Every fall, Medicare beneficiaries have an opportunity to adjust their selections for the coming year to ensure their health care needs will be met.
It’s important to review your selections annually because “Part D prescription drug plans and Medicare Advantage plans can change their pricing and benefits from year to year,” explains Meagan Dow, a senior strategist within the client needs research team at Edward Jones, a financial services firm headquartered in St. Louis, Missouri.
She adds, “The fall open enrollment period is the chance for enrollees to make sure their coverage still works for them and to comparison-shop to see if there’s a better option.”
What to Know About Open Enrollment
Finding the right Medicare plan to fit your needs, reviewing deductibles and understanding the prescription drug coverage gap (also known as the “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.
[8 Reasons to Switch Medicare Part D Plans]
When Is the Medicare Fall Open Enrollment Period?
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 67 million Medicare recipients, according to the Centers for Medicare & Medicaid Services.
[Read: Medicare Enrollment Deadlines You Shouldn’t Miss.]
What Happens During the Medicare Fall Open Enrollment Period?
During the Medicare fall open enrollment period, beneficiaries are able to:
— Change from a Medicare Advantage plan to original Medicare (known as Part A and Part 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 completely opt out of Medicare prescription drug coverage. (Late penalties might apply if you didn’t sign up for Medicare Part D and don’t have other “creditable” prescription drug coverage when you first became eligible.)
In most states, you aren’t guaranteed the option to switch or join a new Medigap plan during this time.
Changes made during this period go into effect on January 1 of the following year.
Medicare beneficiaries are encouraged to review their Medicare coverage every year during fall open enrollment. At the same time, you can also scrutinize other plan options to ensure you’ve selected the most appropriate plan for your needs.
“If someone is unhappy with their choice of original Medicare, they’ll have the option to switch to a Medicare Advantage plan,” Dow explains.
However, she notes that it can be difficult to switch back to original Medicare with a supplemental Medigap plan once someone has opted for Advantage.
“They should understand all the differences — and not just the benefits touted on commercials and ads — before switching,” she says.
[READ Medigap vs. Medicare Advantage: Which Should You Buy?]
Are There Other Deadlines I Need to Know About?
There is a second open enrollment period from January 1 to March 31 for people already enrolled in Medicare Advantage plans to either change their Medicare Advantage plan or switch to original Medicare.
Dow says she only recommends making the switch back to original Medicare if you’ve qualified for a supplemental Medigap plan.
What Happens If I Miss the Open Enrollment Period?
In most cases, if you don’t enroll in a Medicare plan during the fall open enrollment window, you won’t be able to sign up until the following year.
But there are some exceptions to this rule. For example, you can still enroll if you’ve:
— Lost health coverage
— Moved
— Gotten married
What Do I Need to Watch Out For During Open Enrollment?
Each year, insurance plans can change. Some of these adjustments can include:
— Increases in premium costs and deductibles
— Changes to the medications included in the plan’s prescription drug formulary
— Changes to the list of health care professionals and facilities that are covered or in network
How Can I Find Out What’s Changing in My Plan?
Any planned changes to your coverage will be communicated via an Annual Notice of Change letter. You should receive this letter sometime in September.
Paula Muschler, president of Insurance Branch, a company that advises Medicare beneficiaries on their coverage options, says it’s important to review this information carefully to ensure your coverage still meets your needs.
“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.”
If you’ve reviewed that letter and you’re comfortable with the changes outlined, including any price updates, you can stick with your current plan, Dow says.
However, “it can still be beneficial to compare plans, since there may be a different plan available that’s a better fit,” she notes.
Are There Tax Implications Associated With My Medicare Selections?
Most states still do not have a tax penalty for individuals who choose not to sign up for a health insurance plan. Exceptions include Massachusetts, New Jersey, Rhode Island, California and Washington D.C., which do penalize the uninsured. Vermont residents are required to have health insurance coverage, but there is no penalty if they don’t.
