Every fall, people with Medicare have an opportunity to review their health coverage and decide whether it still meets their needs. This time of year is known as the Medicare Annual Enrollment Period (AEP), also called Medicare Open Enrollment.
Whether you're happy with your current coverage or considering a change, understanding your options can help you make an informed decision about your healthcare for the coming year.
The Medicare Annual Enrollment Period runs from October 15 through December 7 each year. Any changes made during this period generally take effect on January 1 of the following year.
You don't necessarily need to change your coverage every year. However, taking time to review your options can help you understand what's covered, what your healthcare may cost, and whether your current plan continues to meet your needs.
Here are five important things to keep in mind during Medicare AEP.
1. Know What You Can Change During Medicare AEP
The Annual Enrollment Period gives you an opportunity to make certain changes to your Medicare coverage. The options available to you depend on your current coverage and eligibility.
During this period, you can generally:
- Switch from Original Medicare to a Medicare Advantage plan.
- Switch from a Medicare Advantage plan back to Original Medicare.
- Change from one Medicare Advantage plan to another.
- Join, change, or drop a Medicare prescription drug plan if you have Original Medicare.
- Make certain changes to prescription drug coverage associated with a Medicare Advantage plan.
It's important to understand how these options work before making a decision. For example, returning to Original Medicare may mean you need to consider separate prescription drug coverage. You may also want to explore Medicare Supplement Insurance (Medigap), which has its own eligibility and enrollment rules.
The takeaway: Start by understanding your current coverage and the changes you're eligible to make. You can explore your options without automatically deciding to switch plans.
2. Review Your Coverage for the Upcoming Year
Your Medicare coverage may change from one year to the next, even if you keep the same plan. Monthly premiums, deductibles, copayments, covered services, and prescription drug costs can all affect your healthcare expenses.
If you're enrolled in a Medicare Advantage or prescription drug plan, review two important documents your plan sends you:
- Annual Notice of Change (ANOC): Explains changes to your plan's costs, benefits, coverage, and other details for the upcoming year.
- Evidence of Coverage (EOC): Provides detailed information about what your plan covers, what you pay, and the rules you need to follow.
Pay attention to changes that could affect your everyday healthcare needs. A plan that worked well for you this year may have different costs or coverage next year.
If you don't receive these documents or have questions about what they mean, contact your plan for assistance.
The takeaway: Don't assume your coverage will stay exactly the same. Review the details so you know what to expect in the new year.
3. Check Your Doctors, Hospitals, and Prescription Medications
Access to the healthcare professionals and medications you rely on is an important part of choosing coverage.
If you have a preferred primary care provider or see specialists regularly, check whether they're included in a plan's provider network. You may also want to verify that nearby hospitals and pharmacies are available under the coverage you're considering.
For prescription medications, review your plan's formulary, which is its list of covered drugs. Check whether your medications are covered and whether their costs, restrictions, or coverage requirements will change.
Keep in mind that provider networks and prescription drug coverage can vary by plan and location. Don't assume that a doctor, pharmacy, or medication covered by one plan will be covered the same way by another.
Before enrolling in a different plan, contact the plan directly and confirm the details that matter most to you.
The takeaway: Make a list of your doctors, specialists, pharmacies, and prescription medications before comparing coverage. This can help you focus on the details that affect your daily healthcare.
4. Look Beyond the Monthly Premium
A plan's monthly premium is only one part of the overall cost of healthcare.
When reviewing Medicare coverage, consider the full picture, including:
- Monthly premiums: What you pay each month to maintain your coverage.
- Deductibles: What you may need to pay for covered services or medications before certain benefits begin.
- Copayments and coinsurance: Your share of the cost when you receive healthcare services or prescriptions.
- Out-of-pocket costs: What you may pay throughout the year for covered care.
- Prescription expenses: How much your regular medications may cost under the plan.
- Additional benefits: Whether services you use are included and what coverage rules apply.
Your healthcare needs and expenses may change from year to year. Consider the services you used most often this year and any care you expect to need next year.
A plan with a lower monthly premium may not necessarily have the lowest overall cost for your individual circumstances. Comparing the different costs and coverage details can give you a clearer understanding of what to expect.
The takeaway: Look at the total cost of your healthcare, not just the monthly premium. Understanding how you may pay for care throughout the year can help you make a more informed decision.
5. Use Trusted Resources and Give Yourself Time
Medicare information can feel overwhelming, especially when you're receiving mail, phone calls, and advertisements about different plans.
You don't have to make a decision based on the first offer you receive. Take time to review your options, ask questions, and confirm information with reliable sources.
Here are several resources that can help:
- Medicare.gov: Visit Medicare.gov to learn about coverage options and compare available Medicare health and prescription drug plans.
- 1-800-MEDICARE: Call 1-800-633-4227 for official Medicare information and assistance.
- Your current health plan: Contact your plan if you have questions about its benefits, costs, provider network, or upcoming changes.
Be cautious about unsolicited calls or messages asking for your Medicare number or other personal information. Never feel pressured to enroll in a plan before you understand its terms.
Remember that December 7 is the deadline for making changes during the Annual Enrollment Period. Give yourself enough time to review your options and complete any enrollment steps you choose to take.
This article is for educational purposes only and does not constitute insurance, financial, or legal advice. Coverage, costs, eligibility, and enrollment rules vary. For information about your individual situation, contact Medicare or a qualified broker.
