Open enrollment is a healthcare term that refers to the period each year when you are able to enroll in a new, or change your existing, health insurance plan.
You can initially enroll in Medicare for a seven month period beginning three months before your 65th birthday, or a set period of time after you become eligible from disability. Or, if you work beyond age 65, you have an eight month special enrollment period after leaving your employer-sponsored plan. These two Medicare enrollment periods are different than Medicare open enrollment.
When is Medicare open enrollment?
Medicare open enrollment happens between October 15 to December 7 annually. Your new Medicare coverage will begin on January 1 next year.
The period is designed to give you plenty of time to select the right plan, while still ensuring enrollees have their new membership cards in hand by the time new plans start.
Mark it in your planner, or set up a recurring Google calendar event. The dates don’t change from year to year.
What is the Medicare open enrollment period?
Medicare plans change from year to year. That means the physicians and pharmacies included in-network, or cost for health coverage might be different. And so do your personal circumstances. Maybe you have a new health condition that comes with a new medication, and that alters your prescription plan needs. Or, perhaps you had surgery recently, and your recovery requires new specialists outside your coverage. Possibly, you have a 2-star plan, and you’ve realized you want to upgrade to a 5-star plan.
“Every year, Part D drug and Medicare Advantage plans can change many things about the coverage,” explains Diane Omdahl, president and founder of 65 Incorporated, a Medicare guidance service. She continues, “Changes that can happen to the Part D prescription drug coverage include”:
- the premium
- its formulary
- the tier of a medication
- the annual deductible
- copayments or coinsurance
- coverage rules (step therapy, prior authorization)
- network of pharmacies
- star ratings
Omdahl explains that Medicare Advantage plans can also change details about coverage of health benefits, including:
- the monthly premium
- the annual out-of-pocket spending limit
- the annual medical deductible
- out-of-pocket costs (copayments, coinsurance, drug costs)
- network of providers
- star (quality) ratings
- optional benefits, such as vision or dental coverage
Open enrollment is the time to make adjustments so your insurance reflects your up-to-date situation. You can switch from Original Medicare to Medicare Advantage, change Medicare Advantage plans, or enroll in a new or change an existing Medicare Part D prescription drug plan.
How do you know if you need to change Medicare plans?
It’s always a good idea to review the materials your current plan sends you to make sure there aren’t any changes that apply to you, such as “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC). If you’ve done that, and you’re happy with your coverage or your needs haven’t changed, you don’t have to do anything during open enrollment.
If your plan is being discontinued, you should receive a non-renewal notice by October 2 from your carrier.
What Medicare plans are available?
You can start reviewing the plan options for open enrollment on October 1. There is a new Medicare Plan Finder tool for 2020, so unless you choose to use the old tool, the site will look a little different. Some of the plans include:
- Medigap plan
- Medigap policy
- Medicare Part A
- Medicare Part B
- Part B premium
- Medicare Part C
- Medicare supplement plan
You can compare coverage options by visiting Medicare.gov or calling 1-800-MEDICARE. You can say agent at any time to speak with a representative. Or, if you’re unsure what to do, there may be a volunteer organization, like SHIP, in your neighborhood that assists seniors in enrolling in the best Medicare plan.
Is Medicare open enrollment the same as ACA open enrollment?
The marketplace for Affordable Care Act healthcare plans also has a fall open enrollment period. These health plans are intended for people who are under- or uninsured, and generally aren’t for people who are eligible for Medicare.
What if you miss initial or open enrollment?
If you didn’t sign up for Medicare during your initial enrollment period and aren’t eligible for a special enrollment period, you can enroll during the general enrollment period from January 1 to March 31 every year, though you may pay a penalty or higher premiums for late enrollment.
As of 2019, you can also switch from Medicare Advantage to Original Medicare or switch to a different Medicare Advantage plan during this time.