What You Need To Know About Medicare’s Annual Election Period and Open Enrollment Period

Most Medicare beneficiaries look forward to Medicare’s Annual Election Period and Open Enrollment Period. However, there are also some who might be new to Medicare and may need clarification on a few issues. 

Each fall we, or at least some of us, look forward to the new Medicare season so we can have the option to change plans with which we are not happy.  Medicare Open Enrollment and Annual Election Period (AEP) are not same as people might suspect.  As a result, many of you will ask, when are they?  What are they?

Medicare’s Annual Election Period is each year from Oct. 15 to Dec. 7. It is the period of time that those people who are on Medicare, and have a Medicare Advantage Plan, can change plans.  Also, those who have original Medicare and a Part D drug plan can change their prescription plan.  If you didn’t enroll in a Medicare Part D plan when you were first eligible, you can do so during the Annual Election Period, although a late enrollment penalty may apply.

During the Open Enrollment Period, which is from January 1st through March 31st, you have the opportunity to make a change to your Medicare Advantage plan regardless of whether you joined a new Medicare Advantage plan during the AEP or simply chose not to disenroll from your current Medicare Advantage plan.

You have a one-time option of changing or leaving your Medicare Advantage Plan during the Open Enrollment Period.

During the Open Enrollment Period, you can:

  • Switch to a different Medicare Advantage plan
  • Drop your Medicare Advantage plan and return to Original Medicare (Part A & B)
  • Apply for a Medicare Supplement plan if you return to Original Medicare (Part A & B)
  • Enroll in a stand-alone Medicare Part D Prescription Drug Plan (only if you return to Original Medicare (Part A & B))

However, you will not be allowed to do the following:

  • Switch from Original Medicare (Part A & B) to a Medicare Advantage Plan
  • Join a Medicare Part D Prescription Drug Plan, if you are on Original Medicare (Part A & B)
  • Switch from one Medicare Part D Prescription Drug Plan to another, if you are on Original Medicare (Part A & B)
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There are many reasons people switch their Medicare plans.

For instance, a particular doctor or hospital may no longer be in the network, a favorite doctor no longer accepts the plan, co-pays have gone up, a specific prescription is no longer covered or quite simply, the health or prescription plan has decided not to participate in Medicare for the upcoming year and the plan will no longer exist. It is important to remember that you need to be careful when choosing your new plan because you will locked into it for a whole year.

Advantage and drug plan providers can make changes each year — things like cost, coverage and which providers and pharmacies are in their networks.

People should always review the materials their plans send them, like the “Evidence of Coverage” and “Annual Notice of Change.” These materials should be received by October 15th.

If your plans are changing, you should make sure the plan will still meet your needs for the following year. If you’re satisfied that your current plans will meet your needs for next year and they are still being offered, you don’t need to do anything.

A few things to consider when looking at plans. A health plan that has no premium may not be the best plan for your situation; it may be for some. Some plans have a large maximum out-of-pocket or deductible. Some plans give you the freedom to choose any provider while others have restrictions.

Switching Medicare Advantage Plans is quite simple. You apply for the new plan and when accepted you will be automatically dropped from the old plan.

You can change a Part D (prescription) plan in exactly the same way. You can call Medicare or go to Medicare.gov, call a plan directly or call a licensed insurance agent to get help figuring out which plans are best for you. The new plans go into effect on Jan. 1 of the new year.

For those folks who want leave their Advantage plan and to go back to original Medicare, they can do so at this time.

Original Medicare doesn’t cover all costs. In fact, there are some sizable “holes” in Medicare’s coverage. But there are some enticing advantages to original Medicare as well.

Many people go back to original Medicare with the intention of getting a Medigap/Supplement to fill in the “Gaps.”

The only concern is that they are generally out of their IEP (Initial Election Period) when they are guaranteed to get any plan they want.

So, in order to add a Medicare Supplement at this time, they will probably need medical underwriting. If they have serious medical issues they may not qualify for a Supplement or they could face pre-existing condition clauses.

So, it may be a good idea to get approved for the Medigap/Supplement before dropping your Advantage plan.

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Medicare’s Annual Election Period and Open Enrollment Period are the times we are given to reevaluate our coverage if we are not happy with our previous choices. Take advantage of this!

Check, reevaluate, ask questions, see if there is a plan that works better for you. It is your responsibility and in your best interest. So, take a second look to make sure you have what is best for you and then sit back, relax and enjoy the fall.

As always, we are happy to help you if you have any questions or want to look at your options. You can speak with one of our licensed agents by calling 1-877-413-1556 or clicking here to schedule a free consultation.

Original Article by Kim Cowles and Mike Reisert

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