Medicare’s open enrollment period—Oct. 15 through Dec. 7—is fast approaching. Every year this window of time gives you the opportunity to change your Medicare coverage. In most instances, it’s the only time each year you have this chance. If you do enroll in or change your coverage during open enrollment, your new plan’s effective date will be Jan. 1 of the upcoming year.
Here’s what you need to know as you prepare for another year of Medicare coverage.
(As you read, if you run into new or forgotten terminology, check out our new health care glossary.)
How do I know if I need to take action?
Consider your health care experience for the last year. What did you learn? What needs addressing? If your current plan no longer meets your needs or you are otherwise unhappy with it, you will likely want to consider looking at other options during Medicare’s open enrollment period. But even if you’re happy with your current plan, things can change at this time each year. Make sure you know whether your plan will change.
In the weeks approaching the enrollment period, keep an eye out for any notices from your current insurance company. Closely review any correspondence for mention of possible changes to your plan, which can include plan costs, benefits and rules for the upcoming year.
Plans can also change their formularies, which indicate what prescription medications are covered by the plan and any restrictions—such as prior authorizations, quantity limits and step therapies. If you are enrolled in a Medicare Advantage plan, the physician network could change as well, meaning physicians who are in-network for you this year, might not be covered next year.
What options do I have?
If you decide you want to change, your options will generally depend on your current plan.
- If you are enrolled into Original Medicare (parts A and B) with a stand-alone Part D, prescription drug plan (PDP), your options are: to switch to another PDP with your current company, to a new PDP with another company, or to a Medicare Advantage plan.
- If you are enrolled into a Medigap plan (also known as Medicare supplemental plans) and choose to switch to Medicare Advantage, you will no longer be able to keep your Medigap plan. Medigap plans have strict enrollment guidelines and are not included in the enrollment period for Medicare.If you decide to drop your Medigap plan, note that you may not be able to enroll into another Medigap plan in the future. This depends on your specific situation, your age and where you live—as states have different rules when it comes to Medigap plans.
- If you are enrolled into a Medicare Advantage plan, your options are to enroll into a plan with another company, or to enroll into a different plan with the same company. If you are unhappy with the Medicare Advantage plan benefit structure, you have the opportunity to switch back to Original Medicare (A and B). If you choose to do so and you still need prescription drug coverage, you would need to enroll in a stand-alone PDP during open enrollment as well.
- If you are happy with your current plan(s) and feel that the coverage is still meeting your needs and therefore choose to keep your plan(s) as they are, you do not need to take any action. However, it is important to verify that your plan will be offered in your area for the upcoming year.
What do I need to do to enroll?
To view the available plans in your area during open enrollment, visit medicare.gov. The Medicare website will provide you with a list of all plans being offered based on your zip code, and also allows you to filter your search results to find plans that best meet your needs. Some of the filter options include: setting maximum plan premium and deductible amounts, showing only plans that cover all of your medications, selecting plans with certain overall star ratings, and more.
When viewing plans, it is important to verify that your needs, both current and anticipated, are met. You can access plan details on the Medicare website, the specific plan websites or by calling the plan directly. Here are some things you may want to consider:
- What plan premium can you afford?
- Does the plan have a deductible? Is it affordable?
- Are you comfortable with the copay and/or coinsurance amounts?
- Are your medications covered?
- Are there any restrictions on your medications? Do they meet your needs?
- If looking at Medicare Advantage plans, you should also consider:
CVC knows that navigating plan options can be overwhelming and confusing and we are happy to help you with this process by preparing plan comparisons for you to review, and answering any questions you may have.
Once you have made your decision and selected a plan you feel best meets your needs, you must enroll before the Medicare open enrollment period closes on Dec. 7. You can do so at medicare.gov, by calling 1-800-MEDICARE or by contacting the plan directly.