Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
Are you comparing your Medicare coverage options each year? According to the Kaiser Family Foundation, more than half of all people on Medicare don’t. Medicare Open Enrollment is when you should consider your options and make changes if needed.
Read on to learn when to join, switch, or drop a Medicare plan and what you can do during open enrollment periods. Plus, gain insight into Medicare eligibility and how to pick a plan that is right for you.
When is Medicare Open Enrollment?
Medicare Open Enrollment occurs annually in the fall from October 15 through December 7. Changes made during this period become effective the following year on January 1.
What is Medicare Open Enrollment?
Medicare Open Enrollment is when Medicare beneficiaries can make a change to their Medicare health and drug coverage. It is helpful to plan for open enrollment each year, as it’s your opportunity to evaluate your current coverage to see if it is still the best choice for you.
With an understanding of your health needs and preferences, you can anticipate what the coming year may bring. Consider what matters most to you regarding provider choice, costs, and how easy it is to access care when you need it. You may be able to save money on drug costs and health care costs by changing to a different plan.
You must already be enrolled in Medicare to take advantage of fall open enrollment.
What can you do during open enrollment?
During open enrollment, you can:
- Change from Original Medicare to a Medicare Advantage (MA) plan that is available in your area. If you join an MA plan that offers drug coverage, you won’t need your Medicare prescription drug coverage (Part D). If you have a Medicare Supplement plan (Medigap), you will not be able to keep it.
- Change from your Medicare Advantage Plan to Original Medicare. If you do this, consider purchasing a Medicare prescription drug plan.
- Switch from one Medicare Advantage Plan to another.
- Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to one that does.
- Switch from a Medicare Advantage Plan that does offer drug coverage to one that doesn’t.
- Switch from one Medicare Part D drug plan to another.
- Enroll in a Medicare Part D drug plan if you didn’t enroll when you were first eligible for Medicare. You may pay a late-enrollment penalty if you haven’t maintained creditable prescription drug coverage.
- Drop your Medicare drug coverage altogether. If you decide to do this and go without drug coverage for 63 days or longer, you may have to pay the late-enrollment penalty if you try to purchase a plan later.
What can’t you do during open enrollment?
Remember, you have to be a current Medicare beneficiary to take advantage of fall open enrollment. During open enrollment, you can’t:
- Enroll for the first time in Medicare. If you missed your initial enrollment period, you can enroll in Medicare during the general enrollment period from January 1 through March 31 each year. Late penalties may apply, and coverage begins on July 1.
- Enroll in or switch to a different Medicare Supplement Plan (Medigap) unless you are in your initial 12-month trial period for a Medicare Advantage Plan or have purchased a Medigap policy within the last six months. Medicare open enrollment was established to allow for changes to Medicare Advantage and Part D prescription drug coverage plans, not Medigap policies.
What if You Miss Open Enrollment?
Suppose you miss open enrollment and already have a Medicare Advantage Plan. In that case, you can make a change during the Medicare Advantage Open Enrollment period that happens every year from January 1 through March 31.
During Medicare Advantage Open Enrollment, you can switch to a different Medicare Advantage Plan with or without drug coverage, or you can drop your Medicare Advantage Plan and return to Original Medicare. You can also purchase drug coverage (Part D) if you switch to Original Medicare or change to a Medicare Advantage Plan without drug coverage.
Changes will go into effect the first of the month following the month that your new plan gets your request for coverage. For instance, if you join a different Medicare Advantage Plan in February, the new plan will start on March 1. You can only make one change during the Medicare Advantage Open Enrollment period.
You may not have to wait a year to make changes to your plan if you qualify for a special enrollment period (SEP), such as a 5-star special enrollment period that is open from December 8 through the following November. If a 5-star plan is available in your area, you can join or switch to one. This applies to Medicare Advantage Plans, Part D plans, and Medicare Cost plans.
Are there special enrollment periods?
Yes, there are special enrollment periods (SEPs) when you can change your Medicare Advantage Plan and Medicare prescription drug coverage, depending on your circumstances. For instance, if you move or lose your insurance coverage, you will be eligible for a SEP. Rules about the type of changes you can make and when you can make them are different for each SEP. For a complete listing with details about what you can do, click here.
