Your initial Medicare enrollment period begins when you reach the age of 65 or become eligible for a Medicare plan through disability. However, this is not your only option for choosing your coverage. You can make changes to your Medicare plan during Medicare Open Enrollment Period.
Furthermore, you can use the open enrollment window to make the following changes to your coverage.
- registering for Medicare Advantage
- registering for a Medicare Part D plan
- switching from Medicare Advantage to Original Medicare
Open enrollment is an excellent time to review your Medicare health insurance coverage. So, make sure it best meets your budget and requirements. Navigating the Medicare maze is a challenging task, and the annual enrollment period can be perplexing for seniors and family caregivers. Here are eight things you should know about Medicare Open Enrollment (MOE) to make wise decisions about a health insurance plan for yourself or a loved one.
1) Medicare Open Enrollment Lasts from October 15 to December 7 Each Year
Whether you’re enrolling in Medicare for the first time or switching your current coverage, timing is critical. Medicare establishes timeframes for beneficiaries to make specific changes. For example, your Initial Enrollment Period (IEP) begins three months before your 65th birthday includes your birthday month, and continues for three months afterward. The IEP has been the first opportunity for most seniors to decide things about their Medicare coverage.
Other enrollment periods, such as MOE, occur regularly. Certain life circumstances and changing health needs and prices may necessitate an annual review of alternative coverage options. MOE is the appropriate time to do so. Being aware of one-time and recurring deadlines allows beneficiaries to select the most coverage options at the lowest possible cost.
2) There are Two Ways for Obtaining Original Medicare
Seniors can opt for Original Medicare (Parts A and B) on their own, with the option of adding Part D prescription drug coverage. Those who receive Railroad Retirement Board (RRB) and Social Security benefits will be automatically registered in Medicare Part A coverage (Hospital Insurance) and Medicare Part B plan (Medical Insurance). Most Medicare beneficiaries get free coverage for Part A. Still, you need to pay monthly insurance premiums for Part B. If you don’t need Part B (e.g., if you are covered by your company or your spouse’s employer), you must notify your insurer after receiving your Medicare card.
You will be charged for Part B premiums if you do not.
The other alternative is the Medicare Advantage Plan (Part C), which combines Original Medicare benefits with additional benefits. Private insurance companies that have contracts with Medicare sell Advantage Plans, which frequently include prescription drug coverage. These companies must adhere to specific Medicare guidelines. However, each Advantage Plan is free to charge different out-of-pocket costs and set different rules for how beneficiaries receive medical care (such as whether you need a referral to consult a specialist or if you have to use in-network suppliers, doctors, and facilities). These rules and costs are subject to change on an annual basis.
3) What Options do You have During Medicare Open Enrollment?
Beneficiaries can select from the actions listed below. Any modifications made during the MOE period will take effect on January 1 of the following year.
- Change your Medicare coverage from Original Medicare to a Medicare Advantage Plan.
- Return to Original Medicare after leaving a Medicare Advantage Plan.
- Change from one Medicare Advantage Plan to a different Medicare Advantage Plan.
- Change from a Medicare Advantage (MA) plan that does not provide drug coverage to a Medicare Advantage Plan that does offer prescription coverage.
- Sign up for a Medicare Prescription Drug Plan.
- You can switch from one Medicare Prescription Drug Plan to another.
- You should discontinue your Medicare prescription drug coverage entirely.
- Don’t do anything. If you haven’t received an Annual Notice of Change (ANOC) in the mail informing you that your current insurance is changing or ending and you’re still satisfied with it, you don’t need to do anything. You are not required to re-enroll in or renew the Medicare plan every year. Your existing program will automatically roll over and remain in effect if you continue to pay any necessary premiums.
4) Medicare doesn’t Pay for All of Your Medical Expenses
It is a common misconception that Medicare covers all medical expenses for seniors. According to a recent AARP Public Research Institute report, Medicare beneficiaries paid a minimum of $5,801 in out-of-pocket medical care costs in 2017.
