocket maximum to cap your yearly expenses. For these reasons most Medicare beneficiaries with Original Medicare also enroll in a Medigap or Medicare Supplement plan to help pay some of these out of pocket costs. Monthly premiums for Medigap plans vary based on the plan you choose, the insurance carrier, your zip code, age, gender and history of tobacco use. If you are applying for a Medigap plan outside of your initial enrollment period , you will have to answer some health questions. Certain chronic health conditions could result in denial of coverage or higher premiums.
  • Original Medicare does not cover your prescriptions drugs, so you will need to enroll in a stand-alone Part D plan which has its own monthly premium. Plans vary by insurer. It’s important to review each carrier’s drug formulary to know how your prescriptions will be covered.

Original Medicare does not cover ancillary benefits such as vision, dental and hearing. If these are important to you, you can purchase separate stand-alone policies that offer this coverage.

How a Licensed Local Medicare Agent Can Help

Understanding Medicare and choosing the right coverage might feel a little overwhelming, but making the right decision is very important since you might not be able to make another change during the year unless you qualify for a Special Enrollment Period.

When you work with a local licensed Medicare agent, they will educate you on your choices and help you make an informed decision. You can make an appointment with an agent during Open Enrollment to review your options. If you decide to change your coverage, they will help you with the application and enrollment process and ensure you have no gaps in coverage.

In order to help the agent determine the right coverage for you, you should plan to come prepared to discuss your lifestyle such as how much you travel and your budget. Bring a list of your current doctors, and specialists, your preferred hospitals and pharmacies, as well as a list of your prescription medications with dosages. An agent can also help you determine if you qualify for any financial assistance with your out of pocket expenses through state or federal programs.

When you work with a local Medicare agent you will have a trusted resource who can provide education, guidance and support throughout the year.

Need a Medicare agent? Visit our Medicare agent directory.