During the Medicare open enrollment period, also called the annual enrollment period (AEP), Medicare participants can change certain choices they made about their plans. This period runs from October 15 through December 7 every year so that seniors can make adjustments to their health care policy that work better for them. Here, we explain who can make changes, the types of changes you can make, and considerations for why Medicare enrollees make changes to their health care plans.
What is the Medicare open enrollment period?
Medicare open enrollment, also known as the annual enrollment period or the annual coordinated election period, is the window of time between October 15 and December 7 during which eligible individuals can make specific changes to their plans. Let’s take a look at who can make changes and what you can and can’t change during this time period.
Who is eligible for the Medicare open enrollment period?
You can change your existing coverage if you are already enrolled in Medicare. This applies to individuals with Medicare Advantage or original Medicare.
If you have not yet enrolled in Medicare, you will need to wait for one of the following enrollment windows:
- Initial enrollment period: This seven-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 special enrollment period at any time of the year.
Changes you can make during the annual enrollment period
If you are currently enrolled in Medicare, you can make certain changes to your plans, including switching from original Medicare to a Medicare Advantage (Medicare Part C) plan that’s available in your area.
You can also change from a Medicare Advantage plan back to original Medicare. Keep in mind that if you want to switch to original Medicare, you may also want to have a Medigap policy — something you might not have if you currently have a Medicare Advantage plan. Medigap policies are generally only guaranteed during your six-month Medigap open enrollment period, starting the first month you’re 65 or older and have Medicare Part B. These plans can be more challenging or expensive to buy after this initial time frame.
Also, when you first sign up for a Medicare Advantage plan upon turning 65, you have one year to evaluate that plan and choose to change back to original Medicare. Waiting longer than a year will subject you to underwriting for a Medigap plan, which could lead to much higher premiums or even the inability to find a plan that will insure you if you have preexisting conditions.
You can also switch from one Medicare Advantage plan to another Medicare Advantage plan. If you’re not happy with your Medicare Advantage plan after Medicare open enrollment, you can make a change during the Medicare Advantage general open enrollment period, which is from January 1 to March 31.
You can enroll in a Medicare drug plan (Part D), switch from one Medicare drug plan to another Medicare drug plan, or drop your Medicare drug coverage altogether. You can rejoin a Medicare drug plan in the future, but if you go 63 days in a row or more without other creditable prescription drug coverage, you have to wait for an enrollment period to sign up for coverage again, and you may be subject to a late enrollment penalty.
Changes you make to your coverage become effective on January 1.
Reasons to evaluate your Medicare plan during the open enrollment period
Medicare health and drug plans can make specific changes to their policy each year, including plan name, premiums, coverage costs, pharmacy and provider networks, plan benefits, and covered drugs. Because some of these changes might not align with your senior care needs, it’s helpful to understand them 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 they adequately protect your health and financial needs. Another helpful resource is the official Medicare handbook, which outlines changes and important details about Medicare plans for the upcoming year.
Here are some additional changes to look for in your plan and your situation:
- 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 in your plan’s network. 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 coverage: Each year, plans can change the list of drugs they choose to cover.
- Personal changes: If your health or financial situation has changed in the past year, you may need to change your plan to one that is better suited to you.
Do I need to change my Medicare Supplement (Medigap) plan during open enrollment?
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, doing a telephone interview based on your medical history, and learning whether you have been approved. Changing Medigap plans can be done at any time throughout the year, but make sure you are accepted on a new plan before you cancel your old one.
Changing your Medigap plan outside the initial enrollment period (when you first sign up for Medicare) might result in higher premiums due to underwriting requirements.
The bottom line
Reviewing all available options will help you decide if you want to make changes and ensure you are not surprised by unexpected changes in January. Contact a reputable agent or the State Health Insurance Assistance Program (SHIP) if you still need clarification. If you miss your opportunity to change plans during the Medicare open enrollment period, you may have to wait until the following year to sign up for coverage.
