You should probably know by now that your Medicare plan may not stay the same next year. Costs, benefits, prescription drug coverage, and provider networks can change—making the Medicare Annual Enrollment Period (AEP) an important opportunity to make sure your plan still fits your needs.
AEP runs from October 15 through December 7. During this time, Medicare beneficiaries can make certain coverage changes for the coming year. Here’s what you need to know about the Annual Enrollment Period.
What Can You Change During AEP?
During AEP, you can:
- Enroll in a Medicare Advantage plan.
- Switch from one Medicare Advantage plan to another.
- Leave Medicare Advantage and return to Original Medicare.
- Join, switch, or drop a Medicare Part D prescription drug plan.
Medicare Advantage plans (Part C) may offer additional benefits not covered by Original Medicare, such as certain dental, vision, hearing, or fitness benefits. Plans also differ in premiums, out-of-pocket costs, provider networks, and other coverage rules.
Be particularly careful before dropping prescription drug coverage. Going without Part D or other creditable prescription drug coverage could result in a late enrollment penalty.
However, if your current plan continues to meet your needs, you may not need to do anything during AEP.
What to Check Before Deciding
Start with your plan’s Annual Notice of Change (ANOC). Pay attention to changes in benefits, premiums, costs, and other plan details for the upcoming year.
Next, consider whether your own needs have changed. Are you taking new medications? Seeing new doctors or specialists? Expecting different healthcare expenses?
If you have or are considering Medicare Advantage, confirm that your preferred doctors, specialists, hospitals, and pharmacies participate in the plan’s network. Depending on the type of plan, out-of-network care may cost more or may not be covered except in certain circumstances.
Don’t Overlook Prescription Drug Costs
If you take prescription medications, check your Part D plan’s formulary, or list of covered medications. Formularies can change from year to year.
Make sure your prescriptions remain covered and check what you could pay for them. Consider the pharmacy network, deductible, copayments, coinsurance, and any coverage requirements that could affect your medications.
Looking beyond the monthly premium can give you a better picture of your potential prescription drug costs for the year.
What Happens If You Miss AEP?
If you miss the December 7 deadline, your ability to change plans may be limited. Depending on your circumstances and current coverage, you may need to wait for another enrollment period.
Some people qualify for a Special Enrollment Period (SEP) after certain events or changes in circumstances. For example, moving outside a plan’s service area or losing certain other coverage may create an opportunity to make a change.
Because eligibility and deadlines vary, do not assume a Special Enrollment Period will apply.
AEP vs. Medicare Advantage Open Enrollment
The Medicare Advantage Open Enrollment Period (MA OEP) runs from January 1 through March 31 and applies to people already enrolled in a Medicare Advantage plan.
During MA OEP, eligible beneficiaries can make a one-time switch to another Medicare Advantage plan or leave Medicare Advantage and return to Original Medicare. Someone returning to Original Medicare can also join a separate Part D plan.
MA OEP cannot be used by someone with Original Medicare to enroll in Medicare Advantage for the first time. AEP offers a broader range of opportunities to change Medicare Advantage and prescription drug coverage.
Make Your Medicare Choices Count
A few key details can make a meaningful difference in your healthcare costs and access in the coming year.
Before December 7, check your plan’s costs and benefits, confirm your doctors and prescriptions are covered, compare your options, and choose the plan that best fits your healthcare needs and budget.
For help with Medicare plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or request a quote.
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