Medicare Open Enrollment - Expert Answers Your Questions

Are you thinking about changing to a different Medicare plan or making changes to your current one?  There are certain rules regarding when you can make these types of changes. This week we have another special post from our Medicare expert, Danielle Roberts.  She is highly qualified to answer your questions about Medicare, how it works and the timing of changes you may want to make.  If you still have questions after reading this post, her contact information is in the sidebar and there is a link to her site in the "About the Author section."

 

Getting Ready for Medicare Open Enrollment

Medicare has several periods each year when beneficiaries can make important plan changes and coverage elections. However, we often find that many beneficiaries are not certain what each of these election periods is for and what they should be doing each year to review their coverage.
  

In this post, we’ll explain the upcoming windows and how you can prepare for them.

 

Medicare Open Enrollment Period vs Annual Election Period

 

Medicare uses the term “open enrollment” for multiple different election periods, so it’s easy to get them confused. We find it easiest if beneficiaries refer to the fall enrollment period as the Annual Election Period (AEP). This helps to keep the election periods straight in your mind.

The Annual Election Period begins October 15^th and goes until December 7^th. There is also a new Medicare Open Enrollment Period for 2019 which will go from January 1^st to March 31^st.  Let’s go over what changes you can make in each period because they are different.

 

Medicare’s Annual Election Period: October 15 – December 7

 

When you enroll in a Medicare Advantage plan or a Part D drug plan, you are locked in for the rest of the calendar year. You must wait until the Annual Election Period to make changes to your plan(s).

During the AEP you can switch from one Medicare Advantage plan to another and you can switch from one Part D drug plan to another drug plan. You can also switch from a Medicare Advantage plan back to Original Medicare and vice versa. 

When you make any of these changes during the AEP, your new plan goes into effect January 1^st of the following year. (If you don’t make any changes to your current plan, your current plan will auto-renew for the next year.)

 

Medicare’s New Open Enrollment Period: Jan 1 – March 31

 

Sometimes people who enroll in a Medicare Advantage plan during the AEP find that they do not like their new plan. It could be that they did not understand their coverage, or it might also be that they learned too late that one of their doctors is not in the network.

In recent years, these beneficiaries would be locked into that plan for the entire year. However, beginning in 2019, Medicare has a new Open Enrollment period from January 1^st to March 31^st that will allow beneficiaries who are enrolled in a Medicare Advantage plan to make a one-time change.

During this OEP, they can change to a different Medicare Advantage plan or they can disenroll from their Advantage plan to return to Original Medicare and elect a new standalone Part D drug plan to go alongside that coverage.

It’s important to note that if you drop your Advantage plan and decide not to enroll in a Part D plan, you can be penalized for the time you go without creditable drug coverage.

Here’s a recap:

The Medicare Annual Election period in the fall is for all Medicare beneficiaries. It is for enrolling in, disenrolling from or changing either your Medicare Advantage plan or your Part D drug plan. The last plan selection that you make prior to December 7^th will become effective January 1^st. 

The Medicare Open Enrollment Period which begins in January only applies to beneficiaries who are enrolled in a Medicare Advantage plan. These beneficiaries can either switch from one Medicare Advantage plan to another or they can switch from a Medicare Advantage plan back to Original Medicare.

You cannot switch from one Part D drug plan to another during the OEP. That’s the main difference between the AEP and the OEP.

 

Your Annual Notice of Change Letter

 

The first step to getting ready for the AEP is to review your Annual Notice of Change (ANOC). Your ANOC is a letter sent to you by your current Medicare Advantage plan or Part D drug plan.

This letter states all changes that your current insurance carrier is making for the following year. It lists changes in monthly premiums, copays, coverage, deductibles, and drug formularies. You will want to review this thoroughly to ensure you make the right decision during the AEP.

 

Medigap Open Enrollment

 

To add to the confusion around the term “open enrollment,” there is also a one-time Open Enrollment period for Medigap plans.

The Medigap Open Enrollment is a one-time window that begins with your Part B effective date. During the six months directly after your Part B effective date, all Medicare beneficiaries have a one-time chance to enroll in a Medigap plan without having to answer health questions. This is a “use it or lose it” enrollment period. Once it has passed, it does not recur again.

This does not mean that later you cannot attempt to change your Medigap plan. In fact, Medicare beneficiaries can apply for new Medigap plans anytime throughout the year. However, unless you live in a specific state with different rules or have a guaranteed issue window because you are leaving employer group health coverage, you will have to answer health questions whenever you apply for a Medigap plan outside of your one-time Medigap open enrollment period. Depending on your answers and your medical record, you could be denied coverage for a new Medigap plan.

 

Get Ready with A Medicare Broker

 

Working with a Medicare broker can take the stress out of the decision making. A broker can evaluate each of your plan options in your area and explain any applicable rules. This will help you have more confidence in your choice.

About Guest Post Author, Danielle Roberts:  This guest post was written by our Medicare expert, Danielle Roberts, one of the co-founders of Boomer Benefits and a frequent contributor to this blog.  As always, we greatly appreciate her willingness to share her expertise and her ability to calmly explain these difficult-to-understand issues in clear terms.

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