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Medicare has been providing vital healthcare to retirees since 1965, and the Medicare Open Enrollment period runs each year from Oct. 15 through Dec. 7. This time frame is an opportunity for those already enrolled in Medicare to update portions of their coverage or totally change it for the coming year.
For those who are also enrolled in a Medicare Advantage Plan, there is a separate Medicare Advantage Open Enrollment period, which runs from Jan. 1 through March 31 each year, during which they can make adjustments to that coverage, too.
Medicare’s Open Enrollment period for 2023 has just begun. Use it to evaluate your current Medicare coverage and determine if you need to make any changes for 2024.
What can you do during Medicare Open Enrollment?
The annual Medicare Open Enrollment period allows those already enrolled in original Medicare or in a Medicare Advantage plan the opportunity to modify or change their coverage for the coming year. Any changes made during the 2023 period will go into effect beginning Jan. 1, 2024.
- Join a Medicare Advantage plan or switch to a different one.
- Move from original Medicare to a Medicare Advantage plan or vice versa.
- Change Medicare Part D drug plans or join one.
What can’t you do during Medicare Open Enrollment?
The annual Medicare Open Enrollment period is not the time to join Medicare; it is designed only for those already in the program. Those who want to join Medicare have their own initial enrollment period, which is a seven-month window surrounding their 65th birthday. This period may be delayed for those who are still working and covered by an eligible employer’s plan—or are covered by a spouse’s plan through their employer.
If you are already receiving Social Security retirement benefits when you turn 65, you don’t have to do anything to join original Medicare. The government will automatically enroll you.
What's available during Medicare Open Enrollment?
Original Medicare consists of Part A, which is hospital insurance, and Part B, which is medical insurance. All recipients must enroll in parts A and B and pay the Part B premium. Those enrolled in original Medicare must also obtain Part D drug coverage as well. One option for those currently enrolled in a Medicare Advantage plan is to switch to original Medicare during the Open Enrollment period. Note that if you already have hospitalization through your employer or your spouse’s, you don’t need to enroll in Part B.
Medicare Advantage is also known as “Part C.” These plans are offered through private insurers and carry the Part A and Part B benefits from original Medicare, but with drug coverage added. Some Advantage plans also offer additional benefits, such as dental and vision coverage. These are not provided by original Medicare.
Medicare Part D
Medicare Part D is prescription drug coverage. Having drug coverage of some kind is mandatory for all Medicare participants. Failure to have it will result in a permanent recurring penalty.
Medicare Supplemental Insurance
Medicare supplement plans, also known as “Medigap plans,” are offered by private insurers to cover some or all of Medicare’s coinsurance and deductible costs, which can run as high as 20%. Medigap policies are only available with original Medicare; they cannot be sold to someone using a Medicare Advantage plan.
Here’s one thing to consider with a Medigap policy: If you enroll within six months of being eligible for Medicare Part B, insurers cannot reject you or charge extra due to a health condition. If you switch plans later on, including moving from Medicare Advantage to original Medicare, there generally are no such protections, though this will vary by state.
How to pick the best coverage
There are a number of factors to consider in choosing the best Medicare coverage options for you.
In reviewing your coverage during the Open Enrollment period, it is a good idea to look at your current plan’s cost. In the case of a Medicare Advantage plan, this will include premiums and any limits on annual out-of-pocket costs. In the case of original Medicare, out-of-pocket costs will include the cost of a drug plan and anything you pay for a Medigap supplemental policy.
If your plan indicates a stiff cost increase for 2024, it can pay to look at other options during the Open Enrollment period.
Medicare Advantage plans generally have a network of approved doctors, hospitals, and other providers. Using out-of-network providers almost always results in higher treatment costs. If your Advantage plan’s network has changed—or if you find that some doctors and providers you need are not covered—it can pay to look at other Advantage plan options.
Original Medicare has no network, and virtually all doctors and hospitals are covered. In some cases this may provide a reason to move from a Medicare Advantage plan to original Medicare during open enrollment.
Changes in your health
If your health situation has changed in the past year, you might find that some of your new doctors and other providers are not covered by your current Advantage plan. This can prompt you to look at Advantage alternatives or even at original Medicare.
Changes in your health might also result in changes to the prescription medicines prescribed by your doctors. This may be a reason to switch Advantage plans or, if you use original Medicare, to seek out a different Part D drug plan.
Best Medicare Advantage plans
The best Medicare Advantage plan is the one that most closely fits your needs. Every plan has some differences, and you will need to evaluate the benefits of each one that you consider. The Medicare.gov website offers this comparison of Advantage plan types.
There are a number of comparisons of Advantage plans available online, including on the Medicare website. Some healthcare companies that are often mentioned include:
- United Healthcare
- Kaiser Permanente
- Elevance Health
- WellCare Health Plans
- Blue Cross Blue Shield
Here are some important dates to be aware of regarding Medicare Open Enrollment.
Medicare Open Enrollment: Oct. 15 to Dec. 7
Existing Medicare enrollees can make a variety of changes to their coverage for the following year.
Medicare changes start: Jan. 1
Changes made during the Open Enrollment period take effect for the new year.
Medicare Advantage Open Enrollment: Jan. 1 to March 31
Those enrolled in a Medicare Advantage plan can make a variety of changes to their coverage.
