Medicare Annual Open Enrollment Period Starts This Month. Here’s What You Need to Know 

Medicare’s annual Fall open enrollment period – sometimes called the Annual Election Period, starts October 15th and runs through December 7th.

That’s when Medicare beneficiaries are entitled to make changes to their Medicare health plans and prescription drug coverage plans for the following year. Open enrollment lets you switch, add, or drop a Medicare Advantage (Part C) or Medicare Part D prescription drug plans. 

 For most individuals, the Fall open enrollment period is your only opportunity to enroll in a new Medicare Advantage or Part D plan during the year. 

 If you choose to make changes to your coverage, the changes will become effective January 1st of next year.

Why Would I Want to Make Changes to my Medicare Coverage?

You might want to make changes to your Medicare coverage for multiple reasons. Insurance providers often make changes to their plans or premiums. Or your personal situation might have changed. Or you may simply decide you want a feature or benefit offered in another plan.

Here’s why you might want to make a change:

• You are diagnosed with a new medical condition, requiring ongoing treatment or monitoring.
• You have procedures or surgeries planned for next year.
• You need a new, expensive prescription drug, so you need to add Part D coverage or find a plan with that drug in its formulary.
• You move outside your plan’s service area.
• Your plan is no longer available.
• You are in a Medicare Advantage plan with a narrow network and you want to be able to choose your own doctor.
• You want to use a different hospital that’s not in your Medicare Advantage network
• Your budget has changed.
• Your plan raised its monthly premium, deductible, or other cost.
• A new and better plan is now available in your area.
• You are unhappy with your service
• You are in a Medicare Advantage plan with a limited network and you are unhappy with your care providers
• Your prescription drug plan dropped a drug you need from your formula and you need it covered.
• You want a plan with more comprehensive benefits.
• You want to add or drop coverage for benefits while traveling outside of the U.S.
• Your plan has a poor rating on Medicare.gov.
• You want to switch from Medicare Advantage to a Medicare Supplement plan or vice versa.

How do I know if my existing Medicare plan has changed pricing or coverage?

If your Medicare plan made material changes to your premium, copays, co-insurance, or coverage, you should have received an Annual Notice of Change (ANOC) document from them. You may also have received an Evidence of Coverage (EOC) document from them, as well. Review these documents carefully to make sure their plan is still appropriate for your needs.

If you didn’t receive an ANOC from your carrier, call them and ask them to send any change notices to you.

Make sure your preferred care providers will still be in your networks next year. Make sure the drugs you need will still be covered, and see if the plan is making pricing changes.

Note for Diabetics

Many Medicare Advantage and Part D plans are changing their pricing for insulin this year, with some offering insulin at much lower out-of-pocket costs than before, under the Insulin Senior Savings Model.

Participating plans offer coverage choices that include multiple types of insulin at a maximum 

copayment of $35 per month’s supply. (The $35 maximum copayment doesn’t apply during the catastrophic coverage phase of Medicare drug coverage.) 

The model is designed to save Medicare beneficiaries who take insulin to manage their diabetes an average of $446 per year in out-of-pocket costs. 

This is a great reason to check your plan’s formulary and pricing. To see if your plan or another plan in your area participates in the Senior Savings model, speak to one of our Personal Benefit Managers to help find the best plan for you. 

Cheaper Isn’t Necessarily Better

Medicare Advantage, Medicare Supplement, and Medicare Part D plans aren’t all alike. Plans vary widely in pricing, care networks, covered products and services, and other key areas.

Even Medicare supplement plans, which come with standardized benefits in most states, can vary widely in pricing from plan to plan, zip code to zip code, and individual.

Sometimes the cheapest plan will require more out-of-pocket costs than more expansive plans with higher premiums. Sometimes paying a higher premium may save you hundreds or even thousands in out-of-pocket costs overall.

What if I miss the Fall Annual Enrollment Deadline?

Generally, if you miss the Fall annual enrollment deadline to change your Medicare plan, you won’t be able to change Medicare Advantage or Part D prescription plans later in the year.

You can potentially switch Medicare supplement coverage at any time. But if you miss your initial seven-month enrollment window (which is centered around the month in which you turn age 65 for most readers), you will have to go through medical underwriting. 

If you have serious pre-existing conditions, you may have to pay more. You may also have to wait up to six months before the new Medicare supplement plan will pay for treatment for your pre-existing conditions.

Original Medicare will still cover treatment for these pre-existing medical conditions. But you’ll have to cover the full Part A deductible, Part B deductible, co-insurance, and copays as long as your Medicare supplement plan excludes them.

You can switch back if you like!

If you switch to a different plan and you don’t like it, the law allows you to switch back to this year’s plan. 

You must switch during the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1st through March 31st.  During this time, you can switch from one Medicare Advantage plan to another, or to Original Medicare, with or without a Part D prescription drug plan.

The Affordable Health Sharing Alternative

In addition to Medicare supplement and Medicare Advantage, there is another increasingly popular non-insurance alternative that may provide you with significant help with your out-of-pocket medical costs in retirement: Health sharing.

Health sharing plans are not insurance. Instead, health sharing plans are voluntary associations of people with similar values and a commitment to a healthy lifestyle who agree to share one another’s medical bills not covered under Medicare.

In many cases, health sharing offers a flexible and economical alternative to traditional insurance approaches, with savings of up to 50%. Coverage for pre-existing conditions is limited, and you must agree to the Health Sharing Ministry Organization’s statement of principles document.

HSA For America is one of only a few insurance brokers who offers our clients a full spectrum of risk reduction solutions for Medicare beneficiaries, including health sharing options. 

Beware of Medicare Scammers

Some unscrupulous people attempt to scam seniors by posing as Medicare representatives or survey takers. No legitimate Medicare agent will contact you out of the blue via phone, text, or email. Do not give out private information to anyone who contacts you unsolicited.

What to Do Now

If you are happy with what you’ve got, you do need to do anything.

Wiley P. Long, III
President – MediGap Advisors