Medicare Annual Enrollment Period: What You Need to Know and Do October 15 – December 7

The Medicare Annual Enrollment Period is almost here again!

Every year from October 15 through December 7, Medicare plans take over advertising everywhere. It’s impossible to ignore, but it isn’t always clear what the Annual Enrollment Period means for you.

In this video, we’re going to go through what you should do every year during the AEP, what you can do if you choose, and which Medicare plans are not affected by the Annual Enrollment Period.

Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To… ​

The Medicare Annual Enrollment Period(AEP) occurs every year from October 15 through December 7 and applies to Medicare Advantage plans and Medicare Part D plans but NOT Medicare Supplements, also known as Medigap policies.

First, what should you do during the Annual Enrollment Period?

If you are in a Medicare Advantage Plan or a Part D plan, you will receive an Annual Notice of Change by September 30. Take a little time to review the changes that your plan is making for the new year. Although the whole packet from the insurance company may be huge, there is usually a clear summary of changes document that is a good place to begin. 

If the changes for the new year don’t affect you, you can stay in the plan by doing nothing during the Annual Enrollment Period from October 15 through December 7. Your coverage will continue in the new year.

However, if you find yourself in this situation, it’s always a good idea to look at all plans being released in your area to see if any of them would be a better fit for you than your current plan, since they all can change every year.

If your current plan’s changes will affect you negatively, you should definitely plan to look at other options in your zip code during the AEP.


What to look for in your Annual Notice of Change:

If you have a standalone Part D plan, check the monthly premium, the annual drug deductible, pharmacy network (Is your pharmacy still in network?), and your medications (Did the Tier level or copay change for any? Are there any new restrictions on your medications?)

If you have a Medicare Advantage plan, check the monthly premium, any deductible amounts, the out-of-pocket maximum for the year, provider networks (Are your doctors staying in the network?), and copay and coinsurance amounts for medical services you routinely use or expect to use in the upcoming year.

If you are in a Medicare Advantage plan that includes Part D drug coverage (an MAPD plan), you’ll need to look at all of the above in your Annual Notice of Change.


Talk to your medical providers:

Communicate with your doctor’s office. Some doctors and medical practices change networks from year to year or decide to only accept certain types of Medicare plans for the new year. If your doctor is doing this, you need to know during the AEP.

Next, what can you do during the Annual Enrollment Period?

1. Switch from one Part D plan to another.
   
   This is very common and easy to do. Part D plans can change every year, so the one you enrolled in a year ago, or five years ago, or ten years ago, may no longer be your best option. Enrollments are handled online or over the phone and are quick and simple.
   
2. Switch from one Medicare Advantage plan (either MA or MAPD) to another Medicare Advantage plan.
   
   If changes to your current plan will negatively impact you, or if changes to other plans make those a better option than your current plan, it’s easy to enroll in a new Medicare Advantage plan for the new year.
   
3. Switch from a Medicare Advantage plan that has Part D prescription drug coverage to one that does not.
   
   If you have creditable prescription coverage from another source, this may be a good option for you. If you don’t have creditable drug coverage, this is not a recommended action.
   
   If you enroll in a Part D plan or Medicare Advantage plan with drug coverage later, you will pay the late enrollment penalty for the entire time you were without creditable drug coverage.
   
4. Switch from a Medicare Advantage plan that doesn’t include Part D prescription drug coverage to one that does.
   
   In this case, you will need to provide proof of creditable drug coverage to avoid paying the Part D late enrollment penalty.
   
5. Switch from Original Medicare with a Medicare Supplement and Part D plan to a Medicare Advantage (MAPD) plan.
   
   If the new Medicare Advantage plans are a better fit for your situation than your current coverage of Original Medicare plus a Medicare Supplement and Part D plan, you can drop your Medicare Supplement and Part D plan and enroll in a Medicare Advantage plan with Part D coverage included during the Annual Enrollment Period.
   
   If you choose this option, your standalone Part D plan will be automatically canceled, but you will need to request that your Medicare Supplement company end your coverage on December 31.
   
6. Leave a Medicare Advantage plan and return to Original Medicare.
   
   If no Medicare Advantage option for the new year works for you, you can leave your Medicare Advantage plan and return to Original Medicare, Parts A and B, during the Annual Enrollment Period.
   
   However, be aware that you may not be able to purchase a Medicare Supplement plan to cover the gaps in Medicare Parts A and B.
   
   More on that in a moment. Stay tuned.
   
7. Enroll in a Part D plan.
   
   If you are leaving a Medicare Advantage plan to return to Original Medicare, you can enroll in a standalone Part D plan during the AEP.
   
8. Drop Part D coverage.
   
   During the AEP, you can drop your standalone Part D plan. This may be beneficial if you or your spouse has coverage through an employer that provides creditable prescription drug coverage that makes your Part D plan unnecessary.
   
   Be sure what is provided is creditable coverage before dropping a Part D plan so you don’t end up having to pay a late enrollment penalty later if you enroll in a Part D plan down the line.

Those are the things you can do during the Annual Enrollment Period. Whether you make any of those changes on October 15 or December 7 or any day in between, plan changes all become effective on January 1.

One note: generally, you can’t enroll in both a Medicare Advantage plan and a standalone Part D plan at the same time. The only exceptions to that are some Private-Fee-for-Service plans, Medical Savings Account plans, Cost plans, and certain employer-sponsored Medicare health plans.

Finally, what Medicare plans are not affected by the Annual Enrollment Period?

Medicare Supplements, also known as Medigap plans do not fall under the Annual Enrollment Period. These are much older plans that follow different enrollment rules.

You can change your Medicare Supplement plan any time during the year. However, in most states, and under most circumstances, you will have to answer health questions and provide a list of your medications and pass underwriting in order to be able to purchase a new plan.

There are exceptions based on state laws, and there are some guaranteed issue Medicare Supplement companies that accept everyone age 65 or older who has Medicare Parts A and B, but don’t assume that if you leave a Medicare Advantage plan and return to Original Medicare during the AEP that you will be able to purchase a Medigap plan. That’s definitely something to look into before leaving your Medicare Advantage plan.

The health questions for Medigap underwriting do vary from company to company, so a broker will be able to assist you in finding a company that is likely to accept your application, if at all possible.

If you are thinking of leaving your Medicare Advantage plan during the AEP and want to purchase a Medicare Supplement plan, start the process early. If you apply for a Medigap plan on October 15 with a January 1 effective date, which is the earliest you can leave your Medicare Advantage plan, you should have an answer with plenty of time left in the AEP to apply to a different Medigap company if necessary.

What if you have a Medicare Supplement plan you’re happy with?

Medicare Supplement plans are guaranteed renewable as long as you pay the premium, and they do not change benefits from year to year. You do not need to do anything during the Annual Enrollment Period if you want to keep the Medigap plan you have.

If you have questions about your Medicare coverage and what you should do during this year’s AEP, feel free to give our office a call at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation. We’re here to help you have a stress-free AEP and make sure you are in the best Medicare plan for your unique situation.