Most seniors and caregivers are aware of the annual Medicare Open Enrollment Period that runs from October 15 until December 7, but the Centers for Medicare and Medicaid Services (CMS) is now offering another important time when changes can be made to one’s coverage.
Starting in 2019, Medicare beneficiaries can utilize the Medicare Advantage Open Enrollment Period (MAOEP) that runs from January 1 through March 31 each year, which replaces the old Medicare Advantage Disenrollment Period (January 1–February 14).
During the new MAOEP, beneficiaries enrolled in Medicare Advantage Plans (also known as Part C) can cancel their coverage if they find it does not fit their needs. Those who elect to do so can switch to another Advantage Plan or revert back to “Original Medicare.” Original Medicare consists of Parts A and B, which are offered directly through CMS rather than a private insurance company. Beneficiaries who choose to revert to Original Medicare also have the option to enroll in a stand-alone Prescription Drug Plan (Part D).
However, beneficiaries cannot switch from Original Medicare to an Advantage Plan. Furthermore, those who are already on Original Medicare may not join a Part D Plan or switch to a different Part D Plan during this period.
If you or someone you know is considering taking advantage of the new 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 2019, the most common maximum out-of-pocket 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.
- Know 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 policy (also known as Medigap). Most states offer 10 different Medigap Plans denoted by letters A through N. Each lettered plan must provide the exact same minimum level of supplemental coverage, so Plan F from one company must legally provide the same basic coverage as Plan F from another insurer. You can search for Medigap policies offered in your state on Medicare.gov. However, keep in mind that after your Medigap Open Enrollment Period (the six-month period after you enroll in Part B) ends, Medicare Supplement Plans are medically underwritten, which means some people may not qualify or costs may be prohibitive.
- Don’t lose 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 new MAOEP, you may need to purchase stand-alone coverage for vision and dental care.
While this new Open Enrollment Period may seem like an easy opportunity to make changes to Medicare coverage, the decision is actually very complicated and requires thorough research. Carefully comparing the extent of coverage and costs of each option will help ensure you do not run into any 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.