If you’re a Medicare beneficiary, the open enrollment period is a time to reevaluate your health coverage, compare your options, and see if there are other plans available that better meet your needs.
Below is everything you need to know about Medicare open enrollment so you can choose the best coverage option for you.
When is open enrollment for Medicare?
The Medicare open enrollment period occurs every year in the fall. In 2020, the open enrollment period runs from October 15 until December 7. When you choose a plan during this time, your new coverage will go into effect on January 1.
Medicare open enrollment: the basics
While you may receive certain benefits when you first enroll in Medicare, each year, there may be changes to your Medicare insurance plans. Cost, coverages, and in-network providers and pharmacies can change. Fortunately, you have the option to modify your coverage during Medicare open enrollment. From October 15 until December 7, you can choose to enroll in a different Medicare plan so you have the best plan to meet your needs.
Information for the next year’s Medicare plans will become available in October. If your current plan is changing, you’ll be able to see the adjustments in the Annual Notice of Change or Evidence of Coverage document you receive in the mail.
Depending on your situation, you may be enrolled in Original Medicare or a Medicare Advantage Plan. Original Medicare is the federal insurance program that includes Part A (hospital insurance) and Part B (medical insurance). You may also add Medicare Part D to your policy, which covers prescription medications.
Medicare Advantage Plans — also known as Medicare Part C — are offered by private insurance companies, but are approved by Medicare. They bundle your Part A and Part B benefits, and usually include prescription drug coverage as well.
What you can do during open enrollment
During the open enrollment period, you can do the following:
- Switch from Original Medicare to a Medicare Advantage Plan: Medicare Advantage often includes coverages that Original Medicare doesn’t, including prescription drug coverage.
- Switch from a Medicare Advantage Plan: If you decide you don’t need the extra services offered by your Medicare Advantage Plan, you can change back to Original Medicare.
- Change Medicare Advantage Plans: You can select a new Medicare Advantage Plan. For example, you can switch to a plan that offers prescription drug coverage if your old one didn’t offer that benefit.
- Join or switch Medicare Part D Plans: You can enroll in a Prescription Drug Plan, also known as Medicare Part D, or switch plans.
If you want to switch to a Medicare Advantage Plan, you have to meet the following requirements:
- You must be enrolled in Medicare Part A and B
- You cannot have end-stage renal disease; if you do, you’re ineligible for a Medicare Advantage Plan
The open enrollment period is not for new Medicare enrollees. If you’re over 65, don’t currently have a Medicare plan, and are looking to enroll in one, you’ll have to wait until the general enrollment period in January.
6 things to consider before Medicare open enrollment
Before Medicare open enrollment begins, keep the following factors in mind to help you choose the right coverage:
- Your healthcare needs: Your health determines what kind of coverage you need. If you have chronic health conditions, you’ll likely need a different plan than if you were in excellent health. In light of the COVID-19 outbreak, it’s more important than ever to pay close attention to your health. Both Medicare and Medicare Advantage Plans cover lab tests for COVID-19 with no out-of-pocket costs. They also cover FDA-authorized antibody tests if you were diagnosed with a prior COVID-19 infection and hospitalizations related to COVID-19. Both original Medicare and Medicare Advantage will cover a vaccine if one becomes available, as well.
- Out-of-pocket costs: When comparing health plans, pay close attention to monthly premiums, deductibles, copayments, and coinsurance. Those costs affect how much you have to pay out of your pocket.
- Prescription drug needs: If you take prescription medications and don’t have coverage through an employer or union, you’ll likely need to purchase a separate Medicare Part D plan or enroll in a Medicare Advantage Plan that offers prescription drug coverage.
- Other services or items: Original Medicare doesn’t cover services like eye exams, hearing aids, or dental care. However, many Medicare Advantage Plans cover these services, so it may be worth enrolling in an Advantage Plan.
- Travel plans: Original Medicare provides coverage anywhere in the United States, but does not cover your medical care outside of the country. By contrast, your coverage is dependent on your plan under a Medicare Advantage Plan. Some plans include out-of-network coverage and may cover medical treatments outside of the country.
- Healthcare providers: When choosing a Medicare plan, think about what providers you want to use. With Medicare Advantage, you can choose plans that offer in-network-only coverage or offer out-of-network coverage. While in-network plans are less expensive, they may also offer less flexibility and fewer treatment options.
How to get help with Medicare open enrollment
If you need help choosing a plan or you have questions during Medicare open enrollment, use the following resources to get assistance:
- Medicare Plan Finder: The Medicare Plan Finder is an interactive tool provided by the Centers for Medicare and Medicaid Services. You can use it to view available plans, see coverage options, and compare costs.
- Call Medicare.gov: You can call 1-800-633-4227 to get help with choosing a Medicare plan.
- Contact your state health insurance assistance program: Each state operates a state health insurance assistance program (SHIP). You can get local one-on-one Medicare counseling and advice to help you make informed healthcare decisions. You can use the SHIP locator tool to find a SHIP office near you.
FAQs about Medicare open enrollment
Can you change Medicare plans after open enrollment?
You can change Medicare plans after open enrollment under special circumstances, including:
- You move to a new address outside your plan’s service area, or your new location has different plan options
- You moved into or out of an institution, such as a long-term care facility
- You lost your employer or union coverage
- You’re no longer eligible for Medicaid
- Medicare ended your plan’s contract
What happens if you miss Medicare open enrollment?
If you are already enrolled in a Medicare plan and don’t make any changes during open enrollment, your plan will automatically renew on January 1.
If you are over 65 and haven’t enrolled in Medicare yet or missed your initial enrollment period, you have the opportunity to enroll during the general enrollment period from January 1 to March 31, and your coverage will start July 1. If you’re enrolling late, you may have to pay penalties. Here are some potential penalties you might be faced with:
- Medicare Part A: If you don’t qualify for premium-free Medicare Part A and have to purchase it, your monthly premium will increase by 10%. The higher premium will apply for twice the number of years that you didn’t sign up.
- Medicare Part B: Your premiums will increase by 10% for each full 12-month period that you were late signing up for Medicare benefits.
- Medicare Part D: The penalty is calculated by multiplying 1% by the national base beneficiary premium ($32.74 for 2020) by the number of months that you skipped prescription drug coverage. The amount is rounded up to the nearest $0.10.
Who is eligible for Medicare open enrollment?
Medicare open enrollment is generally for people who are already covered by Medicare and looking to review or change their plans.
If you are about to turn 65, you can enroll in Medicare outside of the open enrollment period. Your enrollment window begins three months before the month of your 65th birthday, includes the month you turn 65, and ends three months after the month you turn 65. Once you have Part A and Part B coverage, you can decide if you want to enroll in a Medicare Advantage Plan or add a prescription drug plan to your coverage.
The bottom line on Medicare open enrollment
The Medicare open enrollment period will be here before you know it. Even if you’re satisfied with your current coverage, it’s a good idea to review your health plan, costs, and benefits to ensure you have the best plan possible for your healthcare needs.
Medicare plans are always changing, so what was the best plan for you this year may not be the right option for next year. You may also be able to find a more affordable plan or one that covers more services or items. Carefully evaluate your options, keep your out-of-pocket costs in mind, and comparison shop so you can find a plan that maintains and improves your health while staying within your budget. Doing your due diligence will help you avoid any Medicare open enrollment mistakes.