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What you need to know about Medicare’s Open Enrollment

The information in this blog pertains mostly to those who are aged 65 and up and do not already qualify for Medicare due to a disability. The information provided is meant to serve as a guideline and does not qualify as legal advice. For questions or more information, we recommend you visit the medicare.gov website or speak with a local insurance agent.

It is highly recommended that everyone reviews their Medicare plan annually as oftentimes your plan does not reflect changes to your health and medication needs. Additionally, plans also change every year so there may be a plan out there that better fits your needs.


When does open enrollment take place?

There are three main timelines you should be aware of.

  1. Initial enrollment is a seven-month period that begins three months prior to your 65th birthday, includes the month you turn 65, and extends another three months after your 65th birthday. If you sign up for a plan during the three months prior to your 65th birthday, your coverage begins the first day of the month you turn 65. If you sign up during your birthday month, or in the three months after your birth-month, coverage beings the first day of the month after you ask to join the plan.1

  2. Open enrollment occurs annually from October 15th through December 7th. During this time, you can join, switch, or drop your plan and coverage begins starting January 1st. If you didn’t enroll in Medicare when you were first eligible, you cannot use the fall open enrollment period to enroll. Instead, you must use the Medicare general enrollment period which runs from January 1st to March 31st.2

  3. Medicare General Enrollment and Medicare Advantage open enrollment is from January 1st through March 31st every year. If you enroll during the general enrollment period, your coverage will take effect July 1st.

What can I do during open enrollment?1

There are a number of changes that can be made during the Open Enrollment period.

  • 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 offers 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 drug plan.

  • Switch from one Medicare drug plan to another Medicare drug plan.

  • Drop your Medicare drug coverage completely.

Conversely, you cannot make changes to any Medigap plans, which are only guaranteed-issue in most states during a beneficiary’s initial enrollment period and during limited special enrollment periods.2


What Medicare plan is right for me?

Knowing which Medicare Part D plan is right for you can be difficult. However, there are six key things to consider when reviewing your Plan.

  1. Your current plan’s formulary has changed, and your medications are placed into different tiers. These often change year to year, so be sure to look at this closely when it is time to review/renew your plan.

  2. Your medication needs have changed. Whether you have switched to a new medication, or are taking one you did not previously take, reviewing which plans are best based on your current medication needs is crucial. For example, if you’re paying a relatively high premium for a specific plan that places one of your recurring medications in a relatively low tier, but you then switch to a generic version of that drug that’s cheaper across the board, it pays to see if you can get away with paying a lower premium.3

  3. Your current pharmacy isn’t included in the plan’s network. Oftentimes, insurance companies instruct plan participants to use certain pharmacies or mail order services. Before signing up for a plan, talk with your pharmacy to ensure you will be able to use them or if there is another plan that will work that also allows you to keep your current pharmacy.

  4. You’re paying a higher premium for a plan that you aren’t utilizing. Sometimes, it’s worth paying up for a Part D plan that offers better coverage, because what you fork over in premiums, you make up for in copays. But if you don’t have any ongoing prescriptions, then you may be better off opting for a lower-cost plan.3

  5. If you have a lower income, you may qualify for better benefits. Low-income members, including those who have both Medicare and Medicaid, are able to apply for different benefits. It is important to know all your options. Click here for more information on the ‘Extra Help’ program.

  6. Star ratings. Good star ratings – especially ratings of four stars and above – can mean a plan has demonstrated quality customer service and has a track record of paying attention to your many health care needs (such as periodic screenings or health assessments). By that same token, you should be wary of plans with fewer than four stars. Those plans often have a track record of mistreating their members, providing subpar customer service, and being slow to process member claims and appeals – delaying or even preventing access to needed health care.4

What is the Medigap?

Medigap is another name for Medicare Supplement insurance plans which help patients pay for out-of-pocket healthcare costs you may incur with Original Medicare Parts A and B. Medigap enrollment starts the first day of the month you turn 65 years old and enroll in Medicare Part B. During that time, you can buy any Medigap policy sold in your state regardless of your health status. During this six-month Medigap enrollment period, insurers must charge people with preexisting conditions the same price as they charge people in good health.5


If you apply for Medigap coverage after your open enrollment period, in all but four states, insurers are allowed to use medical underwriting to deny or charge more for coverage. This means you may pay more or be denied coverage if you have preexisting medical conditions such as diabetes or heart disease or you are facing an upcoming surgery.5


Sources:

  1. https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan

  2. https://www.medicareresources.org/medicare-open-enrollment/

  3. https://www.medicareresources.org/medicare-benefits/four-signs-you-need-a-new-medicare-part-d-plan/

  4. https://www.medicareresources.org/medicare-benefits/seven-rules-for-shopping-medicare-part-d-plans/

  5. https://www.nerdwallet.com/article/insurance/medicare/medicare-open-enrollment-periods-for-2020-21

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