MEDICARE ANNUAL OPEN ENROLLMENT

Medicare Annual Open Enrollment runs from October 15 through December 7 each year. This is the time when Medicare beneficiaries can review their current coverage and make changes for the following year. Changes made during this period generally take effect January 1. Even if you are happy with your current coverage, it is worth reviewing your plan each fall. Medicare Advantage and prescription drug plans can change premiums, copays, provider networks, pharmacy networks, drug formularies, and other benefits from one year to the next. National Benefits Consultants helps Medicare beneficiaries understand those changes and review available options before making a decision.

What Can You Change During Medicare Annual Open Enrollment?

During Medicare Annual Open Enrollment, you may be able to:

Switch from one Medicare Advantage plan to another
Join a Medicare Advantage plan
Leave a Medicare Advantage plan and return to Original Medicare
Join, drop, or change a Medicare Part D prescription drug plan if you have Original Medicare
Add or remove drug coverage from a Medicare Advantage plan when permitted
Changes made during Medicare Annual Open Enrollment generally become effective January 1 of the following year.

What Should You Review Before October 15?

A good Medicare review starts before the enrollment period becomes busy.
Before October 15, review:

Your current premium
Medical copays and coinsurance
Your plan’s maximum out-of-pocket limit
Prescription drug coverage
Your current medications and drug tiers
Preferred pharmacies
Doctor and hospital networks
Specialist access
Travel and out-of-area coverage
Dental, vision, hearing, or other supplemental benefits
Any changes in your health or prescription needs

The goal is not to change plans simply because Open Enrollment is available. The goal is to understand whether your current coverage will continue to meet your needs for the coming year.

Review Your Annual Notice of Change (ANOC)

If you are enrolled in a Medicare Advantage or Medicare prescription drug plan, your plan sends an Annual Notice of Change each fall. The Annual Notice of Change explains changes in coverage, costs, and other plan details that will take effect in January. Medicare says beneficiaries should receive this notice in September. Do not automatically assume your plan will remain the same. Review the Annual Notice of Change carefully for changes to:

Monthly premiums
Medical copays
Prescription drug costs
Covered medications
Provider networks
Pharmacy networks
Plan benefits
Out-of-pocket limits

If something important has changed, Medicare Annual Open Enrollment gives you an opportunity to review other available options.

Review Your Evidence of Coverage

Your Evidence of Coverage provides more detailed information about how your Medicare plan works. Medicare plans generally send this document in the fall. It explains what the plan covers, what you may pay, and other important plan rules. The Annual Notice of Change tells you what is changing. The Evidence of Coverage helps you understand how the plan works in greater detail. Both documents can be useful when deciding whether your current coverage still fits your needs.

Prescription Drug Coverage Deserves a Fresh Look

A medication that was inexpensive this year may move to a different drug tier. A preferred pharmacy may change. Prior authorization requirements may be added. Another Medicare Part D or Medicare Advantage plan may cover your prescriptions differently.
Before choosing coverage for the next year, review:

Every prescription you currently take
Dosage and frequency
Drug tiers
Preferred pharmacy status
Mail-order options
Deductibles
Copays or coinsurance
Specialty medication rules

Prescription drug coverage is one of the most important reasons to review Medicare options annually.

Doctors and Hospitals

Provider networks can change. If you are enrolled in a Medicare Advantage plan, confirm that your doctors, specialists, hospitals, and other important providers are expected to remain in-network for the coming year. Do not rely solely on what was true this year. If keeping a particular physician or health system is important to you, provider access should be part of your annual Medicare review.

What If You Are Happy With Your Current Plan?

You do not have to change Medicare coverage every year. If your current plan remains available and continues to meet your needs, staying with the same coverage may be appropriate. But staying with a plan should be an informed decision. Review the Annual Notice of Change, prescription coverage, provider network, costs, and benefits before deciding to leave your coverage unchanged.

Medicare Annual Open Enrollment Is Not the Same as Medicare Advantage Open Enrollment

Medicare has more than one enrollment period, and the names can be confusing. Medicare Annual Open Enrollment runs from October 15 through December 7 and is available to Medicare beneficiaries who want to review and change Medicare health or drug coverage for the following year.
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31. That January through March period is only for people who are already enrolled in a Medicare Advantage plan. During that period, they may switch to another Medicare Advantage plan or leave Medicare Advantage and return to Original Medicare. They cannot use that period to switch from Original Medicare into Medicare Advantage or change standalone Part D plans while remaining in Original Medicare.
Understanding which enrollment period applies to your situation can help avoid missed opportunities or unnecessary confusion.

Switching Back to Original Medicare

Thinking About Returning to Original Medicare? Medicare Annual Open Enrollment allows someone enrolled in Medicare Advantage to return to Original Medicare. However, that decision deserves careful review. Someone returning to Original Medicare may need separate prescription drug coverage and may also want to consider Medicare Supplement Insurance.
Medigap enrollment rules are different from Medicare Advantage and Part D enrollment rules. Depending on the situation, medical underwriting or other eligibility rules may apply. Do not assume that leaving Medicare Advantage automatically guarantees access to any Medicare Supplement plan you want. Review the entire coverage picture before making the change.

How National Benefits Consultants helps

Medicare Annual Open Enrollment can generate a lot of advertising, mail, phone calls, and conflicting information. National Benefits Consultants helps clients focus on the factors that actually matter.

Our Medicare review may include:

Current plan changes
Prescription medications
Preferred pharmacies
Doctors and hospitals
Medical costs
Prescription drug costs
Medicare Advantage options
Part D prescription drug plans
Whether the current plan still fits
Questions about Original Medicare and Medicare Supplement Insurance

Our goal is not to change coverage simply for the sake of making a change. Our goal is to help clients understand their options and make an informed decision for the year ahead.

Review Your Medicare Coverage Before the Rush

Medicare Annual Open Enrollment runs from October 15 through December 7. You do not need to wait until the last week of enrollment to start reviewing your coverage. National Benefits Consultants can help you understand your current plan changes, review available Medicare options, and prepare for the year ahead. Call 720-488-9892 or contact National Benefits Consultants to schedule a Medicare review.

Medicare Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.