When Can I Start Signing Up For Medicare?
Medicare is the federal health insurance program designed for adults age 65 and older (though some younger people with qualifying disabilities can access Medicare too). You have a seven-month window to enroll around your birthday. That window opens three months before you turn 65 and ends three months after your birth month.
Because finding the right Medicare plan for your needs can take some time, it’s best to get started as early as you can when researching and comparing options.
“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.”
Dow recommends booking a few hours on your calendar in mid-October to sit down and review coverage.
How Can I Best Evaluate Different Plans?
There are many factors to consider when researching your Medicare plan options. When reviewing the various plan options available to you, ask the following questions:
— Does the plan cover your preferred health care providers and facilities?
— What are your health needs, and how much have you spent on health care in previous years?
— Are you planning to relocate? Will your 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 are the plan’s preferred pharmacies close to where you live?
When comparing Part D plans, Dow recommends using Medicare’s plan comparison tool. There, you can type in the medications you take and your preferred pharmacies to check whether they are all in network.
It’s also important to note that Medicare Advantage plans aren’t standardized.
“Provider networks, drug coverage, premiums, deductibles, copays/coinsurance and out-of-pocket maximums vary from plan to plan,” Dow says. “It’s important to do the work upfront to ensure a new plan meets your needs.”
If you’re considering Medicare Advantage, with or without a Part D plan, you can search and review what’s available in your area with U.S. News’s Best Medicare Advantage Plans ratings.
Should I Sign Up for the Affordable Care Act (ACA) Instead?
The Affordable Care Act changed health insurance options in the United States by providing health insurance plans for people who can’t get coverage through Medicare or an employer.
If you’re enrolled in or eligible for Medicare, the Health Insurance Marketplace under the ACA is not for you. And actually, it is illegal for a licensed insurance agent or a health plan to sell you a Marketplace plan if it is clear that you’re eligible for or are currently covered by Medicare.
If you currently have Marketplace insurance, you should sign up for Medicare as soon as you’re eligible. The only time you can choose a Marketplace plan instead of Medicare is if you are ineligible for premium-free Medicare Part A.
Where Can I Get Information About and Help With Signing Up for Medicare?
While wading through your options and choosing the best Medicare plan for your needs can seem complicated and confusing, the good news is that help is available. Contact the following offices for more information and guidance:
— State Health Insurance Assistance Programs. Each state has a SHIP program where you can access free, no-obligation, personalized counseling services. Staffed by highly trained volunteers, these organizations can help you learn more about what’s available locally. Find yours at shiphelp.org.
— CMS. The Medicare Rights Center supports a national helpline, where you can ask questions and get advice on all Medicare issues. You can reach this center at 1-800-333-4114.
— Local resources. Your local senior center and your local Area Agency on Aging can also point you to additional resources to help you make the best Medicare decision for your needs.
— A licensed broker. There are many licensed Medicare insurance agents and brokers across the country who can help. Dow recommends looking for someone who’s independent and sells both Medigap and Medicare Advantage. It’s also wise to look for someone who doesn’t favor only one company’s products.
What Else Should I Know About Medicare Open Enrollment?
There have been some significant changes implemented in the wake of the recently passed Inflation Reduction Act, so Dow recommends being extra vigilant in double checking your options during the open enrollment period.
For example, this law capped out-of-pocket maximums at $2,000 for prescription drug coverage starting in 2025, according to Dow, and many plans are changing their pricing and formularies in response.
So, while it’s wise to review your options every year, “there could be more changes than average to prescription drug coverage this year,” she notes.
More from U.S. News
A Guide to Exercise After Surgery
13 Health Pros and Cons of Aspirin
22 Ways Alcohol Affects the Aging Process
Medicare Fall Open Enrollment: When It Is and How to Prepare originally appeared on usnews.com
Update 10/11/24: This story was published at an earlier date and has been updated with new information.
