Finance

Your Guide to Navigate Medicare Open Enrollment This Year

Are you getting bombarded with TV commercials and a mountain of health insurance advertisements in the mail?

You’re not the only one. It’s that time of year again: Medicare open enrollment.

During this roughly two-month period, Medicare beneficiaries can compare and adjust their coverage. Private insurance companies aggressively advertise their plans in hopes that you’ll sign up for them.

But should you switch plans during the Medicare open enrollment period? How does the process work and what are your options?

In this guide, we break everything you need to know. Let’s get started.

What Is Medicare Open Enrollment?

Medicare open enrollment, also known as the annual election period, runs from Oct. 15 through Dec. 7 each year.

It’s the time when people who are already enrolled in Medicare can make changes to their plans.

If you’re happy with your Medicare coverage, you don’t need to do anything. You don’t need to “renew” your coverage.

During open enrollment, you can:

  • Switch from Original Medicare to Medicare Advantage or vice versa.
  • Switch to a different Medicare Advantage plan.
  • Sign up for Part D if you didn’t enroll when you first became eligible.
  • Change to a different Part D plan.

Whatever changes you make will go into effect Jan. 1. So if you make changes during the 2022 open enrollment period, your new benefits will kick in January 2023.

Information about next year’s plans will be available starting in October.

Need a refresher on Medicare? Check out these 7 frequently asked questions on how Medicare works.

How Do You Sign Up for a New Plan During Open Enrollment?

There are two ways you can enroll in a  new plan during Medicare open enrollment.

  • Use the online Medicare plan finder tool.
  • Call Medicare’s helpline at 800-633-4227 (TTY: 877-486-2048) and ask the representative to conduct the same search for you.

Once you join a new plan, you’ll automatically be removed from your old plan when your new coverage begins.

If you go from Original Medicare to a Medicare Advantage plan, make sure to notify your current Medigap provider if you have one. You’ll also need to contact and cancel your Medicare Part D drug plan if your new Medicare Advantage plan provides prescription drug coverage.

Use the Medicare Plan Finder to Compare Plans During Open Enrollment

Medicare offers an online plan finder tool where you can shop for different Medicare Part D prescription drug plans, Medicare Advantage plans and Medigap supplement plans.

You’ll enter your zip code and any financial help you might be receiving — such as Medicaid — and the tool will show you all the available plans in your area.

Click “Plan Details” to see the total cost of each plan, including its yearly deductible, monthly premium (if any) and copays for different services, like doctor visits, X-rays and ER visits.

If you’re in the market for a new Medicare Part D plan, you can also enter your prescription drug information and select up to five preferred pharmacies for customized estimates on your total out-of-pocket monthly drug costs.

Make sure to accurately enter all the medications you take into the Medicare.gov tool, including the dosages, quantity and frequency. Leaving out details can result in incorrect cost estimates.

You can review up to three different Part D or Medicare Advantage plans side-by-side and filter results by star ratings and available benefits.

Make sure to carefully review details on any plan before signing up.

How to Get Free Help With Medicare Open Enrollment

Have questions about signing up for a plan? A network of free federally funded programs can help.

The State Health Insurance Assistance Program, or SHIP, is a national network of trained volunteers who provide one-on-one assistance, counseling and education to Medicare beneficiaries and their families.

Each state uses federal grant money to administer its own SHIP, which can go by different names — like SHINE in Florida or SHIBA in Idaho.

Here’s how a SHIP counselor can help you during the open enrollment period:

  • Discuss your health insurance coverage and prescription drug plan options.
  • See if you qualify for assistance programs based on your income.
  • Answer open enrollment questions.
  • Help you navigate Medicare late enrollment penalties.

You can find your SHIP by using the online SHIP Regional Locator tool. Or you can call the national network hotline at 1-877-839-2675.

How Do You Find Out What Medicare Coverage You Have?

Not sure if you’re enrolled in Original Medicare or Medicare Advantage? Can’t remember the name of your Part D plan provider?

You can log on to MyMedicare.gov to find out.

MyMedicare.gov is your all-in-one health insurance portal. You can see which Medicare plans offered by private insurance companies you’re enrolled in (such as a Medicare Advantage plan or a standalone Medicare Part D plan), along with limited coverage details.

If you don’t already have a MyMedicare account it’s quick and easy to set one up. You can also see if you already have an account.

How to Create a MyMedicare.gov Account

  1. Go to the Create an Account page at Medicare.gov.
  2. Type in your Medicare number and your Part A or Part B start date. (You can find this on your Medicare card or by logging in to your online Social Security account.) Click Next.
  3. Type in your last name, birth date, zip code and email address. Accept the terms and conditions, then click Next.
  4. Create a username and password, then click Create an Account.
  5. Login to your MyMedicare account.

