Medicare only allows you to change your coverage during specific enrollment periods during the year. It’s important to understand these enrollment periods because they dictate what changes you can make and when you can make them. Missing an enrollment period may mean you have to stay with a plan that no longer fits your needs until the next enrollment period.
You are probably aware of Medicare’s Annual Enrollment Period in the fall, but you may not be as familiar with Open Enrollment Period. Here’s what you need to know about each one and how they are different.
Annual Enrollment Period
Medicare’s Annual Enrollment Period (AEP), also known as fall enrollment, lasts from October 15 to December 7 every year. During this time period individuals already enrolled in Medicare can:
- Switch from one Medicare Advantage plan to another Medicare Advantage plan
- Disenroll from a Medicare Advantage plan and return to Original Medicare Parts A and B
- Switch from Original Medicare and enroll in a Medicare Advantage plan
- Enroll or disenroll from a Medicare prescription drug plan
- Switch from one Medicare prescription drug plan to another
Any changes made during this enrollment period are effective January 1st of the upcoming year.
Each year your insurer is required to notify you of any changes to your plan for the following year. This Annual Notice of Change (ANOC) will outline any changes to your benefits, your out of pocket costs, the insurer’s drug formulary and provider network. This is done just prior to AEP, giving you the opportunity to consider whether your plan is still a good fit. You should also consider if any changes to your health will require different doctors, treatments, or medications. AEP is the time to look for a plan that offers the best coverage for your healthcare needs.
Open Enrollment Period
Medicare’s Open Enrollment Period (OEP) runs from January 1 to March 31 every year. It offers less flexibility than AEP since It is only for Medicare beneficiaries already enrolled in a Medicare Advantage plan.
During OEP you can:
- Switch from one Medicare Advantage plan to another Medicare Advantage plan
- Disenroll from your current Medicare Advantage plan and return to Original Medicare. If you return to Original Medicare you can also enroll in a Part D prescription drug plan during this enrollment period
You cannot:
- Switch from Original Medicare to a Medicare Advantage plan
- Enroll in or switch Medicare drug plans if you are already enrolled in Original Medicare
You can only make one plan change during this enrollment window. Changes made during OEP will be effective the month after you make the change. For example, if you change plans in January, your new coverage will be effective February 1st.
There are several reasons you might want to make change during OEP:
- You inadvertently overlooked your ANOC in the fall and are now aware of changes to your plan that do not align with your needs
- You chose a new plan during AEP and are now discovering you did not fully understand the benefits or the costs
- Your health has changed, and you need a different plan that offers more comprehensive medical and prescription coverage
If you don’t make a change during OEP, you will most likely have to keep your current coverage through the end of the year. Only if you qualify for one of Medicare’s Special Enrollment Periods can you make changes to your coverage at other times of the year.
If Your Financial Situation Changes
If your financial situation changes and you are finding it difficult to afford your Medicare coverage, there are federal and state programs available to help those who qualify. These include federal programs such as Medicare Savings Programs and Extra Help. It is possible to have both Medicare and Medicaid if you qualify. This is known as “dually eligible.” Your state may offer a Pharmaceutical Assistance Program to assist with the cost of prescription drugs if you qualify.
You can apply for these programs any time during the year and if you become eligible you may qualify for a Special Enrollment Period which allows you to change your coverage.
Silver&Smart is your best source for Medicare information. Sign up today for our free news alerts.