October 6, 2016
The Annual Election Period (AEP), commonly referred to as the Medicare Fall Open Enrollment Period, occurs from October 15 to December 7 of each year. During this time, eligible beneficiaries may make changes to their current Medicare coverage. These changes take effect January 1st of the next year.
Depending upon your current Medicare coverage, you have the following options during the Medicare Annual Enrollment Period.
- Switch from Original Medicare (Part A and Part B) to a Medicare Advantage (MA) plan. Medicare Advantage plans are offered by private companies approved by Medicare and provide at minimum the same coverage as Part A and Part B except for hospice care, which continues to be covered under Part A. Many Medicare Advantage plans offer additional benefits, such as routine vision, hearing and/or dental coverage. You must have Medicare Part A and Part B to enroll in a Medicare Advantage plan.
- Drop your Medicare Advantage plan coverage and switch back to Original Medicare Part A and Part B. To obtain Medicare Part D prescription drug coverage, you may enroll in a stand-alone Medicare Part D Prescription Drug Plan (PDP). Stand-alone Medicare Part D Prescription Drug Plans are offered by insurance companies approved by Medicare.
- Change from one Medicare Advantage plan to another
- Switch from a Medicare Advantage plan that does not include prescription drug coverage to one that does include prescription drug coverage, called a Medicare Advantage Prescription Drug plan (MAPD); or switch from a Medicare Advantage plan that does include prescription drug (MAPD) to a Medicare Advantage plan that does not include prescription drug coverage.
- Enroll in a stand-alone Medicare Part D Prescription Drug Plan (PDP) if you have Original Medicare or a Medicare Advantage plan that does not include prescription drug coverage. You cannot enroll concurrently in a stand-alone Medicare Part D Prescription Drug Plan (PDP) and a Medicare Advantage Prescription Drug plan (MAPD).
- Switch from one stand-alone Medicare Part D Prescription Drug Plan (PDP) to another.
- Drop Medicare prescription drug coverage. Give careful consideration before exercising this option. Unless you have creditable prescription drug coverage (creditable means prescription drug coverage that is at least as good a Medicare prescription drug coverage), you may have to pay a late enrollment penalty if you decide later you want to enroll in a Medicare plan that provides prescription drug coverage and you were without creditable prescription drug coverage for at least 63 consecutive days.
Fall Open Enrollment Period Tips
Beneficiaries receive information from their current plans on cost and coverage changes for the upcoming year before the Fall Open Enrollment Period begins. If you are enrolled in a Medicare Advantage plan and/or stand-alone Medicare Part D Prescription Drug Plan, you will receive this information in the Annual Notice of Change (ANOC) and Evidence of Coverage, which describes the coverage for the upcoming year. Plan changes may affect out-of-pocket costs, prescription drug coverage, the plan’s formulary, the plan’s network of participating providers, and new, continued or discontinued benefits. If you are in Original Medicare Part A and Part B this information appears in the Medicare & You handbook published for the next year. You can then evaluate your life circumstances and health status to determine whether your current plan meets your needs or if you need to explore other plans and coverage options.
Listed below are some considerations to keep in mind when deciding whether to enroll in, drop, or switch Medicare Advantage or Part D plan coverage during the Fall Open Enrollment Period:
- Compare out-of-pocket expenses such as copayments, coinsurance, monthly premiums, and annual deductibles, which may vary between insurance companies and by location.
- Be aware of the Medicare Advantage maximum out-of-pocket (MOOP) limit, which varies depending on your particular plan and on whether you use in-network or out-of-network providers. The maximum you could pay out-of-pocket may also vary from year to year for the same plan.
- Research whether a Medicare Advantage plan offers additional benefits that may be of value to you, such as routine vision, dental, and/or prescription drug coverage.
- If you currently have Original Medicare Part A and Part B and a Medicare Supplement (Medigap) plan, and you are considering enrolling in a Medicare Advantage plan for the first time, you may have a “trial right,” which would permit you to switch back to the same Medicare Supplement plan within one year (if it’s still available) if you disenrolled in the Medicare Advantage plan and switched back to Original Medicare.
- If you are in a Medicare Advantage plan and decide to switch back to Medicare Part A and Part B, you may want to check the availability of Medicare Supplement plans where you live. Medicare Supplement plans are offered by private insurance companies and can help you pay for out-of-pocket costs for services covered under Medicare Part A and Part B. These costs may include Medicare deductibles, coinsurance amounts or copayments, for example.
Options Outside of the Fall Open Enrollment Period
While the Fall Open Enrollment Period gives beneficiaries the opportunity to change their plan coverage each year, there are designated alternative enrollment periods that may be available. Two of these are described briefly below.
Special Election Periods (SEPs)
In certain situations you may be able to enroll in a Medicare Advantage plan or a stand-alone Medicare Part D Prescription Drug Plan. Those situations include, but are not limited to:
- Moving to a new address where your existing plan isn’t available.
- Losing your current coverage.
- Experiencing changes in your current plan that affect your health benefits.
Special Election Periods vary depending on personal circumstances that might affect your ability to receive Medicare benefits to which you are entitled if you were not permitted to make a change to your Medicare Advantage plan when the circumstance arose.
If you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare during the period which runs from January 1 to February 14. If you switch to Original Medicare during this period, you’ll have until February 14 to also enroll in a Medicare Prescription Drug Plan to add prescription drug coverage. Your coverage will begin the first day of the month after the plan receives your enrollment form.
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