Importance of Medicare Open Enrollment Periods

importance of medicare open enrollment periods

Why you want to understand Medicare open enrollment periods

If you are enrolled in a Medicare Advantage plan or Medicare Part D prescription drug plan, it is important to understand Medicare’s open enrollment periods. This is because these plans change coverages from year to year and if you are not paying attention, you may end up having coverage for a year (or longer) that is costing you more money than you need to be spending.

Here are some of the items an insurance company can change in the coverage your plan provides.

Click to Enlarge - Open Enrollment Infographic

For Medicare Part D:

  • The Monthly Premium
  • The Annual Deductible
  • The Yearly Out-Of-Pocket Co-Pays
  • Your Drug Formulary – Just one change could cost you thousands of dollars!
  • The Network of Pharmacies
  • Pharmacy Cost-Sharing
  • Coverage Rule for Medications (Quantity Limit, Step Therapy, Prior Authorization)
  • The “Donut-Hole” coverage gap – See a great infographic about the Medicare donut hole here.

For Medicare Advantage Health Plans:

·         The Monthly Premium

·         Your Out-Of-Pocket Co-Pays and Coinsurances

·         Your Maximum Out-Of-Pocket Spending Limit Your Provider Network

Understand that insurance companies can not just “sneak” these changes in under the radar. Each year, they are required to send their policy owners information about changes to the plans prior to open enrollment. Don’t through these changes away without looking them over. If you have, call the insurance company and get a copy. Take the time to look at these changes to see if your current plan is still acceptable.

If you have concerns about your coverage, use Medicare’s Plan Finder to compare plans.

If you still want help, consider enrolling in our Medicare “Tune-Up” service to ensure you are making the best Medicare decisions.

When is Medicare Open Enrollment?

Of course, you will want to know when you are able to make changes to your Medicare Plan. There are several times you can do this:

October 15 through December 7

During this period, enrollees in a Medicare Advantage plan can:

  • Anyone who has (or is signing up for) Medicare Parts A or B can join or drop a Part D prescription drug plan.
  • Anyone with Original Medicare (Parts A & B) can switch to a Medicare Advantage plan.
  • Anyone with Medicare Advantage can drop it and switch back to just Original Medicare (Parts A & B).
  • Anyone with Medicare Advantage can switch to a new Medicare Advantage plan.
  • Anyone with a Part D prescription drug plan can switch to a new Part D prescription drug plan.

When you make changes to your Medicare coverage during open enrollment, the new coverage takes effect January 1st the following year.

Note – You can not enroll into Medicare A and B for the first time during open enrollment unless you are eligible for an initial enrollment period.

January 1 through March 30

This period is known as the Medicare Advantage Open Enrollment Period. During this time, a person enrolled in a Medicare Advantage Plan can:

  • Switch to a different Medicare Advantage Plan with or without drug coverage
  • Go back to Original Medicare and if needed, also join a Medicare Prescription Drug Plan.

If you switch Medicare Advantage Plans or go back to Original Medicare with or without a Medicare drug plan, your new coverage will start the first day of the month after your new plan gets your request for coverage. 

In addition, you may be eligible to make changes to your Medicare plan outside of open enrollment if you experience a life-changing event.

We believe it is difficult for an individual to sort through all of the information regarding Medicare by themselves. Our Medicare RoadMap and consultation services can help you sort through the information, understand what is important to you and allow you to have the right information to make the best decision about Medicare for your unique situation.