What is the Open Enrollment Period?
This is one time every year that Medicare beneficiaries have an opportunity to modify their coverage. It is also called the Annual Coordinated Election Period or the Annual Election Period.
When is the Open Enrollment Period?
The Medicare Open Enrollment Period is October 15-December 7.
What can I do during the Open Enrollment Period?
There are several things you can do. The actions depend on the type of coverage you have now.
If you chose Original Medicare:
- You can drop that coverage and enroll in a Medicare Advantage plan.
- If you also have Part D prescription drug coverage, you can change drug plans or drop the prescription drug coverage entirely. (Think very carefully about dropping the coverage because there can be repercussions.)
- If you don’t have drug coverage, you can join a Medicare Part D prescription drug plan.
If you have a Medicare Advantage plan with prescription drug coverage (known as an MA-PD plan):
- You can switch from that plan to another MA-PD plan.
- You can also switch to a Medicare Advantage plan without drug coverage. (Remember, there can be repercussions.)
If you have a Medicare Advantage plan without drug coverage:
- You can switch from that plan to another Medicare Advantage plan without drug coverage
- Or, you can add drug coverage through an MA-PD plan.
Anyone with a Medicare Advantage plan (with or without drug coverage) can decide to drop that plan and change back to Original Medicare. However, people who make this switch may not be able to purchase a Medigap policy.
When do these changes take effect?
Any changes made during the Open Enrollment Period, such as switching to a different Medicare Advantage plan, take effect on January 1.
How should I prepare for Open Enrollment?
In October, Medicare Advantage and drug plans must send to members the Annual Notice of Changes. This is a summary of changes to your benefits and costs that will take effect January 1 of the next calendar year. The plan can also send the Evidence of Coverage, a detailed description of benefits and costs for for the next plan year. Compare the information in those new plan documents with the ones for your plan(s) currently in effect, looking for any changes.
What things in my coverage can change?
Here are some of the items that may change in a Medicare Advantage plan:
- The monthly premium
- The annual out-of-pocket spending limit.
- The annual deductible
- Your out-of-pocket costs (copayments, coinsurance)
- Network of providers
- Star (quality) ratings
- Optional benefits, such as vision or dental coverage
A drug plan may change:
- The premium
- Its formulary
- The tier of a medication
- The annual deductible
- Copayments or coinsurance coverage rules (step therapy, prior authorization)
- Coverage of medications in the Coverage Gap, also known as the donut hole
- Network of pharmacies
- Star ratings
How do I switch plans?
You can call 1-800-MEDICARE or the new plan. You can also enroll online at medicare.gov or the plan’s website. In some cases, you can also complete a printed application. When you enroll in the new plan, you will be disenrolled automatically from the previous plan. You do not need to take any action.
What if I don’t want to change anything?
If you are satisfied with your coverage and costs, don’t do anything. Your plan will re-enroll you automatically for next year. However, even if you are satisfied, still take time to evaluate changes in your existing plan. If there are changes in benefits or costs, do some window-shopping. Use the Medicare Plan Finder to compare a few plans.
Can I enroll in Medicare during the Open Enrollment Period?
No, you cannot. If you did not enroll during your Initial Enrollment Period, you must wait until the General Enrollment Period, which is January 1-March 31. Medicare coverage will take effect on July 1 and you may face late enrollment penalties.
Can I wait until the next enrollment period,starting in January, to switch plans?
In 2019, this Medicare Advantage Open Enrollment Period replaced the Medicare Advantage Disenrollment Period. This open
enrollment period, from January 1 through March 31, is for those who have a Medicare Advantage plan.
During this time, a person can:
- Switch to another Advantage plan, either with or without prescription drug coverage, or
- Disenroll from the Advantage plan, return to Original Medicare Part A and Part B, and enroll in a stand-alone drug plan. Remember, it may not be possible to purchase a Medigap policy.
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“Open Enrollment Q&A”
A primer for Medicare’s Open Enrollment Period, created by Medicare expert Diane J. Omdahl, RN, MS
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