When is Medicare open enrollment?
Medicare open enrollment starts each year on October 15 and ends December 7. You can make changes that will go into effect the following year.
Knowing when Medicare open enrollment starts is the easy part — how to start the process can be more daunting. Here’s practical advice on what to review about your coverage and what changes you can make.
Original Medicare open enrollment basics
Original Medicare consists of Part A (hospital coverage) and Part B (doctor and outpatient services). You’ll also want to consider a stand-alone Part D drug plan that helps pay for prescription medications. There are monthly premiums for Part B and Part D; most people don’t pay a premium for Part A.
Doctors and drugs. Since Part A and Part B are standard for all Medicare beneficiaries, there’s nothing for you to change with this coverage. You can go to any doctor or facility that accepts Medicare. Part D plans vary, however, so this is an opportune time to review your drug coverage and change plans, or add a Part D plan if you don’t have one yet. You can even switch from original Medicare to a private Medicare Advantage plan during open enrollment if you choose. (More below.)
Why I Switched My Drug Plan
In 2020, my Prescription Drug Plan premium was $20 per month. I paid it without question. The next year the insurance carrier announced a premium increase from $20 to $80!!! I didn’t spend more than $20 in prescription drugs for the entire year. After consulting with Medicare, I switched my Rx plan to one with a $7 per month premium. It pays to utilize the Medicare agents who are there to help you!
Is your Physician Dropping from Medicare?
It’s also an opportune time to confirm that your preferred doctors and medical facilities will continue to accept Medicare in the new year. Odds are they will — experts estimate that more than 90 percent of doctors participate in the program and the vast majority of hospitals do as well — but it never hurts to ask.
Supplemental (MediGap) vs. Advantage Plan
Supplemental Insurance. Original Medicare doesn’t pay for everything. Under Part B, for example, you are responsible for 20 percent of the cost of a doctor visit or lab test. Medicare supplemental insurance, also known as Medigap insurance, helps pay for uncovered expenses, including some copays and coinsurance. Supplemental insurance is optional and not subject to the open enrollment period. You can buy a Medigap policy at any time during the year. And you can change your Medigap coverage at any time during the year.
IMPORTANT:
However, there’s something critically important to know about changing your Medigap policy: Insurers handling this coverage can’t turn you down for a policy within six months of your being eligible for Medicare, even if you have a chronic medical condition, are overweight, are a smoker or have any other illness. That’s called a guaranteed issue rule. But once that initial sign-up period is over, these companies can either refuse to sell you a policy or charge you a much higher premium. And that goes for your ability to change policies once you have one. There are four states — Connecticut, Maine, Massachusetts and New York — with laws that require insurers to sell you a Medigap policy all the time or at least once a year.
Neuman points out that if you do not have any preexisting conditions, you probably can change Medigap policies without paying more. It’s worth checking out if you aren’t satisfied with your current supplemental plan.
Medicare open enrollment and prescription drugs
Medicare beneficiaries get their prescription drugs in one of two ways:
- through a stand-alone Part D prescription drug plan,
- or as part of their Medicare Advantage plan.
A common check for both options during open enrollment should be whether the medications you take are still covered under your current plan — and at what cost.
- Beneficiaries should also look at what pharmacies are preferred by your current plan and whether those still are most convenient for you.
- You should also look at whether you can save money by getting your drugs through the mail and whether your plan offers that.
Switching between Medicare options
Here’s what to consider if you are thinking about switching from one Medicare option to another during open enrollment:
- Switching from original Medicare to a Medicare Advantage plan. Make sure your providers are covered in network in the MA plan you select. Also be aware that you will likely be subject to more management of your care: Some plans will require referrals to specialists, and MA plans often require prior authorization from the plan for some diagnostic tests and other services.
- Switching from Medicare Advantage back to original Medicare. The rules let you do this, but there’s a big caveat: If you want to go back to original Medicare, you may not be able to get a supplemental (Medigap) plan — or at least one that’s affordable — that helps you pay for some out-of-pocket costs under original Medicare.
- Switching between MA plans. This is the time of year for you to take a hard look at your current Medicare Advantage plan and shop around to see if there might be a plan where you live that will better suit your needs and your pocketbook.
Financial assistance if you can’t afford Medicare
If you are having trouble affording your Medicare premiums, copays and other out-of-pocket costs, the federal government has four Medicare Savings Programs that provide help for people with limited incomes.
How to get help picking a Medicare plan
Beneficiaries can compare plans and change their enrollment by going to www.medicare.gov. During the open enrollment period, there is also live chat assistance on the website.
In addition, Medicare has a 24-hour, seven-day-a-week hotline where representatives can answer your open enrollment questions.
That toll-free number is 800-633-4227
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SOURCE: Dena Bunis covers Medicare, health care, health policy and Congress. She also writes the Medicare Made Easy column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.