To give you an idea of the variety of SEPs that Medicare allows, here are some examples. This is not an exhaustive list. If you think you may qualify for a SEP because your circumstances have changed, please contact Medicare, your current plan, or review this resource page:
- You moved and have different options for plans available to you. You can switch to a new Medicare Advantage Plan or Medicare prescription drug plan. Depending on when you tell your plan that you moved, you will have at least two months to make the switch.
- You moved into a skilled nursing facility. You can join a Medicare Advantage or Medicare drug plan, switch plans, drop your drug plan, or drop your Medicare Advantage Plan and return to Original Medicare. This opportunity lasts for as long as you live in the facility and continues for two months after you leave.
- You are no longer eligible for Medicaid. You can join a Medicare Advantage or Medicare drug plan, switch plans, drop your drug plan, or drop your Medicare Advantage Plan and return to Original Medicare. This opportunity lasts for three months from the date you were no longer eligible or the date you were notified, whichever is later.
- Your financial situation changed, and you qualify for Extra Help paying for Medicare prescription drug coverage. You may be able to join, switch, or drop Medicare drug coverage one time during three different three-month periods that run from January through September.
How Do You Enroll in Medicare?
The Centers for Medicare & Medicaid Services (CMS) is the agency in charge of the Medicare program; however, Social Security processes your application for Original Medicare Part A and Part B. Social Security enrolls you in Original Medicare.
To enroll in Medicare, contact your local Social Security Office, call 1-800-772-1213 (TTY 1-800-325-0778), or access the Social Security website. If you worked for the railroad and are not already receiving retirement benefits, contact the Railroad Retirement Board (RRB) at 1-877-772-5772 to enroll in Medicare.
Other parts of Medicare that Medicare-approved private insurance companies administer are:
- Medicare Supplement plans (Medigap) to help pay for out-of-pocket costs associated with Original Medicare.
- Medicare Advantage plans (Part C) as an alternative way to get your Medicare benefits. You cannot have a Medigap plan and a Medicare Advantage plan.
- Medicare prescription drug coverage (Part D). If you join a Medicare Advantage plan that includes drug coverage, you won’t need Part D.
You must be enrolled in Medicare Parts A and B to access these plans. You enroll in these plans operated by private insurance companies by contacting the plan you want. For more information on your Medicare coverage choices, click here.
Who is eligible for Medicare?
Medicare is the federal health insurance program for people 65 and older and younger people living with disabilities or permanent kidney failure. To qualify for Medicare, you must be a U.S. citizen or lawful permanent resident.
You are eligible for Part A (hospital insurance) at age 65 at no cost if one of the following applies:
- You receive or are eligible to receive benefits from Social Security or the Railroad Retirement Board (RRB).
- Your spouse (living or deceased, including divorced spouses) receives or is eligible to receive Social Security or RRB benefits.
- You or your spouse worked long enough in a government job through which you paid Medicare taxes (a federal employment tax that helps fund the Medicare program).
- You are the dependent parent of a fully insured deceased child.
If you don’t meet these requirements, you may be able to purchase Part A
According to the Social Security Administration (SSA), if you are under age 65, you are eligible for Medicare Part A at no cost if one of the following applies:
- You’ve been entitled to Social Security disability benefits for 24 months.
- You receive a disability pension from the RRB and meet certain conditions.
- You receive Social Security disability benefits because you have Lou Gehrig’s disease (amyotrophic lateral sclerosis).
- You worked long enough in a government job through which you paid Medicare taxes, and you have met the Social Security disability program requirements for 24 months.
- You’re the child or widow(er) age 50 or older, including a divorced widow(er), of a worker who has worked long enough under Social Security or in a Medicare-covered government job, and you meet the requirements of the Social Security disability program.
- You have permanent kidney failure (end-stage renal disease), and you receive maintenance dialysis or a kidney transplant, and one of the following applies:
- You’re eligible for or receive monthly benefits under Social Security or the railroad retirement system.
- You’ve worked long enough in a Medicare-covered government job.
