7 Things to Know About Medicare Open Enrollment

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Navigating the Medicare maze is a complicated feat, and the annual enrollment period can leave seniors and caregivers feeling especially confused. Here are seven things to know about Medicare Open Enrollment (MOE) that will help you make the most informed decision.

1. Medicare Open Enrollment runs from October 15 to December 7 every year.

Timing matters, whether you’re initially joining Medicare or changing your coverage, because Medicare sets time-sensitive windows that allow beneficiaries to make specific kinds of changes. For example, your Initial Enrollment Period (IEP) begins 3 months before your 65th birthday, includes your birthday month, and lasts for 3 months after. The initial enrollment period is your first opportunity to make decisions about the coverage you need. Other time periods recur, like MOE. Certain life events and changing health needs and costs may necessitate exploring your coverage options each year. MOE is the time to do so. Being mindful of these annual deadlines can help you choose from the most coverage options at the lowest prices.

2. There are two ways to get Original Medicare.

Seniors can choose Original Medicare (Parts A and B) on its own, with the option to add Part D prescription drug coverage. If you collect benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically be enrolled in Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). There is a premium for Part B. If you don’t need to keep Part B (for example, if you are covered through your employer or that of your spouse), you must follow the directions when you get your Medicare card, indicating you don’t want it. Otherwise, you will be charged.

The other option is a Medicare Advantage (Part C) Plan that bundles Original Medicare with extra benefits and may include prescription drug coverage. Advantage Plans are offered by private insurance companies that contract with Medicare. These companies must follow certain guidelines set by Medicare, but each Advantage Plan can charge different out-of-pocket costs and set different rules for how you receive services (like whether you need a referral to see a specialist or if you have to use in-network doctors, facilities or suppliers). These costs and rules can change each year.

3. What can you do during open enrollment?

Beneficiaries can choose from the actions below. Any changes you make during the MOE period will go into effect January 1 of the following year.

  • 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.
  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that does offer drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare Prescription Drug Plan to another.
  • Drop your Medicare prescription drug coverage completely.
  • Do nothing. If you don’t make any changes during MOE, your existing plan(s) will roll over at the end of the period and your existing coverage will remain in effect.

4. Medicare doesn’t cover all of your medical costs.

It is a common misconception that Medicare covers all of a senior’s medical expenses, however approximately 20 percent of physician fees are paid by the Medicare beneficiary. For this reason, seniors often find themselves paying out of pocket for many of their healthcare expenses.

When you’re deciding whether or not to add, change or drop plans, pay attention to the financial impact of each option. Calculate your total out-of-pocket healthcare expenses from the last year and compare it to other coverage options you’re considering. Be sure to factor in premiums, deductibles, co-pays and prescription drug costs.

5. What happens if you miss the MOE deadline?

If you miss the deadline, you may have to wait until next year before you can make changes, or you risk paying penalties and higher premiums.

Depending on what kind of coverage you have, you may be able to make changes outside of the MOE period. One opportunity is the Medicare Advantage Plan Disenrollment Period (explained in the next item). Otherwise, you’ll have to incur special circumstances, like moving to a new address or losing your current coverage. Only qualifying life events will open up a Special Enrollment Period (SEP) and allow you to make coverage changes. The deadlines and actions you can take vary, depending on the special circumstance. You can find more information on SEPs on the Medicare.gov website.

6. If you don’t like your Advantage Plan, you can disenroll.

An insurance agent might say that you can just switch back if you don’t like the Advantage Plan you choose during MOE, but it’s not that easy. It is possible to get stuck in a plan until the next year’s MOE period.

One option is to switch back to Original Medicare, but you have to act fast. The Medicare Advantage Plan Disenrollment Period only lasts from January 1 through February 14 each year. During this disenrollment period, you can only do two things:

  • If you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare.
  • If you switch to Original Medicare during this period, you have the option to join a Part D Plan. Your coverage will begin the first day of the month after the plan receives your enrollment form.

7. Help is available.

If you don’t understand something about MOE or your coverage options, it’s crucial to ask for help. For more detailed information about Medicare, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

Free one-on-one insurance counseling is also provided by State Health Insurance Assistance Programs (SHIPs). Contact your local Area Agency on Aging for more information or to make an appointment.

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17 Comments

To everyone who posted questions: Each state has a State Health Insurance Program (SHIP). In Washington state, where I live, the SHIP program is called SHIBA (Statewide Health Insurance Benefit Advisors), and is overseen by the Washington State Office of the Insurance Commissioner.

Each state's SHIP is staffed by some paid staff, but mostly volunteers who receive training on insurance issues and how to counsel people on insurance options. This includes a lot of information and training on Medicare. You can find your state's SHIP here: https://www.shiptacenter.org/

Your state's SHIP will be able to tell you what Medicare Advantage Plans are in your area (usually they vary from county to county even within the same state). They could also help you run a "Plan Finder" on the Medicare website to compare your plan options and an estimate of what your costs will be with each plan.
it is so confusing,older people ca not get this including me,we just want regular medicare without any authrizations
I recommend all seniors and their families that you contact to find a local licensed insurance agent to guide you through the decision making process. The above post covers most of the essential items however #2 indicates that you can drop Medicare Part B - while this is true you must have both Parts A and B to enroll in a Medicare Advantage Plan or Medicare Supplement. Also Medicare Supplement plans can be a good option for many seniors as you will have predictable costs in the premium each month rather than unpredictable and potentially large out of pocket costs when you get sick. Many Medicare Advantage plan now have an out of pocket maximum of $6700 which make a Medicare Supplement a bargain at less than $3000/year. Also, if you drop your Medicare Supplement you may not be able to get it back refers to the fact that (after turning 65) there are health questions and underwriting related to Medicare Supplements - so not all that apply for will qualify (although some western states have begun to have a special enrollment period for Medicare Supplements without underwriting).