During the annual Medicare Annual Enrollment Period (AEP), you can change your Medicare Advantage plan (MA/MAPD) or Medicare Drug plan (Part D). This period runs from October 15 through December 7, and any plan change will become effective January 1. Here, we outline who can make changes, the types of changes you can make, and the steps to take to make the right choice for your needs.
Who is eligible for the Annual Enrollment Period (AEP)?
You can change your existing coverage if you are already enrolled in Medicare. This applies to individuals with a Medicare Advantage plan, Original Medicare (Medicare Part A and Part B), and a Medicare supplement plan with a drug plan.
If you have not enrolled in Medicare yet, you will need to wait until one of the following enrollment windows is available to you:
- Initial Enrollment Period: This 7-month window starts three months before you turn 65 and ends three months after your birthday month.
- General Enrollment Period: People who didn’t sign up during initial enrollment can get Parts A and B between January 1 and March 31.
- Special Enrollment Period: Certain personal circumstances, such as leaving a job that provides health insurance, may trigger a SEP at any time of the year.
What can I do during the Annual Enrollment Period?
It’s helpful to know the terms that refer to the Medicare Annual Enrollment Period. “Annual Open Enrollment Period,” “Medicare Open Enrollment,” or Annual Coordinated Election Period may be used interchangeably, and they describe the period from October 15 through December 7. when eligible individuals can make certain changes to their plans.
During the Annual Enrollment Period, recipients are allowed to
- Change from Original Medicare to a Medicare Advantage Plan.
- Change from a Medicare Advantage Plan back to Original Medicare.
- Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
- Enroll in a Medicare drug plan.
- Switch from one Medicare drug plan to another Medicare drug plan.
- Drop your Medicare drug coverage altogether.
If you change your coverage, it becomes effective on January 1.
Reasons to evaluate your Medicare plan during the Annual Enrollment Period
Medicare health and drug plans can make certain changes to their policy each year, including changes in plan name, premium, coverage costs, pharmacy and provider networks, plan benefits, and the list of drugs covered. Because some of these changes might not align with your senior care needs, it’s helpful to understand so you can switch to a plan that’s better suited for you.
You can evaluate your plan details for the following year to ensure it adequately protects your health and financial needs. Another helpful resource is the official Medicare and You handbook, which outlines changes and important details to know about Medicare plans for the upcoming year. In addition to reviewing the handbook, here are some details you can review in your plan’s annual notice of change:
- Costs: Compare premiums, deductibles, coinsurance, and copayments. They may vary from year to year and from plan to plan.
- Network: Look for changes to the list of doctors, pharmacies, and other health care providers. A doctor or hospital may be in-network this year but not the following year.
- Covered Services: Review the scope of services covered, as specific services may be discontinued or altered.
- Drug Formulary: Each year, plans can change the list of drugs they choose to cover.
- Personal Changes: If your health or financial situation changes, you may need to change your plan to one better suited for you.
How to prepare for Medicare AEP
Step 1: Review your plan’s Annual Notice of Change (ANOC)
For most plans, you can anticipate some changes from year to year. Your current plan must send you an Annual Notice of Change (ANOC) which will explain any changes to your current policy that will take effect in the upcoming year. Be sure to look out for this communication in the fall.
You can contact your plan provider directly if you missed this mailing or have any questions. You can also visit Medicare’s consumer website at Medicare.gov. Always be cautious of misleading advertisements or phone calls from salespeople that may sound too good to be true.
Step 2: Decide if your plan still works for you
After reviewing your plan’s ANOC letter and your previous year’s health assessment, you should be able to make one of the following decisions:
- If the changes taking place in your current plan for the upcoming year are acceptable to you, no action is needed; your plan automatically renews by default.
- If your plan is being terminated for the upcoming year, you will want to determine if they will automatically enroll you in a new plan or if you need to select a new one.
- If the changes in your current plan for the following year do not meet your needs, you will need to find a new plan better suited for you.
Step 3: Compare plan options
If you have decided to make a plan change for the following year, various options are available depending on the level of coverage you want. You can talk to a trusted, licensed agent or use Medicare.gov. Below are some critical considerations:
- For Medicare Advantage: Be sure to consider the plan’s cost structure (deductibles, copayments, coinsurance, etc.), the network of doctors, and additional benefits (vision, dental, hearing, gym membership).
- For Medicare Drug plan (Part D): Ensure your pharmacy of choice is in the network, and your prescriptions are covered at the lowest available price.
- Bonus Tip: If you choose to use the Medicare drug plan finder option at Medicare.gov, it will produce a list of plans available in your zip code organized by the total cost (total premium and out-of-pocket expenses for the year).
Step 4: Change your plan if you need to
Once you have decided on a plan, you can complete an enrollment application either through your agent, insurance carrier or Medicare.gov. The deadline for making changes during AEP is December 7, and the new plan will become effective on January 1 of the following year. Once the application is processed, your previous plan will automatically terminate, effective on December 31.
Do I need to change my Medicare Supplemental plan during AEP?
Generally, Medigap policies do not require the same yearly evaluation as Medicare drug plans; these plans are typically long-term solutions. In most states, changing Medigap plans can include completing an application, answering medical questions, receiving a telephone interview based on your medical history, and finally, learning whether or not you have been approved. Changing Medigap plans can be done at any time throughout the year.
The bottom line
To ensure that you are not surprised by unexpected changes in January, it’s essential to review all available options and decide if you want to make changes. If unsure, contact a reputable agent or the State Health Insurance Assistance Program (SHIP). If you miss your opportunity to change plans during AEP, you may have to wait until the following year’s AEP.