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Medicare Open Enrollment – What Do I Need to Know?

Medicare’s open enrollment period occurs each year between October 15 and December 7. This is the best opportunity for current Medicare participants to modify their coverage, if their healthcare needs have changed.

How to Search for Medicare Plan Options

Medicare offers a Plan Finder tool online or you can call 1-800-MEDICARE to find out about new Advantage plans in your area. Or, check out the State Health Insurance Assistance Program site to find help in your state.

Can Anyone Make Changes During the Open Enrollment Period?

No. Medicare’s Open Enrollment Period is only for those who are already enrolled in the program. Prospective enrollees are eligible to join Medicare during an Initial Enrollment Period beginning 3 months before their 65th birthday and continuing 3 months thereafter. If they miss this initial enrollment window, they must wait until Medicare’s General Enrollment Period, which runs from January 1 to March 31 of each year (with coverage taking effect July 1st). Note that if you fail to enroll in Medicare during your Initial Enrollment Period, you may be subject to financial penalties in the form of premium surcharges.  

Are Changes Made During Open-Enrollment Effective Immediately?

No. Any updates to coverage selected during the Open Enrollment Period are effective beginning the subsequent January 1st

What Changes Can Be Made During Medicare’s Open Enrollment?

During the Open Enrollment Period, participants can switch between different Medicare plans and coverage add-ons, to better match their current healthcare needs.  Some of the coverage options that can be added, dropped, or adjusted include:

Medigap Coverage

Medigap is a supplemental insurance policy purchased from private insurers and is designed to help cover the costs of certain medical expenses that original Medicare (also called Medicare Part A & B) doesn’t cover. A Medigap policy might cover expenses such as:

  • Copayments
  • Coinsurance
  • Deductibles
  • Medical care when traveling abroad

Note that you can only purchase Medigap insurance if you have not purchased a Medicare Advantage (Part C) plan (see below). Also, keep in mind that the best time to purchase Medigap insurance is during the first 6 months that you are eligible (upon reaching age 65 and enrolling in Medicare Part B). During this “guaranteed issue period” for Medigap, you cannot be denied coverage for a pre-existing condition, and pricing is standardized for all participants living in a particular state. If you forego Medigap coverage initially, and subsequently a serious illness, you may find it difficult or impossible to purchase a policy.  

Medicare Advantage

Medicare Advantage (also called Medicare Part C) is a type of healthcare plan offered by private companies contracted through Medicare. It’s designed to combine Part A (hospital insurance) and Part B (medical insurance) as well as, in some instances, offer a prescription drug plan or other additional coverage (dental, vision, etc). Medicare Advantage frequently boasts bundled cost savings (particularly for younger, healthier retirees)—with the trade-off that participants may be restricted to a smaller “in-network” group of authorized doctors.   

During open enrollment, you can choose to switch back original Medicare, if you found that Medicare Advantage did not fit your needs. Alternately, you might remain in Medicare Advantage, but switch to a different provider or plan which better matches your health care needs. Regardless, it’s important to shop around because costs and coverage terms change every year.     

Medicare Part D (Prescription Drug Plan)

Most Medicare Advantage plans already include prescription drug coverage. However, if you are on original Medicare and want drug coverage, you need to select a supplemental “Part D” plan. Note: if you do not enroll in a Part D plan when first eligible, you will likely owe a late enrollment penalty if you decide to add this coverage later.   

It is important to check for changes to your Part D coverage every year. Plan premiums and drug formularies change frequently, and your prescription needs may change as well. Use the open enrollment period to shop around for the Part D plan which best suits your current health needs.   

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