Consider the financial impact of each option when deciding whether to add, change, or drop Medicare plans. Estimate your total out-of-pocket medical care costs from the previous year and compare them to the other coverage options you’re anticipating. Be sure to factor in deductibles, co-pays, premiums, prescription drug expenses, and any new/rare medical costs that may appear in the coming year. This takes time, but it is the most effective way to avoid unexpected bills.
5) What Happens if You Fail to Meet the Medicare Open Enrollment Deadline?
If you miss the deadline for open enrollment, you may need to wait until next year before you can perform any changes, or you risk paying higher penalties and premiums. Depending on the type of coverage you purchase, it might be possible to make changes outside the MEO period.
One option is the Medicare Advantage Open Enrollment window (explained in the next section). Alternatively, a qualifying life event like moving to a new state or losing your current insurance, will be required to initiate a SEP (Special Enrollment Period), during which coverage changes are permitted. The deadlines and steps you can take vary depending on the specific circumstances. You can find more information about SEPs at NewMedicare.com.
6) You can Change Your Medicare Advantage Plan if You don’t Like it
It was once possible to be locked into a Medicare Advantage Plan until the following year’s Medicare open enrollment period. Fortunately, beginning in 2019, Medicare changed its rules, allowing seniors with Advantage Plans to make additional changes after the fall open enrollment period ends. The Medicare Advantage (MA) Open Enrollment period runs from January 1 to March 31 each year. Beneficiaries can only do two things during this window:
- If you are currently enrolled in Medicare Advantage (MA) Plan (with or without prescription coverage), you can switch to another MA plan (with or without drug coverage).
- Moreover, if you have a Medicare Advantage Plan, you can leave it and turn it back to Original Medicare. You can also sign up for a Medicare Part D plan.
Adjustments made during this period will be effective on the first day of the following month.
7) How to Enroll in 2021 Medicare Coverage
Medicare Open Enrollment is available to people who already registered in Medicare coverage. This would be your initial registration window if you enrolled in a Medicare plan for the first time. Your eligibility for the Medicare plan will determine the steps you need to take during your initial enrollment.
You must apply directly to Medicare if you are not receiving benefits from Railroad Retirement Board or Social Security Welfare. People who receive these benefits will be automatically enrolled in Medicare when they become eligible.
You can apply for Medicare in a variety of ways, including:
- Through online registration portals
- By calling your state agency
- By going to your social security office
- Through submitting a letter to your regional social security office
- If you are already enrolled in a Medicare health plan, you do not need to complete these steps. Instead, you can use this open enrollment window to renew your coverage.
You can do this by reviewing your insurance agency website and searching for new plans. You can then choose a plan and join it.
Moreover, you do not need to take any additional steps. You can select your new plan if you register for the new program during open enrollment. Remember, you’re choosing coverage for the following year, which means your coverage will change in January, not immediately.
8) Medicare Assistance is Available
You must seek assistance if you don’t understand something about MOE or the available coverage options. For more information on Medicare coverage, go to NewMedicare.com or call 844-844-3049 (TTY: 1-800-855-0511).
Your state agency will also provide free one-on-one insurance counseling. Contact our licensed agent or broker for more information or to schedule an appointment. The insurance agents and counselors understand the ins and outs of Medicare plans and can even assist seniors in finding other benefits and resources that minimize medical care costs.
The Major Takeaway
- You can make changes to your current insurance plan during open enrollment.
- You have the option of registering in an Advantage plan, joining a Part D plan, or returning to your original Medical plan.
- If you have already purchased a Medicare Advantage plan, you can switch to a different program. You can also renew your Part D coverage during open enrollment.
- You might be able to switch plans during annual enrollment by simply enrolling in new coverage.
- Changes made during open enrollment become effective on January 1 of the following year. Thus, your old health plan will be automatically disenrolled.