- You’re the child or spouse (including a divorced spouse) of a worker (living or deceased) who has worked long enough under Social Security or in a Medicare-covered government job.
If you are eligible for Part A at no cost, you can enroll in Part B and pay a monthly premium. If you are age 65 or older and a legal resident or citizen of the U.S. but would have to pay for Part A, you can opt to purchase Part B only.
Is initial enrollment different from open enrollment?
Yes, initial enrollment is a once-in-a-lifetime window of opportunity that happens around your 65th birthday or the 25th month after you become eligible for Medicare due to disability. If you have already been receiving retirement or disability benefits, you will automatically be enrolled in Medicare Parts A and B. Your initial enrollment period is when you can:
- Enroll in Medicare for the first time if you are not automatically enrolled.
- Opt out of Part B. All Medicare beneficiaries must pay a monthly premium for Part B. If you have other medical insurance coverage, you may delay enrollment in Part B.
- Opt for a Medicare Advantage Plan as an alternative to Original Medicare. You must be enrolled in both Parts A and B to do this.
- Purchase a stand-alone drug coverage plan (Part D) if you keep Original Medicare or don’t have prescription drug coverage with your Medicare Advantage Plan or another insurance plan.
- Purchase a Medigap plan as a supplement to Original Medicare.
Your seven-month initial enrollment period is the first time you can enroll in Medicare. It starts three months before the month you turn 65, includes your birthday month, and ends three months after the month you turn 65.
If you are not covered by employer-sponsored group health insurance, it is best to enroll during the first three months of this initial period to ensure that your Medicare benefits start the first of the month you turn 65. If you qualify for Medicare due to disability, your initial enrollment period ends three months after your 25th month of disability benefits.
Open enrollment occurs annually each fall from October 15 through December 7, when current Medicare beneficiaries have the opportunity to make changes to Medicare health and drug plans. If you missed your initial enrollment period, you can not enroll in Medicare during the fall open enrollment period.
How Do You Pick or Change Medicare Plans?
Choosing the Medicare plan that is best for you is a process. You may remember what it was like to choose an insurance plan through a previous employer or your state health exchange. You looked at your options for coverage; the cost of monthly premiums, deductibles, co-pays, and other potential out-of-pocket expenses; your prescription drug coverage; and your anticipated health care needs in the coming year.
The process of choosing a Medicare plan is very similar. You consider who your preferred providers are and research options that are available to you in your area. Whether you choose a Medicare Advantage Plan with drug coverage or Original Medicare plus a prescription drug coverage plan, you will make a list of your current medications. As you review plan options, anticipate how health care costs fit into your budget.
If you have Original Medicare, look at next year’s costs. If you have a Medicare Advantage Plan, review your Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) to see if any changes to your plan will affect you. These documents are available to you each fall.
There are resources to help you shop for and compare plans, either online or in person. Medicare.gov is a wealth of information.
- You can compare plans in your area here or find someone to talk to here.
- You can get local, unbiased, one-on-one counseling through your state health insurance program (SHIP) or contact your local Area Agency on Aging to find out where you can get personalized assistance.
- You may prefer to speak with a Medicare licensed insurance agent in your area.
All of these services are provided at no cost to you.
How do you find the right Medicare plan?
The best place to start is medicare.gov’s Plan Finder to see what is available in your area. Compare similar plans from different companies side by side. Each plan has information about costs and benefits. If you create an account, you can add your drugs one time and save the list so you don’t have to add them manually each time you look at a different type of plan.
The right plan for you is the one that offers what is most important to you. For instance, if you don’t typically need much health care and are open to seeing only in-network providers when you need care, you may choose a zero-premium Medicare Advantage Plan. If you access your health care frequently and want to have your choice of providers, you may choose a Medigap plan with a monthly premium, so you know that most of your Original Medicare out-of-pocket expenses will be covered.
As you age and if you develop more health concerns, you may want different coverage than you did when you first became eligible for Medicare. You need to know that if you don’t get a Medicare Supplement plan (Medigap) when you are first eligible, you may not be able to get one, or you may have to pay higher premiums to get one later.
How do you change the plan you have?
- If you enroll in a new Medicare Advantage or drug plan, you will automatically be disenrolled from your old plan when your new coverage starts.