More on Medicare coverage
How to enroll in original Medicare (Part A and Part B)
Those who have claimed their Social Security benefits by the time they reach age 65 will be automatically enrolled in Medicare parts A and B. This is also the case for those enrolled in Railroad Retirement Board benefits. Those receiving disability benefits from either source will also be automatically enrolled in parts A and B.
For those not receiving Social Security benefits when they turn 65, there is an initial enrollment period that starts three months before their birth month and ends three months after it. In this case you would enroll in Medicare Parts A and B through Social Security or the Medicare website. Note that if you are covered by a qualifying employer health insurance plan or another eligible source, you can delay enrollment in parts A and B until you are no longer covered. Many people may still enroll in Part A, as this coverage is free.
How to enroll in Medicare Part D coverage
Medicare Part D consists of prescription drug plans offered by private insurance companies. Those who are enrolled in original Medicare and have coverage under parts A and B are required to have drug coverage, which they can obtain with a Part D plan.
Enrolling in a Medicare Advantage plan is another way to get prescription drug coverage, as most Advantage plans include it. Again, those enrolled in Medicare must demonstrate that they have creditable drug coverage. If they don’t, they risk paying permanent recurring penalties.
Note that if you are still covered by an employer prescription drug plan through your employer or your spouse’s employer—or through some other plans such via TRICARE or the VA—as you may not need to enroll in Part D. To avoid the penalties, check with Medicare. You need what is defined as “creditable prescription drug coverage.”
How to enroll in Medicare Supplement (Medigap)
Medicare Supplement, also known as “Medigap,” coverage takes care of some or all of the out-pocket-costs you will be responsible for arising from the co-pays, deductibles, and other expenses that may not be covered. Medigap is only available with original Medicare; it cannot be purchased if you are covered by a Medicare Advantage plan.
If you have insurance coverage through an employer, retiree medical coverage, or TRICARE coverage for life through military service, they may take care of some or all of the gaps in original Medicare coverage. If you don’t, a Medigap policy can help cover some or all of the coinsurance associated with original Medicare.
Medigap is issued by private insurers and entails paying a premium. If the policy is purchased within six months of being eligible for coverage under Medicare Part B, there is a guaranteed-issue provision with no penalty for any type of medical condition. After that six-month period insurers in most states can charge a higher premium to those who have certain health conditions or even deny coverage. This is something to consider if at some point you decide to switch from original Medicare to a Medicare Advantage plan or vice versa.
How to enroll in Medicare Advantage (Medicare Part C)
To enroll in a Medicare Advantage plan (Part C), you generally must first be enrolled in parts A and B. You can enroll in a Medicare Advantage plan during your initial enrollment period, during the annual open enrollment period, or during certain special enrollment periods. If you are already enrolled in an Advantage plan, you can change to another one during the Medicare Advantage Open Enrollment period.
Once you’ve decided on an Advantage plan, there are several options for enrolling:
- Look for an online enrollment option on the plan’s website.
- Work with a trusted insurance agent who works with Medicare Advantage plans.
- Contact the plan by phone.
- Contact Medicare at 800-633-4227.
TIME Stamp: The Medicare Open Enrollment period is the time to review your coverage and implement any changes
The annual Medicare Open Enrollment period is an excellent time to review and evaluate your existing Medicare coverage. Whether you use original Medicare or Medicare Advantage, this is when you should look at all aspects of your current coverage to determine whether you need to make some changes or not. These might include:
- Getting Part D drug coverage or changing it.
- Moving to original Medicare from a Medicare Advantage plan.
- Moving from a Medicare Advantage plan to original Medicare.
- Changing from one Medicare Advantage plan to another.
- Adding Medigap coverage to original Medicare.
Healthcare is typically one of the largest expenses for retirees. Whether or not you end up making any changes to your current Medicare coverage, reviewing it in light of your anticipated needs for the upcoming year should ensure that they and it are well matched.
Frequently asked questions (FAQs)
What is the biggest disadvantage of Medicare Advantage?
Perhaps the biggest potential disadvantage of a Medicare Advantage plan is being restricted by its network of doctors, hospitals, and other providers. If you need to use an out-of-network provider, it can prove quite expensive. As many of these networks have a geographic bias, if you plan to travel during the year or have another residence in a different part of the country, you could end up spending a lot of extra money that you wouldn’t be charged by an in-network provider..
What are the rules to have a Medicare Advantage plan?
In order to join a Medicare Advantage plan, you must have Medicare Part A and Part B and live in the plan’s coverage area. People suffering from end-stage renal disease (permanent kidney failure) generally are not eligible to join a Medicare Advantage plan.
What is the initial enrollment period for Medicare Advantage?
The initial enrollment period for Medicare Advantage is the same as for Medicare in general. There is a seven-month window surrounding your 65th birthday, starting three months before your birth month and ending three months after it..
What are the three Medicare enrollment periods?
In addition to your initial enrollment period, there are three to be aware of:
- The annual Medicare Open Enrollment period. Each year brings an opportunity for those already enrolled in Medicare to make changes to their coverage for the following year.
- The annual Medicare Advantage Open Enrollment period. This offers those enrolled in a Medicare Advantage plan the opportunity to make changes in their coverage.
- Special enrollment periods. These cover certain situations that might occur in your life, including relocating to a new address, losing other insurance coverage (such as Medicaid or an employer’s plan), changes in your current plan’s relationship with Medicare, and a number of others.
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