Understanding Medicare Open Enrollment

Medicare open enrollment, also known as Medicare’s annual election period runs from October 15th to December 7th each year. During this time period, Medicare enrollees can reexamine their coverage and make changes or add new policies if they wish to do so.

It’s important to note that the Medicare open enrollment period cannot be used to enroll in Medicare for the first time.

In this post, we’ll outline what the open enrollment period is used for, along with how to enroll in the Medicare plans of your choice.

Changing Plans During the Open Enrollment Period

After you’re enrolled in Medicare, you’ll have the opportunity to change certain aspects of your coverage each year. During the Medicare open enrollment period that runs from October 15th to December 7th you are able to:

  • Switch from Original Medicare to Medicare Advantage
  • Switch from Medicare Advantage to Original Medicare
  • Switch from a Medicare Advantage plan to another
  • Switch from one Medicare Part D plan to another
  • Join a Medicare Part D plan
  • Drop your Part D coverage

Each year there is also a Medicare Advantage Open Enrollment period from January 1st to March 31st. During this time you are able to:

  • Switch to Original Medicare and enroll in a Part D plan
  • Switch to a different Medicare Advantage plan.

You are only allowed to make one plan change during this window, unlike the fall enrollment period where you are able to make multiple changes.

Re-evaluating Medicare Coverage During Open Enrollment

Each year, insurance companies can make changes to Medicare plans that will impact out-of-pocket costs such as deductibles, monthly premiums, and drug costs.

Pharmacy networks, a list of doctors, hospitals, and pharmacies that negotiate prices with insurance companies, can also make changes to a plan’s formulary (list of covered drugs).

Because of these changes, it is a good practice to re-evaluate your Medicare plan each year to ensure it still meets your needs.

Here are some other benefits of looking over your coverage during open enrollment:

  • Finding a higher quality plan. Check the star rating of your plan and if yours is less than 3, consider using Open Enrollment to switch.
  • Switching to better prescription drug coverage can reduce out-of-pocket costs and ensure any needed prescriptions are still covered by your plan.
  • Save money and keep your in-network doctor by changing Medicare Advantage or Part D plans.

What You Can’t Do During the Open Enrollment

The annual Medicare Open Enrollment period does not apply to Medigap plans as these are only guaranteed-issue in most states during limited special enrollment periods and a beneficiary’s initial enrollment period.

If you didn’t enroll in Medicare when you were first eligible, you are not able to use the open enrollment period to enroll. Instead, you’ll use the Medicare general enrollment period which runs from January 1st to March 31st.

The general enrollment period can be used by people who didn’t sign up for Medicare Part B when they were first eligible and who don’t have access to a Medicare Part B special enrollment period. It’s also for those who have to pay a premium for Medicare Part A and didn’t enroll in Part A when first eligible.

Medicare Eligibility

Most Americans become eligible for Medicare at age 65 but some people will become eligible earlier.

Here is a detailed overview of eligibility for the different parts of Medicare coverage:

  • 15% of all Medicare beneficiaries are under 65 and became eligible after receiving Social Security disability benefits for two years or being diagnosed with ALS or end-stage renal disease.
  • To enroll in Medicare Advantage, you must enroll in both Medicare Part A and Part B. Your Medicare Advantage plan will take the place of the two parts and will likely include Part D prescription drug coverage as well.
  • To enroll in Medicare Part A without having to pay a monthly premium, you or your spouse must have worked for at least 10 years in the United States while paying Medicare taxes during that time.
  • If your income is over $87,000 for an individual or $174,000 for a couple, you’ll pay more for your Part B and Part D coverage.
  • You’re eligible to enroll in Medicare Part D as long as you have either Medicare Part A or Part B.
  • If you’re enrolled in Medicare Part A and Part B but not Medicare Advantage you’re eligible to enroll in a Medigap plan to supplement your Medicare coverage. You’ll have a six-month guaranteed issue window during which you can sign up for any Medigap plan available in your area.

Enrolling In Original Medicare

If you’re a U.S. resident that already receives Social Security or Railroad Retirement Board benefits, the federal government automatically enrolls you in both Medicare Part A and Medicare Part B when you turn 65.

You’ll receive your Medicare card in the mail about three months before your 65th birthday and your coverage will go into effect the first of the month that you turn 65.

Be aware that Medicare Part B has a monthly premium that will be deducted from your Social Security or Railroad Retirement check. You are able to opt-out of Part B to avoid the premiums, but this is usually only a good idea if you have health insurance from your current employer or your spouse’s employer.

If you’re turning 65 and you’re not yet receiving Social Security or Railroad Retirement benefits, you will not be automatically enrolled in Original Medicare. In this case, you’ll be able to enroll during a seven month enrollment period that includes the three months before your birth month, the month you turn 65, and the three following months. Enrollment takes place through the Social Security Administration.

If you are disabled and receiving Social Security Disability benefits, your Medicare coverage will automatically start in the 25th month of you receiving disability benefits. Note, that if you have ALS or end-stage renal disease, you won’t have to wait two to get Medicare coverage.

Enrolling In Medicare Advantage

To join a Medicare Advantage Plan, you need to live in an area where a plan is offered and have enrolled in Original Medicare (Part A and Part B).

Medicare Advantage plans combine your Medicare Part A and Part B coverage into one plan. You’ll still have to pay a premium for Part B in addition to the premium for Medicare Advantage.

You can enroll in a Medicare Advantage plan when you’re first eligible for Medicare or during the annual Medicare open enrollment period.

Enrolling In Medicare Part D

Enrollment in Medicare Part D is first available during the period when you’re first eligible for Medicare. You will likely have the option of selecting a Medicare Advantage plan that includes Part D prescription drug coverage and using that instead of Medicare Parts A, B, and D.

If you enroll in Medicare during the January – March general enrollment period, you can enroll in Medicare Part D between April 1 and June 30.

If you’re enrolled in a Medicare Advantage plan and use the Medicare Advantage open enrollment period to switch to Original Medicare, you’ll also have the option to enroll in a Part D plan to supplement your Original Medicare coverage.

We’re Here to Help You Choose the Medicare Plan That’s Right for You

Knowing your rights and Medicare options is an important part of choosing the right Medicare coverage. At Coverage 2 Care, we take the stress out of enrollment by helping you compare plans to find the right benefits for you. Our licensed professional agents will help you find affordable solutions to maximize your savings and get the coverage you need.

Contact us today to have one of our agents help you get the benefits you deserve!

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