Medicare Fall Open Enrollment: When It Is and How to Prepare

The annual fall open enrollment period for Medicare, also known as the annual election period, is a time when people with Medicare can choose or alter their Medicare coverage. The Medicare fall open enrollment runs from October 15 to December 7 of each year. There is a second open enrollment period from January 1 to March 31 for people in Medicare Advantage plans to either change their Medicare Advantage plan or switch to original Medicare.

Finding the right Medicare plan to fit your needs, reviewing deductibles and understanding the prescription drug coverage gap, or “donut hole,” can be confusing when you don’t know where to look for information.

Here are some FAQs that beneficiaries should consider during the Medicare fall open enrollment period:

When Is Open Enrollment?

The Medicare fall open enrollment period, which runs from October 15 through December 7, is the window for Medicare recipients to review, tailor or change their plans. This is a pivotal time for roughly 64 million Medicare recipients, according to the Centers for Medicare & Medicaid Services.

[Read: Questions to Ask During Open Enrollment]

What’s the Medicare Fall Open Enrollment Period?

During the Medicare fall open enrollment period, beneficiaries are able to:

— Change between a Medicare Advantage plan and original Medicare (parts A and B).

— Change from one Medicare Advantage plan to another.

— Enroll in a Part D prescription drug plan, change from one Medicare prescription drug plan to another or opt out of Medicare prescription drug coverage completely.

Changes made during this period go into effect January 1 of the next year.

Overall, Medicare premiums are decreasing. The Centers for Medicare and Medicaid Services announced that the average price of a Medicare Advantage plan will decrease to $18 per month in 2023, compared to $21.22 in 2021.

Medicare beneficiaries are encouraged to review their Medicare coverage every year during fall open enrollment to see if there are new Medicare plan options that may better suit their needs. In most cases, if you don’t enroll for a Medicare plan during the fall enrollment window, you won’t be able to sign up until the next year. The exceptions to this rule are if certain life events occur outside of the fall season, including loss of health coverage, moving, getting married and having a baby or adopting a child.

Over the past year, your plan’s benefits may have been altered or your premiums may have risen or fallen, says Paula Muschler, president of Insurance Branch, a company that advises Medicare beneficiaries on their coverage options. “Don’t put it aside, don’t think your plan isn’t changing,” she says. “It might be small changes, but they may be changes you need to pay attention to.”

Most states still do not have a tax penalty for individuals who choose to not sign up for a health insurance plan. Exceptions include Massachusetts, New Jersey, Rhode Island, California and Washington D.C., which do penalize the uninsured.

[READ: What Is a Health Savings Account?]

I Turn 65 Soon — I’ll Be Eligible for Medicare, but I Haven’t Enrolled Yet

People who will become Medicare-eligible soon have a different deadline.

When you’re first eligible for Medicare, people turning age 65 can sign up for Medicare during a seven-month window that begins three months before their 65th birthday and ends three months after their birthday month. It’s encouraged not to wait until the last minute to review the Medicare plan options available to you.

“The reason you want to start early is you don’t want any (medical coverage) gap,” Muschler says. “You need to review your options and how you will use your coverage.”

Things to consider:

— Do you have a preferred health care provider or hospital?

— What are your health needs and how much have you spent on healthcare in previous years?

— Will your particular choice of Medicare coverage travel with you if you move?

— Are your medications covered, and how much will you pay out-of-pocket each time you fill them?

— Are there restrictions on where you can fill your prescriptions, and if so, are the plan’s preferred pharmacies close to where you live?

— How has your plan’s coverage changed since last year?

[READ: Everything About Primary Care Physicians vs. Internists vs. Family Physicians.]

Should I Sign Up for the Affordable Care Act Instead?

Not if you’re enrolled in or eligible for Medicare. The Health Insurance Marketplace under the ACA is designed to help individuals not eligible for Medicare access health insurance.

Moreover, it’s illegal for an insurance broker or a health plan to sell you a Marketplace plan if it’s clear that you’re eligible for or are currently covered by Medicare.

[Read: Best Insurance Companies for Medicare Part D Prescription Drug Plans.]

Where Can I Get Information About, and Help With, Signing Up for Medicare?

There are many available resources.

For free personalized counseling services, you can reach out to your State Health Insurance Assistance Program. Find yours at shiptacenter.org.

The Medicare Rights Center also has a national helpline, which can be reached at: 1-800-333-4114.

Don’t forget to consider community resources — such as senior centers — as potential sources of information and assistance when choosing the healthcare plan that best suits you.

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Medicare Fall Open Enrollment: When It Is and How to Prepare originally appeared on usnews.com

Update 10/11/22: This story was previously published at an earlier date and has been updated with new information.

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