Medicare Open Enrollment Begins October 15

Every year between October 15 and December 7, Medicare beneficiaries can make changes to their coverage if they are enrolled in:

• Original Medicare (health care coverage that includes Part A Hospital Insurance and Part B Medical Insurance that is managed by the federal government);

• A Part D Medicare plan (Prescription Drug Coverage); or

• A Medicare Advantage plan (a private health insurance plan that is Medicare-approved and must follow rules set by Medicare that may or may not include prescription drug coverage).

This open enrollment period provides an important opportunity for individuals over 65 years of age to review their Medicare coverage to determine if a different plan may better meet their needs. If a beneficiary decides that they do not want to make any changes then no action is required, and they will keep their current plan. It may be helpful to think of open enrollment as an annual ‘check-up’ for Medicare coverage and benefits.  

Why it’s Important for Beneficiaries to Review Their Medicare Plan Every Year

Selecting which Medicare plan is best during your initial enrollment period is understandably a big decision. Many people consider factors such as their health status, financial situation, and preferred healthcare providers before they enroll in Medicare for the first time. Since these factors may change from year to year, taking the time to review Medicare options annually during the October 15 through December 7 open enrollment period is always a good idea. In addition, the COVID-19 pandemic has revealed how unexpected events can quickly impact your life.

Changes in Your Health or Life Circumstances

Some questions to consider when deciding whether to make changes to Medicare include:

1. Do you want or need flexibility in providers locally and throughout the country?

2. Do you have medical conditions requiring the care of specialists?

3. Do you take prescription medications and need help to cover the cost of your prescription drugs?

4. Could you be prescribed additional prescriptions or have a change in prescriptions?

5. Do you plan to travel or spend a significant amount of time outside of your state?

6. Do you want or need the protection provided by a Medicare Supplement Insurance (Medigap) plan that reduces the cost you will owe for each covered medical care service throughout the year?

7. Do you want or need the protection provided by a Medicare Advantage plan that sets a maximum amount you will owe in costs for the year whether incurred after one or many covered medical care services?   

8. Does your plan provide sufficient and affordable coverage should you experience an unanticipated health event?

Changes to Your Medicare Plan

The open enrollment period is also a good time for beneficiaries to learn what changes have been made to their plan for 2021. It’s important to remember that Medicare plans can make changes each year that may affect coverage, costs, and service area. This includes possible changes in providers.

Some items to consider include:

1. What will be your premiums, deductibles, copays or coinsurance, and, if applicable, your maximum out of pocket?

2. Will your medications be on your plan’s formulary and at what tier?

3. Will your plan require prior authorization or step therapy for care you may need?

4. Will your providers be in your network if you have a Medicare Advantage plan or will your  providers be a Medicare participating provider if you have original Medicare?

5. Will your plan require a referral to see a different provider or specialist if the need arises?       

Be Aware of Penalties or Restrictions When Making a Change

Before making a change, beneficiaries should research and understand any restrictions or limitations that may apply. For example, if someone did not purchase a Medicare Supplement Insurance (Medigap) plan when they were first eligible, they may not qualify for or may pay more to purchase a plan later if outside of a Medigap protection (guaranteed issue rights) period. Click here for more information.  Similarly, it is important to understand the Part D late enrollment penalty before adding Part D drug coverage for the first time or before dropping Part D drug coverage (in either a Medicare Advantage plan or a stand-alone Part D plan).              

Changes That Can Be Made During Open Enrollment

Below is the list of changes that can be made during the October 15 through December 7 open enrollment period:

• Change from original Medicare to a Medicare Advantage plan.

• Change from a Medicare Advantage plan back to original Medicare.

• Switch from one Medicare Advantage plan to another Medicare Advantage plan.

• Switch from a Medicare Advantage plan that does not offer drug coverage to a Medicare Advantage plan that offers drug coverage.

• Switch from a Medicare Advantage plan that offers drug coverage to a Medicare Advantage plan that does not offer drug coverage.

• Join a Medicare Prescription Drug plan.

• Switch from one Medicare drug plan to another Medicare drug plan.

• Drop your Medicare prescription drug coverage completely.

This information may be found on the Medicare.gov website.

Helpful Tools and Resources

Beneficiaries who have Medicare Advantage or a Part D drug plan should have received (by September 30) an Annual Notice of Change (ANOC) which includes any changes in their plan’s coverage, costs, or service area that will be effective January 1 of the new year. Medicare Advantage or Part D drug plans will also send an Evidence of Coverage (EOC) that provides details about the plan including what it covers and how much the beneficiary will pay. The 2021 costs for Part A and B of original Medicare have not yet been released as of the date of this blog. This information is typically released later in the fall.

The Centers for Medicare and Medicaid Services (CMS) has an official handbook called Medicare & You 2021 that sets forth extensive information to help guide people in their Medicare search or you may call 1-800-MEDICARE (800-633-4227). You can also preview 2021 Part D drug plans and Medicare Advantage Plans on the Medicare.gov website by clicking here. Another resource for information is your State Health Insurance Assistance Program (SHIP).

CSC’s Cancer Support Helpline counselors are another resource to learn more about your Medicare options. Counselors can be reached at 1-888-793-9355, Monday – Friday between 9:00 am and 9:00 pm ET and Saturday – Sunday between 9:00 am and 5:00 pm ET.