Once you log in, you’ll see information about your Medicare plan enrollment and eligibility information. This info can help inform your decisions during the fall open enrollment period.

It’s free to set up your MyMedicare account. The site is administered by the U.S. Centers for Medicare & Medicaid Services — a part of the federal government.

What Are Your Medicare Coverage Options During Open Enrollment?

Your choices during the open enrollment period depend on the type of Medicare coverage you have: Original Medicare or Medicare Advantage.

If You Have Original Medicare

Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

Everyone is enrolled in Original Medicare when they join the program. You’ll pay a monthly premium for Part B coverage.

You’ll need to buy prescription drug coverage from a separate Part D plan. You may also buy a Medigap supplement insurance plan to help pay for out-of-pocket costs Original Medicare doesn’t cover.

During open enrollment you can:

  • Switch from Original Medicare to Medicare Advantage.
  • Sign up for Part D drug plan if you didn’t enroll when you first became eligible.
  • Change to a different Part D plan.
  • Cancel your Part D coverage.

Part D Coverage

Part D prescription drug coverage is technically optional. But going without it or signing up late can result in a costly late enrollment penalty.

Part D prescription drug plans change their formularies, or the list of drugs they cover, each year. That’s why experts recommend reviewing your Part D benefits and coverage once a year to ensure you’re getting the best value.

The Medicare Plan Finder tool lets you input your specific medications so you can side-by-side compare the total cost for a Part D drug plan, including monthly premiums, yearly deductibles and drug costs.

You Have a Medicare Advantage Plan

Medicare Part C, better known as Medicare Advantage, is an all-in-one alternative to Original Medicare. Medicare Advantage plans are sold by private insurance companies.

Most Medicare Advantage plans bundle in Part D prescription drug coverage, allowing you to get all your Medicare benefits in a single plan.

Many include additional benefits Original Medicare doesn’t cover, like hearing, dental and vision coverage.

During open enrollment you can:

  • Switch back to Original Medicare.
  • Switch to a different Medicare Advantage plan.

You’ll pay a separate premium for your Medicare Advantage plan in addition to your monthly Part B premium. Some Medicare Advantage plans have $0 premiums for those that qualify, but you’ll still owe your Part B premium.

Medicare Advantage plans also restrict you to a specific network of doctors.

Make sure to review your copays for a Medicare Advantage plan, including how much you’ll pay out-of-pocket for ER visits, ambulance rides and inpatient care.

What You Can’t Do During Open Enrollment

You can’t sign up for Medicare during open enrollment. Open enrollment is only for people already enrolled in Medicare.

If you didn’t sign up for Medicare when you were first eligible (during your initial enrollment period), you get another chance to do so — but not during open enrollment.

Instead, you can sign up during what’s known as the general enrollment period, which runs from Jan. 1 to March 31 each year.

If you enroll in Medicare for the first time during the general enrollment period, your coverage starts July 1.

Open enrollment also isn’t the time to change your Medigap coverage.

The best time to sign up for a Medigap plan is during the first six months you’re first eligible for Medicare around your 65th birthday.

After that six-month window, Medigap insurance companies can deny you coverage or charge you much higher rates for a policy.

Should You Switch to a New Plan During Open Enrollment?

Private insurance companies — they administer Medicare Advantage and standalone Part D plans — tweak coverage and costs every year.

They might drop coverage for certain prescription drugs, increase or decrease their out-of-pocket maximums or change their pricing structure for different services, like copay amounts at the doctor’s office.

As a result, you might be paying significantly more for health care just by sticking with your current Medicare coverage.

Or you may have started taking a new medication your current Part D drug plan doesn’t cover, or you want to check out other Medicare Advantage plans in your area.

The truth is not shopping around at least once a year can mean overspending on Medicare, experts say.

“In addition to potentially better meeting their health care needs, reviewing plans annually can help save money because plan costs fluctuate regularly,” said Rebecca Kinney, director of the Office of Healthcare Information and Counseling for the U.S. Department of Health and Human Services’ Administration for Community Living.

If there are changes to a plan’s benefits or coverage, the provider is required to send you a letter known as the Annual Notice of Change in September.

The notice explains what changes to premiums, deductibles, copays and coverage the plan will make next year.

If you’re happy with your Medicare coverage and nothing is changing, then stick with your current plan.

If you don’t make any changes during open enrollment, your current coverage simply rolls over into the next year.

But if changes are on the horizon, or you feel like you’re paying too much for your coverage, shopping around is a smart decision.

Rachel Christian is a Certified Educator in Personal Finance and a senior writer for The Penny Hoarder.


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