Most seniors and caregivers are aware of the annual Medicare Open Enrollment Period that runs each fall from October 15 until December 7, but the Centers for Medicare and Medicaid Services (CMS) offer another important time when beneficiaries can change their coverage.
Since 2019, Medicare beneficiaries have been able to utilize the annual Medicare Advantage Open Enrollment Period (MA OEP) that runs from January 1 through March 31. This enrollment period replaced the Medicare Advantage Disenrollment Period (MADP) that ran from January 1 through February 14 each year.
During the MA OEP, beneficiaries who are currently enrolled in Medicare Advantage Plans (also known as Part C Plans) can change their coverage if they find it does not fit their needs. Those who elect to do so can switch to a different Advantage Plan or revert to “Original Medicare,” which consists of Part A (hospital insurance) and Part B (medical insurance). Unlike Advantage Plans, Original Medicare is offered directly through CMS rather than a private insurance company. Beneficiaries who choose to disenroll from their Part C Plan and revert to Original Medicare also have the option to enroll in a stand-alone Prescription Drug Plan (Part D Plan). Any changes made during the MA OEP are effective on the first of the following month.
Beneficiaries cannot switch from Original Medicare to an Advantage Plan during this period. Furthermore, those who are already enrolled in Original Medicare may not join a Part D Plan or switch to a different Part D Plan.
If you or someone you know is considering taking advantage of the 2020 Medicare Advantage Open Enrollment Period, take care to avoid gaps in coverage. I encourage beneficiaries to consider the following important pieces of advice before acting:
- Know the gaps in Original Medicare.
Like Medicare Advantage Plans, Original Medicare has deductibles and coinsurance. But, unlike Advantage Plans, Original Medicare doesn’t have a cap on annual out-of-pocket costs if you get sick or injured. In 2020, the most common maximum out-of-pocket (MOOP) limits for Medicare Advantage Plans are $6,700 and $3,400 for covered medical services, which can be a real asset for some beneficiaries. Some plans have even lower caps. It’s also important to remember that Original Medicare does not cover the cost of prescription drugs.
- Set your priorities for coverage.
I encourage people to make a checklist of benefits they want to keep before dropping or switching an Advantage Plan. For example, be sure your current doctor(s) will still see you if you change to Original Medicare or another Advantage Plan. If you take any prescription drugs, be sure to research your options and costs for drug coverage.
- Consider a Medicare Supplement.
If you’re planning to switch to Original Medicare, you may want to consider bolstering your coverage with a Medicare Supplement Insurance policy (also known as Medigap). Most states offer 10 different Medigap Plans denoted by letters A through N. By law, each lettered plan must provide the exact same minimum level of supplemental coverage, so Plan A from one company must provide the same standardized coverage as Plan A from another insurer. You can search for Medigap policies offered in your state on Medicare.gov. However, keep in mind that Medicare Supplement Plans are medically underwritten. If you try to enroll in a Medigap Plan outside of your Medigap open enrollment period (the six-month period after you enroll in Part B), you may not qualify or the costs may be prohibitive.
- Avoid losing additional benefits.
Some Advantage Plans provide routine dental, vision and hearing coverage, which Original Medicare does not. Medicare Supplement Plans do not typically cover these services either. So, if you drop your Advantage Plan during the MA OEP, you may need to purchase stand-alone coverage for vision and dental care.
While the Medicare Advantage Open Enrollment Period may seem like an easy opportunity to make changes to Medicare coverage, this decision requires thorough research. Taking care to compare the extent of coverage and costs of each option will help prevent costly surprises down the road.
If you need assistance weighing coverage options for yourself or an aging loved one, contact your State Health Insurance Assistance Program (SHIP) for free one-on-one insurance counseling.