- If you drop your Medicare Advantage (MA) plan and return to Original Medicare, let your MA plan or Medicare know. Be sure to enroll in a drug plan simultaneously, so your health and drug coverage begin together.
Medicare Open Enrollment Checklists
Use these checklists to consider changes to your Medicare coverage:
- Consider how well your current plan met your needs this year.
- Did you need health care? If so, did you see providers of your choice?
- Were you able to see specialists?
- Did you have any issues with health coverage claims?
- Did you meet your deductible or out-of-pocket max?
- Did you develop any new health concerns this year, or do you anticipate needing more health care next year?
- How did your health care expenses affect your budget?
- What could have been better?
- What did you like?
- Prescription drug coverage.
- Did you meet your plan’s deductible?
- Did you reach a gap in coverage and incur out-of-pocket expenses?
- Are your medications still on your plan’s formulary?
- Were you able to get the medications that work best for you?
- Were you satisfied with prior authorization requirements of your plan?
- Are your preferred providers in network for your plan?
- Do your providers accept Medicare assignment?
- Was the referral process to specialists smooth?
- If you are considering dropping your Medicare Advantage Plan and returning to Original Medicare, can you get a Medigap policy?
- Extras/services that Medicare doesn’t cover.
- Were you satisfied with your vision benefits?
- Were you satisfied with your hearing benefits?
- Were you satisfied with your dental benefits?
- Did you use, or wish you had, other extra benefits, such as transportation or gym club memberships?
- Check your eligibility for Medicare Savings Programs, which are run by your state. If your income for 2021 is below $18,000, it may be worth contacting your state’s Medicaid program to find out if help is available to you. Check here, or contact 1-800-MEDICARE to find out where to apply.
Anticipate your health care needs and preferences next year:
- Will you travel or relocate? Make sure you understand your plan’s coverage area.
- Are you losing other health care coverage, for instance, from a group employer-sponsored plan?
- Will you potentially need a procedure or treatment? Make sure you understand how your plan covers it.
- Will you need new eyeglasses, hearing aids, or complex dental work?
- What have you budgeted for health care?
Free resources can help you determine whether or not you want to make a change during this year’s Medicare Open Enrollment. Talk with someone about your particular situation and what is available to you:
- Find and compare costs and coverage of plans available in your area at Medicare.gov.
- Call 1-800-MEDICARE (1-800-633-4227). Help is available 24 hours a day, including weekends. TTY users can call 1-877-486-2048.
- Receive free, personalized, unbiased health insurance counseling from State Health Insurance Assistance Program (SHIP). Go to shiptacenter.org for contact information.
- Talk with a trusted licensed Medicare insurance agent in your community.
- Talk with a representative at your local Area Agency on Aging.
Before you decide to make a change:
- If you like your current plan, but drugs are too expensive, ask your doctor about a generic equivalent.
- Contact a Medigap policy to see if you can get coverage.
- List your specific questions and preferences and ask the plan you are considering.
- Contact your current providers to make sure they are still in network.
- Check the formulary of your plan or the plan you are considering to make sure your medications are there or if they cost more.
How to make a change once you’ve made your decision:
- To join a Medicare Advantage Plan:
- Visit the plan’s website to see if you can join online.
- Fill out a paper enrollment form. Contact the plan to get an enrollment form, fill it out, and return it to the plan. All plans must offer this option.
- Call the plan you want to join. Get your plan’s contact information.
- Call 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.
- When you join a Medicare Advantage Plan, you’ll have to provide your Medicare number, and the date your Part A and Part B coverage started. This information is on your Medicare card.
- To switch to a new Medicare Advantage Plan, simply join the plan you choose. You’ll be disenrolled automatically from your old plan when your new plan’s coverage begins.
- To switch to Original Medicare, contact your current plan, or call 1-800-MEDICARE (1-800-633-4227).
- To drop your Medigap plan or purchase one, contact the insurance company for instructions about disenrolling or applying.
- To join a standalone Part D prescription drug plan, contact the plan you want.
- To drop a Part D plan, Call 1-800 MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.
