Every year, Medicare beneficiaries have from October 15 through December 7 to make necessary changes to their Medicare coverage.
The Medicare Annual Enrollment Period (AEP) runs from October 15 through December 7. If you are a current Medicare beneficiary, this is your yearly opportunity to make changes to your Medicare coverage.
Your AEP options include joining a Medicare Advantage (MA) plan, switching to a new MA plan, and returning to Original Medicare (Parts A and B). You can also join or leave a Medicare Part D prescription drug plan during Annual Enrollment. But what happens if you don't make any changes to your Medicare coverage?
Do You Have to Change Your Medicare Plan During Annual Enrollment?
Although we recommend you at least compare your Medicare plan options during AEP, you do not HAVE to change your current plan.
Every health insurance and prescription drug plan changes at least a little from year to year. Prices go up or down. Healthcare providers leave and enter networks. Drug formularies changes. New plans become available and some plans are discontinued. And, of course, your own healthcare needs may change from one year to the next.
Please note that, if you do not make any changes during Annual Enrollment, your current coverage simply carries over into the following year. Unless you have an Advantage plan that is ending (if so, your plan should have notified you). In that case, if you don't choose a new MA plan, you will most likely be placed back into Original Medicare.
Do You Need to Change Your Medicare Coverage?
Choosing the best health insurance plans can feel so overwhelming that you may be tempted to just ignore the annual election period and hope for the best. Unfortunately, that can cost you in terms of both cash and your health. That's why we're breaking down what you need to look at to compare your options and get the best Medicare coverage for your unique needs and budget.
Start by considering your current needs as well as changes you expect next year. Of course, you don't have a crystal ball (probably). But answering the following questions may help:
- Has your income changed over the past year, or do you expect it to change next year? For example, did you or your spouse retire last year, or do you plan to retire soon?
- Did you receive any new diagnoses from your doctor?
- Has your doctor prescribed any new medications?
- Has your doctor talked to you about scheduling any procedures in the coming year?
- Do you have a chronic condition that is worsening? Or has your doctor warned you that you are in danger of developing a chronic condition, such as diabetes or heart disease?
Understanding your healthcare needs is the first step to determining whether it's time to make a change to your Medicare coverage.
Review Your Current Medicare Coverage
Before Annual Enrollment begins, Medicare Advantage and Part D plans send beneficiaries two documents: The Annual Notice of Change (ANOC) and Evidence of Coverage (EOC). Between them, these documents describe your plan's benefits and costs for the coming year. This includes:
- Cost-sharing changes, including premiums, deductibles, and copayments or coinsurance
- The drug formulary for your prescription drug plan
- Pharmacy networks
- Provider networks
To ensure you receive the ANOC and EOC notifications, you must keep your mailing address up-to-date. In addition to updating your Medicare plan, check your MyMedicare.gov and my Social Security accounts to be sure they have the correct contact information. If you do not have these accounts, we highly recommend creating them as soon as possible. It takes only a few minutes and is the easiest way to keep track of your Medicare and Social Security information.
Does Your Current Medicare Coverage Meet Your Needs?
Now that you know what you need and what your Medicare plan offers, it's time to compare them. Check the following to see whether your plan covers your current and expected healthcare needs:
- Does the network include your healthcare providers? This may include doctors, labs, pharmacies, hospitals, clinics, and durable medical equipment (DME) suppliers.
- Do your providers accept your plan? Just because a provider is in your plan's network does not mean that that provider accepts your plan – or is accepting new patients.
- If your plan covers out-of-network providers, do they accept your plan?
- Does the drug formulary include your prescriptions?
- If you have secondary coverage, does your plan work with it?
Some items may be less "make or break" than others. For example, many people are willing to switch to a new primary care doctor for an otherwise ideal plan. Only you know what your make or break items are.
Do You Like Your Current Medicare Plan?
Sometimes a plan seems great on paper but just doesn't seem to work. Maybe there are too many hoops to jump through, or the preferred pharmacy network means you have to drive 20 minutes every time you need to fill a prescription.
Answer the following questions:
- Can you get ahold of your providers and pharmacy when you need to?
- Does your Part D plan offer alternative methods to fill prescriptions, like mail order pharmacy or 90-day supplies?
