Medicare Open Enrollment Period
The Medicare Open Enrollment period, also known as Medicare Annual Election period, runs from October 15th through December 7th of every year. This is the one time during the year when all Medicare enrollees can make changes to both their health plans and prescription drug coverage. If you have changed the medications you take or have been diagnosed with a new medical condition you may want or need to change your current Medicare plan to better meet your specific medical needs and potentially help you minimize your out-of-pocket costs. Applications for a change in coverage must be received by December 7th and these changes will go into effect on January 1st. During the Medicare Open Enrollment Period, enrollees can:
- Switch to a Medicare Advantage plan from Original Medicare (Part A & B). This change can be reversed through February 14th
- Enroll in a Medicare Part D (prescription drug) plan
- Switch enrollment from one Medicare Part D plan to another Part D plan
- Switch from a Medicare Advantage plan to another Medicare Advantage plan
- Switch from a Medicare Advantage plan to another Medicare Advantage plan that includes prescription drug coverage (MAPD)
- Switch from a Medicare Advantage plan that includes prescription drug coverage to a Medicare Advantage plan that does not include prescription drug coverage
- Switch from a Medicare Advantage plan back to an Original Medicare plan
- Completely disenroll from a Medicare Part D plan
Making changes to your plan during the Medicare Open Enrollment Period is not mandatory and coverage will renew from year to year automatically unless you disenroll. The federal government’s rating system for Medicare plans allows plans with a five-star rating to add beneficiaries at any time during the year. Those who want to switch to a five-star plan are not required to wait for the open enrollment period to begin in order to do so.
Medicare Advantage Disenrollment Period
There is a separate Medicare Disenrollment Period (MADP) which spans from January 1st to February 14th. During this period you may:
- Leave your current Medicare Advantage plan and switch back to Original Medicare. Your coverage begins the first day of the next month
- Once you have switched back to Original Medicare you will have until February 14th to join a prescription drug plan (Part D). Coverage starts the first day of the next month after the plan receives your enrollment form.
Please note that during this period you may not do the following:
- Join, switch, or drop a Medicare Medical Savings Account plan
- Switch from Original Medicare to a Medicare Advantage plan
- Switch your current Medicare Advantage plan to another Medicare Advantage plan
- Switch your current Medicare prescription drug plan to another Medicare prescription drug coverage
Medicare plans and costs can change annually. In 2013, seven of the top 10 available Medicare plans raised drug costs by over 10% while the number of plans that offer discounts through preferred pharmacies increased. In some cases, the costs of monthly premiums may not increase noticeably from year to year but this does not mean that co-pay prices will stay the same. An annual review of your current Medicare plans is the ideal way to minimize premium and out-of-pocket costs as well as personalize your health coverage.
Frequently Asked Questions (FAQ)
I missed the Medicare Open Enrollment Period, can I still sign up?
There are also “special enrollment periods” outside of the annual enrollment period for people whose circumstances qualify them. For example, a Medicare beneficiary who moved to a new region where her Medicare Advantage plan does not have covered healthcare providers would be eligible for a special enrollment period. To see more information on special enrollment periods and check if you may qualify, visit our special enrollment period page.
Can I sign up for Medicare if I am about to turn 65 or just turned 65 and my birthday falls outside of the Medicare Open Enrollment Period?
People who are turning 65 also have an “initial enrollment period” also known as an initial coverage election period (ICEP). Since they are newly entering the Medicare system and Medicare allows them more time to make insurance coverage decisions. With respect to Medicare Advantage and Medicare Part D plans, a person turning 65 can enroll any time beginning with the third month before the month of his or her 65th birthday to the third month after the month of his or her birthday. This provides new Medicare beneficiaries a 7-month window to enroll.
During the Medicare Open Enrollment Period can I enroll in Original Medicare on Healthcare.gov or my state’s exchange and qualify for subsidies?
No, these health insurance exchanges are not for Medicare beneficiaries. They are intended for individuals under the age of 65 who may or may not qualify for subsidies to help them afford health care coverage. Premium subsidies are not available to Medicare beneficiaries. However if you have limited resources and income you may qualify for Extra Help.
What should I do if I forgot to sign up for Original Medicare during my initial enrollment period?
You can still enroll in Original Medicare during the General Enrollment Period which spans from January 1st to March 31st each year. However, your coverage will not start until July 1st and you may have to pay a higher premium for Part A and/or Part B for enrolling late.
If I am happy with my current Medicare plan, is there anything I need to do during the Medicare Open Enrollment Period?
Your current plan choice will continue next year but as mentioned before, Medicare plans can change from year to year. For example, the cost of your plan may increase or decrease and prescription drugs can be added or removed from your plan’s drug formulary (list of covered drugs). Some Medicare plans can change their benefits or narrow their network and stop offering coverage in certain locations. Insurers are required to provide advance notice of significant plan changes but because they determine which changes qualify as significant, it is wise to check your current plan’s details during Medicare Open Enrollment Period to make sure it meets your specific health care needs and if necessary, you can switch to another plan that better suits you.
How does the Medicare Open Period affect me if I am a dual eligible and I qualify for both Medicare and Medicaid?
Unlike regular Medicare beneficiaries dual eligibles can change their Part D plan at any time during the year. They can also switch to a Part D different benchmark plan or to a non-benchmark plan although enrolling in the latter requires a monthly premium. However, a non-benchmark plan may suit you better depending on your specific medication needs. If you are a dual eligible on a special needs plan you qualify for a special enrollment period which allows you to change your plan at the beginning of each month.
When can I join a health or drug plan? http://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html
Understanding Medicare Part C & D Enrollment Periods (October 2012) https://www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf