During the Medicare Annual Enrollment Period, also know as the Medicare Annual Election Period, you can change to a different type of Medicare plan, switch Medicare Advantage plans, or change your prescription drug coverage.
The Medicare Annual Enrollment Period, or AEP, runs from October 15th to December 7th every year. Watch our video below to learn what you can and cannot do during AEP.
Changes Allowed During the Medicare Annual Enrollment Period
During the fall Medicare Annual Enrollment Period, you can:z
- Switch from Medicare Advantage (Part C) to Original Medicare Parts A and B
- Go from Original Medicare to Medicare Advantage
- Change from one Medicare Advantage plan to another
- Sign up for a Medicare 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 in 2020 will take effect on January 1, 2021.
Medicare Advantage and Medicare Part D plan benefits change each year. This means your premiums can increase and your benefits may change.
You’ll receive an Annual Notice of Change in September, this will explain any changes that are going to impact your Medicare Advantage or Part D plans.
If you’re unhappy with the changes, you can change your plan during the Medicare Annual Enrollment Period.
Some Reasons Why You Would Want to Change Your Plan During the 2020-2021 Medicare AEP
- Your premiums are increasing
- The Medicare Advantage plan no longer has your doctor in your network
- Drug formulary drops your medication off the list of the covered drugs
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.
Medigap Plan Comparison Shopping During AEP
Yes, a lot of beneficiaries like to shop and compare their current Medigap plans during AEP Medicare since they’re already shopping for Part D plans. Your benefits will NOT change annually. However, you’re not given guaranteed issue during the Medicare Annual Enrollment Period when switching Medigap plans. This only applies to Medicare Advantage and Part D plans. This means you’ll have to answer health questions and go through medical underwriting unless you qualify for a Special Enrollment Period.
Switch from Medicare Advantage to Original Medicare
If you are enrolled in Medicare Advantage, you do have additional opportunities to switch your coverage back to Original Medicare. The “Medicare Open Enrollment Period” runs from January 1st to March 31st. During this time, you can switch to another Medicare Advantage plan or back to Original Medicare and pick up Part D and a Medicare Supplement plan instead. Your coverage starts on the first day of the month after you enroll.
You have a right to change from Medicare Advantage back to Original Medicare at any time. As long as it’s within the first 12 months of joining a Medicare Advantage plan.
Difference between Original Medicare and Medicare Advantage
Medicare Advantage plans are also called Medicare replacement policies. These policies will be responsible for providing you coverage, instead of Original Medicare.
Original Medicare includes Part A, for hospitalization costs, and Part B, for other medical expenses. Expenses such as doctor visits, tests, emergency room visits, and outpatient procedures. Medicare does not cover prescriptions. With Original Medicare, you can see any health care provider you want, as long as they accept Medicare.
Many people supplement their Original Medicare coverage with a Medicare Part D prescription drug plan and a Medicare Supplement. Depending on the plan, Medigap may pay almost all your remaining medical and hospital costs.
Medicare Advantage, also known as Medicare Part C, is alternative Medicare coverage. These plans are sold by private insurance companies instead of the government.
All Medicare Advantage plans must offer at least as much coverage as Original Medicare Parts A and B. Many plans offer additional benefits, such as prescription drug coverage.
But unlike Original Medicare and Medigap, Medicare Advantage operates with provider networks. You may be restricted to a certain network of providers.
Or, you may pay more if you see an “out of network” provider than if you see one who is “in-network.” If you choose Medicare Advantage, you cannot supplement your coverage with a Medigap plan.
7 things to Consider When Choosing Medicare Coverage During AEP
1. Cost of Monthly Premiums in 2021
You should receive a document in September from your Medicare Advantage and prescription plans called a Plan Annual Notice of Change.
The notice of change explains how your Medicare plan will be different in 2021—including whether you’ll pay a different monthly premium next year.
Look at the 2021 premium for your current plan and compare it with the amount you’re now paying. A significant increase is a good sign it may be time to shop around for a new plan.
2. Medication Coverage
A new year can also bring changes to your prescription drug plan’s formulary (the list of covered drugs), the pricing tiers that drugs are placed in, or the copays required for various types of drugs.
In addition, some Medicare Advantage prescription 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 2021, and how much you’ll pay for them.
If you take expensive medications, it’s a good idea to explore other prescription plans to see if they have lower copays.
3. Expected Annual Medical Costs
Make a list of the doctor visits and procedures you expect for 2021. Then estimate what you will pay for them out of pocket with your current Medicare plan.
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.
4. Healthcare Providers in the Plan’s Network
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 2021.
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 to traditional Medicare coverage with a Medigap plan. Although you will have to answer questions about your health to enroll in Medigap, there are no provider networks with Medicare and Medigap.
You can see any healthcare provider that accepts Medicare.
5. Doctors and Pharmacies in the Plan
If it’s hard to get to the doctor or the drug store, you may not take the best care of your health. Or, 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 spend a lot of time out of state, consider a plan with a nationwide network, or traditional Medicare, which does not have provider networks.
6. Vision, Dental and Hearing Coverage
Traditional 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.
7. 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. After you consider these 7 things you’re ready to choose Medicare coverage during AEP.
Step 1: Make sure you are eligible to enroll
Verifying that you’re eligible to enroll in a Medicare Advantage plan is a crucial first step.
If you meet the requirements for Medicare eligibility, you’re all set to start the enrollment process when it is available to you.
For Medicare Advantage, you’ll need to be receiving Medicare Part A and Part B.
Get your Medicare Annual Enrollment Period Checklist right now by clicking on the image to download a PDF.
Step 2: Decide if your current coverage is what you need
We encourage you to take a deeper look into the coverage you are currently receiving. 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 take away from your plan. For example, if your only doctor visits this year have been routine appointments, you may consider downgrading your plan.
Step 3: Research how Medicare affects your current insurance
When looking into Medicare plans, it is recommended that you discuss with your provider how your insurance works alongside Medicare. In some instances, Medicare advantage could possibly put your current plan at risk. Confirm that they will work together in the most beneficial way for you before making your decision.
Step 4: Compare costs and review them thoroughly
This may be considered one of the most important steps to finding the perfect coverage for you. Often times, you may be able to find a better and more affordable option for health care coverage.
Remember, Medicare Advantage plans are typically cheaper in cost than the Original Medicare plan. Remember to consider co-pays, premiums, and even deductibles while making your decision.
Step 5: Check physician availability
One thing that is often looked over during the Annual Election Period is the availability of good doctors and hospitals. Most plans will come with a directory of doctors, so be sure you are comfortable with those lists.
If you have completed this Medicare AEP checklist and decided on the best option for you, it’s time to move forward. If you still feel like you could use a bit more information, please feel free to contact us today, and we will help get you set up in the right direction.