It’s the most wonderful time of the year! That’s right, Medicare’s annual Open Enrollment Period (you thought I meant the holidays, didn’t you?) Move over sweater weather, turkey and dressing, and time spent with loved ones. Here we are in the middle of that special time of year when current Medicare enrollees can make changes to their existing coverage for the following year. While the complexities of Medicare have been known to make enrollees feel nuttier than your favorite aunt’s fruitcake, we hope to simplify Open Enrollment for those currently enrolled in Medicare and allow you to ring in 2018 feeling confident in your health care coverage.
What is Open Enrollment?
Medicare’s annual Open Enrollment Period (also referred to as Fall Open Enrollment) extends from October 15th through December 7th and allows enrollees to make changes to their coverage for the coming year.
Changes Allowed During Open Enrollment
The chart below summarizes the coverage changes that are allowed during Open Enrollment. Note that any changes made during Open Enrollment will not become effective until January 1, 2018.
|Current Coverage||New Coverage|
|Original Medicare||→||Medicare Advantage|
|Medicare Advantage||→||Original Medicare|
|Part D||→||A different Part D plan|
|Medicare Advantage||→||A different Medicare Advantage plan|
If you have been unable to acquire a standalone Part D plan or drug coverage through a Medicare Advantage plan because you did not enroll in drug coverage when you should have, note that during Open Enrollment you can also acquire prescription drug coverage for the first time.
Important: Proceed with caution if you are considering a change from a Medicare Advantage plan to Original Medicare and also plan to enroll in a Medicare Supplement Plan (also referred to as Medigap). Those who enroll in a Medicare Supplement Plan during their initial enrollment period (i.e. within six months of enrolling in Medicare Part B) are allowed to enroll in a Supplement plan without underwriting. However, applying for a Supplement plan after your initial enrollment period has passed could subject you to higher premiums, waiting periods, or a denial of coverage based on pre-existing health conditions.
Reviewing Your Current Coverage
If you have a Medicare Part D or Medicare Advantage Plan, you should have received a Plan Annual Notice of Change from your plan provider in September. The Notice details information about your plan for the coming year, such as changes to premiums, coinsurance, or prescriptions drugs covered under the plan’s formulary. You should review the Notice to understand how changes to the plan will affect you. Even if you feel that your current coverage will continue to meet your needs in the coming year, it may still benefit you to research other available plans. You may find that changes made to another plan would result in even better coverage for you.
Researching Other Plans
Prior to your search, gather information pertinent to your health care needs that will assist you in evaluating other plans. Prepare a list of health care providers, preferred hospital, preferred pharmacy, and drugs that you currently take (including specific drug names, dosage, and frequency).
Medicare’s Plan Finder tool will allow you to search for standalone Part D and Medicare Advantage plans (referred to as Medicare Health Plans on the site) with or without drug coverage that are available in your area. You should also input your specific prescription drug information to identify plans that cover the drugs that you take. When reviewing plans, consider factors such as premiums, deductibles, coinsurance costs, and whether or not your health care providers are included in the plan’s network (if searching for Medicare Advantage Plans).
The Plan Finder will also provide each Part D or Medicare Advantage plan’s star rating out of five stars. The ratings are provided by the Centers for Medicare and Medicaid Services (CMS) and are based on five criteria that include customer service and member experience.
If you identify a plan or plans that may better suit your needs, it is best to contact the plan directly to confirm the information found on the Plan Finder site prior to enrolling. You can enroll in a Medicare Advantage plan or Part D plan via the Plan Finder web site, or via telephone by calling the plan, or by calling Medicare at 800-Medicare (800-633-4227).
Finding Extra Help
You can visit Medicare.gov for more information or call Medicare’s toll-free help line at 800-Medicare (800-633-4227) for additional information. Each state also has a State Health Insurance Assistance Program (SHIP) with counselors who are available to provide free, one-on-one assistance to Medicare beneficiaries and their families. Visit www.shiptacenter.org to search for contact information for your state’s SHIP.
If you decide not to make any changes to your coverage, you do not have to take any action and will be automatically re-enrolled in the same coverage for next year. If you do decide to change plans, it is not necessary to contact your Medicare Advantage or Part D plan provider or Medicare to notify them that you are cancelling your existing plan. You will be automatically disenrolled in your current Medicare Advantage or Part D plan before your new coverage becomes effective on January 1st, 2018.