Your guide to Medicare open enrollment

The times when changes can be made to your Medicare coverage are called enrollment periods. The most well-known Medicare enrollment period is the Open Enrollment Period, which is in the fall every year from Oct. 15 to Dec. 7. Changes to your plan during this time will be effective on Jan. 1.

What is the Medicare Open Enrollment Period?

During this period, Medicare beneficiaries can change their Part D prescription drug coverage or Medicare Advantage plans. During Open Enrollment, you can do any of the following:

• If you’re on Original Medicare only:
  • Enroll in a Part D prescription drug plan
  • Enroll in a Medicare Advantage plan (Part C)
• If you’re on a Medicare Advantage plan, you can:
  • Switch to another Medicare Advantage plan
  • Drop a Medicare Advantage plan and return to Original Medicare with or without a standalone Part D plan
• If you’re on a Part D prescription drug plan:
  • Switch to another Medicare Part D drug plan
  • Drop your Part D prescription drug plan
  • Enroll in a Medicare Advantage plan

Preparing for Medicare Open Enrollment

During the Open Enrollment Period, there are a few things you need to have handy:

• You should have a list of your prescription drugs, including the dosage and how often you take them.
• Make sure you list any doctors or healthcare providers you want or need to keep.
• You will need your red, white, and blue Medicare Card. Many Medicare beneficiaries enrolled in a Medicare Advantage plan don’t typically carry their Medicare card since it isn’t used at the doctor’s office.
• If you’re also on Medicaid, you may need your Medicaid number.

What if you miss the Open Enrollment Period?

You may not have an opportunity to make changes to your Medicare drug coverage for the following year if you forget or miss the Open Enrollment Period. The only exception will be if you qualify for a Special Enrollment Period (SEP).

Special Enrollment Periods are certain situations that allow you to make a change.Special Enrollment Periods (SEPs) generally last for two months after a qualifying event triggers the SEP. The rules about when you can make changes and the types of changes that you can make are specific to each SEP. 

The most common situations are if you’re moving out of your plan coverage area or getting assistance from the Extra Help program or Medicaid. However, several other situations can trigger a SEP. Contact Medicare or a Medicare community organization if you need help identifying if you qualify.

Medicare Open Enrollment FAQs

How do you know if you need to change Medicare plans?

You may not need to make any changes to your existing coverage. 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 and costs, and your medications remain on your plan’s formulary, or your needs haven’t changed, you don’t necessarily have to do anything during Open Enrollment.

What happens if my Medicare plan is discontinued?

If your plan is being discontinued, you should receive a non-renewal notice by Oct. 2 from your carrier. You will not be automatically enrolled into a new plan unless you have Extra Help. If you do not have Extra Help, you will have two opportunities to enroll in a new plan: during the Annual Enrollment Period and also during a Special Enrollment Period you’ll be eligible for since you lost your Part D coverage. That Special Enrollment Period will last from Dec. 8 to Feb. 28 of the following year. If you are enrolling using the Special Enrollment Period, the start date of the new plan will be the first of the following month that you enroll, so you may have a gap in coverage.

What Medicare plans are available?

In the Open Enrollment Period, all Medicare Advantage and Part D prescription drug plans are eligible for changes this time of year. You can change, add, or drop coverage as long as you must meet the qualifications of the program you want to enroll in. 

You can start reviewing the plan options for Open Enrollment on Oct. 1. There is a Medicare Plan Finder tool that can help. 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 state health insurance assistance program, like SHIP, that assists seniors in enrolling in the best Medicare plan.

Is Medicare’s Fall Open Enrollment the same as ACA Open Enrollment?

No, The ACA Open Enrollment Period is for marketplace health insurance plans for those who are not eligible for Medicare. The Medicare Open Enrollment Period is for Medicare Advantage Plan and Medicare prescription drug coverage. However, the times that these two enrollment periods run are similar.

What is the difference between Medicare Advantage Open Enrollment and Fall Open Enrollment?

The Fall Open Enrollment runs from Oct. 15 through Dec. 7 and can be used by all Medicare beneficiaries no matter what plan they’re currently enrolled in.

The Medicare Advantage Open Enrollment Period begins on Jan. 1 and ends on Oct. 31. This enrollment period is only for Medicare beneficiaries currently enrolled in a Medicare Advantage Plan.

Can you join Medicare mid-year?

You can’t usually join Medicare mid-year unless you qualify for a SEP or are within the eight-month period after losing employer coverage. If you miss your Initial Enrollment Period for Original Medicare, you’ll have to wait until the General Enrollment Period unless you qualify for a Special Enrollment Period.

Is it necessary to enroll in Medicare each year?

Enrollment in Medicare is usually only done once in a lifetime. You can, however, change your Medicare options each year if you choose.

What is the General Enrollment Period for Medicare?

The General Enrollment Period is only for Medicare beneficiaries who missed their Initial Enrollment Period and didn’t qualify for a Special Enrollment Period. For these individuals, they’ll enroll during the General Enrollment Period. The GEP starts on Jan. 1 and continues until Mar. 31, and the Medicare coverage will begin on July 1st of the same year. People who miss Open Enrollment can’t make changes during General Enrollment.

Can you switch back to Original Medicare from Medicare Advantage?

If you are enrolled in a Medicare Advantage Plan and want to return to Original Medicare, you can do so in a valid enrollment period. You can make this change during the Fall Open Enrollment Period, The Medicare Advantage Open Enrollment Period, or a Special Enrollment Period.

RELATED: Original Medicare vs. Medicare Advantage

When can people get information about next year’s Medicare plans?

Information for the following year’s Medicare drug plans (for Part C and D) becomes available on Oct. 1st. This gives 14 days to review the options before the Open Enrollment Period begins.

Is there help for prescription costs with Medicare plans?

Yes! Before enrolling in a Medicare prescription plan, you should compare the plans to find a plan that covers most—if not all—of your prescriptions at an affordable cost. Refer to the plan’s formulary to find this information.

Additionally, you should see if you qualify for the Medicare Extra Help program. This program helps beneficiaries with limited income and resources pay for Part D prescription drug plan costs such as premiums, deductibles, coinsurance, and other costs.

You can also use a free prescription discount card from SingleCare instead of Medicare. These free drug coupons can be emailed, texted, or downloaded and may provide up to 80% savings on prescription drugs.