- Does your plan have an online resource library so you can easily answer questions?
- Is it easy to fill a prescription?
But here's the most important question: Would you recommend your plan to a friend? If the answer is, "No," then it may be time to find a different plan.
How Much Does Your Current Medicare Coverage Cost?
Medicare costs include deductibles, premiums, copays, and coinsurance. The Annual Notice of Change will reveal what you can expect to pay for your Medicare plan in 2021.
To understand the full cost of your Medicare coverage, you need to look beyond monthly premiums. A rock-bottom premium often hides higher out-of-pocket costs elsewhere.
Most beneficiaries do not pay a monthly premium for Medicare Part A. However, if you or your spouse did not pay the Medicare payroll tax for 10 years (40 quarters), the Part A premium is $506 in 2023. Other Part A costs include the $1,600 deductible for each benefit period, which begins the day you're admitted as an inpatient and ends once you go 60 consecutive days without receiving inpatient care.
The standard Medicare Part B premium is $164.90 in 2023. There is also an annual deductible of $226. Once you reach your Part B deductible, you usually pay a coinsurance of 20 percent of the Medicare-approved amount for covered services.
Medicare Part C (commonly known as Medicare Advantage) and Medicare Part D plans are sold by private insurance companies. Prices vary according to which plan and insurance provider you choose. However, even if you have a Medicare Advantage plan, you still owe the monthly Part B premium.
Please note that, if you qualify for both Medicare and Medicaid, you're automatically eligible for Extra Help. This Medicare program helps cover your prescription drug costs. Learn more here.
Our Find a Plan tool makes it easy to compare your Medicare coverage options. Just enter your zip code to start reviewing Medicare plans in your area.
Can You Sign Up for Medicare During Annual Enrollment?
No, Medicare Annual Enrollment is only for current Medicare beneficiaries.
If you are within 3 months of your 65th birthday, you are still within your Initial Enrollment Period (IEP). This begins 3 months before the month you turn 65 and ends 3 months after the month of your birthday. So, if you turn 65 on October 22, your IEP begins July 1 and ends January 31. If your birthday is on the 1st of the month, your IEP begins and ends one month earlier (June 1 through December 31 if your 65th birthday falls on October 1).
You can check Medicare eligibility by calling 1-800-MEDICARE.
Your IEP is also the best time to join a Medicare Supplement plan, commonly known as Medigap. Once you are both age 65 or older AND enrolled in Original Medicare, your 6-month Medigap Open Enrollment Period begins. During this time, you cannot be denied Medicare Supplement Insurance or charged a higher rate, even if you have preexisting medical conditions.
Medigap plans are only available to people enrolled in Original Medicare. If you have a Medicare Advantage plan, you cannot also sign up for Medigap.
If you aren't already enrolled in Medicare when AEP happens, you may do so during the General Enrollment Period. This also runs from January 1 through March 31. However, your only option during General Enrollment is signing up for Medicare Part A and/or Medicare Part B. Once you've done that, you have from April 1 through June 30 to join a Medicare Part C and/or a Medicare Part D plan.
Changes made during General Enrollment take effect on July 1.
What Happens If You Miss Annual Enrollment?
Although Annual Enrollment lasts for 8 weeks, many Medicare beneficiaries either forget to act or don't realize the annual election period has come and gone. Never fear. You may still be able to make changes to your Medicare coverage.
The Medicare Advantage Open Enrollment Period (OEP) occurs every year from January 1 through March 31. If you currently have a Medicare Advantage plan, you may use Open Enrollment to either switch to a new MA plan or return to Original Medicare. In addition, if making that change causes you to lose your prescription drug coverage, you may also sign up for a Medicare Part D plan.
Medicare also offers Special Enrollment Periods (SEPs) to beneficiaries who experience certain life changes, such as moving outside their plan's service area or losing their current coverage. There are dozens of ways to qualify. You can find the full list on Medicare.gov
Create Your My Social Security Account
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Log Into or Create Your My Medicare Account
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Find Your Level of Extra Help (Part D)
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Special Circumstances (Special Enrollment Periods)
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How to Avoid 10 Costly Medicare Mistakes
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