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During the Medicare Annual Enrollment Period, also known as the Annual Election Period, you can make changes to your current Medicare coverage. The Medicare Annual Enrollment Period, or AEP, runs from October 15th to December 7th every year.
Changes Allowed During the Medicare Annual Enrollment Period
- Switch from Medicare Advantage back to Original Medicare
- Disenroll from Original Medicare and enroll in Medicare Advantage
- Change from one Medicare Advantage plan to another
- Sign up for a Part D prescription drug plan
- Change from one Part D prescription plan to another
- Cancel your prescription drug coverage
Any changes you make during the Medicare Annual Enrollment Period will take effect on January 1st of the following year.
Why Change Your Medicare Coverage During the Annual Enrollment Period Window
Medicare Advantage and Part D benefits change each year. This means your premiums can increase and your benefits may change. Some common reasons you may want to change your coverage is due to your premiums increasing, the Advantage plan no longer has your doctor in the network of your plan, or the Drug formulary drops your medication off the list of covered drugs.
You’ll receive an Annual Notice of Change in September from your carrier. The ANoC will explain any changes happening to your current policy that will take effect the following year.
If you’re unhappy with the changes shown in your ANoC, you can change your coverage during the Annual Enrollment Period.
What to Consider When Choosing Medicare Coverage During AEP
Did my monthly premiums increase?
Your ANoC explains how your current coverage will change the following year—including whether you’ll see an increase or not in your monthly premiums. Look at the premium for your current plan and compare it with the premium amount shown on your ANoC. A significant increase is a good sign it may be time to shop around for a new plan.
Are my medications still listed on my drug formulary?
A new year can also bring changes to your drug formulary, the pricing tiers that medications are placed in, or the copays required for various types of prescriptions.
In addition, some Medicare Advantage prescription drug plans now require prior authorization for certain expensive brand-name drugs, potentially making it more difficult to get Medicare to cover these medications.
Find out whether your prescription plan will cover your current medications in the upcoming year, and how much you’ll pay for them. If you take expensive medications, it’s a good idea to explore other prescription plans available in your area to see if they have lower copays.
What are my predicted annual medical costs going to be?
Make a list of the doctor visits and procedures you expect for next year. Then estimate what you will pay for them out of pocket with your current Medicare coverage. Add in a years’ worth of premiums and you’ll have a good estimate of what your healthcare will cost you next year.
You can do this same calculation with other Medicare plans you’re considering, to compare the overall cost of one plan to another. This is one of the many things our agents do each year with our clients.
Is my doctor still in my plan’s network of providers?
A new year can also bring changes to your Medicare Advantage plan’s network of doctors. Confirm that your current providers will still be in your plan’s network for the upcoming year. If they aren’t, you will have to change plans or providers or pay much higher out-of-pocket costs to stay with the same doctors and the same plan.
Another option is to switch back to Original Medicare and enroll in a Medigap plan. Although you’ll most likely have to answer questions about your health to enroll, there are no provider networks with Medicare and Medigap. You can see any healthcare provider that accepts Medicare.
Do I plan on traveling anywhere this year?
If you travel frequently, you may delay getting care until you are at your primary home. Make sure your plan has providers and pharmacies near where you live.
If you live in two places or plan to travel out of state, consider a plan with a nationwide network, or go with Original Medicare, which does not have provider networks.
Does my coverage include vision, dental and hearing benefits?
Medicare doesn’t cover routine dental, vision, and hearing services, but some Medicare Advantage plans do. You can also buy dental, vision, and hearing coverage separately. Consider your needs and the available coverage as part of your overall evaluation of Medicare plans.
What are my current plan ratings?
The Centers for Medicare and Medicaid Services has a star rating system to help consumers compare Medicare plans.
Medicare Advantage and prescription drug plans receive an overall star rating of one to five stars—with five being the best—on factors such as customer service, member experience, and member complaints.
Medicare Advantage plans are also rated on preventative care to help people stay healthy, and management of chronic conditions. If your current plan gets low marks, you may be happier with another option.
Your AEP Checklist
Step 1: Make sure you are eligible to make coverage changes
There are many different enrollment periods when it comes to Medicare. Each just as confusing as the other. It’s important to understand what you can and cannot do during each enrollment window. Otherwise, you could make a move that could negatively impact your Medicare benefits forever.
You won’t be eligible to make changes at this time unless you’re within your Initial Enrollment Period or are eligible for a Special Enrollment Period. You’ll need to wait until the General Enrollment Period to enroll in Original Medicare.
Step 2: Decide if your current coverage is what you want
We encourage you to take a deeper look into the coverage you currently have. Think about your health situation, and what you are currently getting the most use out of. Then, try to figure out how you may be able to supplement or reduce your total out of pocket costs.
You may find the SilverSneakers benefit included in your Part D plan that you thought was so great, you never used it. You could save a few dollars in monthly premiums by switching to a different Part D plan that doesn’t include a gym membership.
One of the more common complaints we hear from our clients is how the dental benefits included in some Medicare Advantage plans were not as comprehensive as initially thought. If you attempted to use them this past year, and we’re unhappy with what you ended up spending out of pocket in cost-sharing, you may want to consider disenrolling in your Advantage coverage and going with a Medigap plan and stand-alone dental plan.
Step 3: Contact an agent to compare plans for the upcoming year
This may be considered one of the most important steps. Often times, you may be able to find a lower premium for the same benefits. Or, you may be able to find a plan with more benefits for the same monthly premium you’re paying now. Just like you would compare your car insurance premiums annually, or even semi-annually, you want to do the same with your Medicare coverage. More than likely, there’s an opportunity to save money somewhere, and every penny counts.
Below, we’ll answer some common questions we hear from our clients.
Do my Medigap plan benefits change during the Medicare Annual Enrollment Period?
No, your Medigap benefits do not change like Part D and Medicare Advantage plans do. Your Medigap plan will cover the same benefits from year to year. What may change is your premiums. Rate increases do happen annually, on the anniversary date of your policy. Your carrier sends out a letter the month before your anniversary date that informs you of any premium increases. If you want to compare the same plan with other carriers to see if another carrier offers the same benefits at a lower premium, we can help.
Can I get a Medigap plan if I switch from Medicare Advantage to Original Medicare?
Yes, you’ll have “Trial Rights” to purchase a Medigap plan if you cancel your Medicare Advantage plan and switch back to Original Medicare within 12 months of joining Medicare Advantage.
If you don’t qualify for Trial Rights, you can still apply for a Medigap plan, but the insurance company will take your health into account in deciding whether to issue you a policy and what the monthly premium will be.
If you enroll in a Medicare Advantage plan during AEP, you’ll have another Open Enrollment Period in January to make changes to it if you’re unhappy with those benefits.
When does the Medicare Annual Enrollment Period start?
When does the Medicare Annual Enrollment Period end?
What is the Annual Coordinated Enrollment Period?
What is the difference between the Medicare Open Enrollment Period and Annual Enrollment Period?
How to Prepare for the Medicare Annual Enrollment Period
Our agents are here to help you understand the dos and don’ts during the Medicare Annual Enrollment Period. Our services are 100% free to you. Don’t end up enrolling in a plan you didn’t want, and end up stuck with it under the next AEP. Give us a call today, or complete our online rate form to have one of our agents lookup rates on all Medicare plans available in your area now.