- Mail or fax a signed written notice to the plan telling them you want to disenroll.
- Submit a request to the plan online if they offer this option.
- Call the plan and ask them to send you a disenrollment notice. You’ll have to complete, sign and send the notice back to the plan.
- To switch to a different Medicare Part D drug plan, contact the plan you want. You don’t need to cancel your old plan; your old coverage will end when your new plan begins.
Are There Different Open Enrollment Periods for Other Parts of Medicare?
Along with Original Medicare, there are other parts of Medicare with which you should become familiar.
- Medicare Advantage (also known as MA or Part C) plans are the alternative way to get your Medicare benefits. Many of these MA plans include drug coverage.
- Original Medicare pays for some but not all of your healthcare expenses, so you may purchase a Medicare Supplement plan (Medigap) to help cover most of the out-of-pocket expenses that Original Medicare does not.
- Medicare drug coverage plans (Part D) are necessary if you have Original Medicare (which does not pay for most drugs) or a MA plan without drug coverage.
The best time to enroll in any of these parts of Medicare is during your initial enrollment period when you are first eligible for Medicare. Remember, open enrollment periods are only for people already enrolled in Medicare and are intended to provide an opportunity to change your current plan to a different one.
When is Medicare Advantage open enrollment?
You can join a Medicare Advantage Plan during your initial enrollment period or, if you are already enrolled in Medicare Parts A and B, during the fall open enrollment period from October 15 through December 7.
You can join a different Medicare Advantage (MA) plan during the Medicare Advantage Open Enrollment period that runs each year from January 1 through March 31. You must already be enrolled in a MA plan to take advantage of this opportunity to make one change to your health or drug plan.
When is Medicare Part D open enrollment?
Open enrollment for Medicare Part D is during the fall open enrollment period from October 15 through December 7. You can join a Medicare Part D plan during your initial enrollment period if you stay with Original Medicare or choose a Medicare Advantage Plan without drug coverage.
You may be able to make a change to your drug coverage during the Medicare Advantage Open Enrollment period that runs each year from January 1 through March 31. You can purchase a Medicare Part D plan if you drop your Medicare Advantage (MA) plan and return to Original Medicare or if you switch to a MA plan without drug coverage.
Is there an open enrollment for Medigap?
If you do not enroll in a Medicare Advantage plan, your initial enrollment period is the best time to enroll in Medigap. The open enrollment period for Medigap starts when you enroll in Medicare Part B and are 65 or older and lasts six months. There is no other open enrollment period for Medigap.
Suppose you are in a Medicare Advantage plan and want to switch back to Original Medicare. In that case, you can buy a Medigap plan with a guaranteed issue right within 12 months of Medicare eligibility. After that time, you may not be able to purchase the Medigap plan you want due to medical underwriting when insurance companies can decide whether to accept your application and how much to charge you based on your health condition.
Learn More From Our Sources
- CMS | Fact Sheet: Whether to Enroll in Part A and Part B at age 65 | Last Accessed November 2021
- KFF | Frequently Asked Questions about Medicare Open Enrollment | Last Accessed November 2021
- HHA | Who is Eligible for Medicare | Last Accessed November 2021
- Medicare | Find and Compare Medicare Plans | Last Accessed November 2021
- Medicare | How to Get Prescription Drug Coverage | Last Accessed November 2021
- Medicare | Join, Switch or Drop a Plan | Last Accessed November 2021
- Medicare | Medicare Advantage Plans | Last Accessed November 2021
- Medicare | Medicare Supplement Insurance (Medigap) | Last Accessed November 2021
- Medicare | Original Medicare | Last Accessed November 2021
- Medicare | Plan for Open Enrollment | Last Accessed November 2021
- Medicare | Special Enrollment Periods | Last Accessed November 2021
- Medicare | Your Costs at a Glance | Last Accessed November 2021
- RRB | Disability Benefits | Last Accessed November 2021
- RRB | Medicare for Railroad Workers | Last Accessed November 2021
- SSA | All About Medicare | Last Accessed November 2021
- SSA | Disability Benefits | Last Accessed November 2021
- SSA | Who to Contact: Social Security or Medicare | Last Accessed November 2021