Use this guide to assess your current health needs and make sure your plan works for you.
From October 15 to December 7, you get a chance to run your own checkup—on your Medicare health and prescription drug coverage. If you have Medicare, it’s one of the most important things you can do each year for your well-being.
After all, your health or other life factors may have changed in the past year. Medicare Open Enrollment gives you the opportunity to make sure your plan will fit your needs in the coming year.
Or if you’ve been considering switching from Original Medicare (Parts A and B) to a Medicare Advantage Plan (an all-in-one alternative to Original Medicare), or vice versa, Medicare Open Enrollment is a chance to do so.
To help you assess your needs and options, here are some of the most common questions older adults have about Medicare in general and Medicare Open Enrollment specifically.
Question #1: Why Should I Care About Open Enrollment?
There are two big reasons. One, your health may have changed since last year, so you may need more or less coverage. Two, your Medicare Advantage Plan (Part C) or Medicare Prescription Drug Plan (Part D) may be changing, or you may have different options available now than when you initially enrolled in Medicare.
To get a handle on your health needs and costs, you may want to review your recent claims and other financial records. You may also want to ask your current doctors about any preventive or ongoing care you may need. For example, are you due for any colon or breast cancer screenings?
- Doctor visits
- Medications or therapies
- Major changes in your health in the past year
- Unexpected health care costs in the past year
- Screenings or procedures in the coming year
If your Medicare Advantage Plan or Medicare Prescription Drug Plan is changing, you’ll receive an Annual Notice of Change (ANOC) document in September. It’s important to review this document because it shows any changes to your:
- Service area or provider network
If you’re enrolled in a Medicare Advantage Plan, health care providers can join or leave a network anytime, and plans can change providers in the network anytime. But if you’d prefer to stick with your current providers, now is a good time to check if they anticipate that they’ll be part of your network.
Didn’t get an Annual Notice of Change document or need more information about any changes? Contact your plan.
Has your plan let you know it is no longer participating in Medicare in the coming year? You can choose a new plan between October 15 and December 7.
Question #2: What Are My Options During Open Enrollment?
There are a few common moves you can consider.
Join or change your Medicare Advantage Plan. These plans include hospital care and medical or doctor care that you would otherwise receive through Original Medicare. Most plans also include prescription drug coverage and extra benefits that Original Medicare doesn’t cover, such as vision, hearing, and dental.
Switch to Original Medicare. This includes hospital care and medical or doctor care. However, you may want Medicare Supplement Insurance (Medigap) or other supplemental insurance to help cover the higher out-of-pocket costs, such as deductibles, copayments, and coinsurance.
Original Medicare doesn’t include prescription drugs, so you may also want to join a Medicare Prescription Drug Plan. It also doesn’t include eye exams for prescription glasses, tests for fitting hearing aids, or most dental care, among other things. See a list of what Original Medicare doesn’t cover here.
Change or drop your Medicare Prescription Drug Plan. You might choose to do this if, say, your current plan will no longer cover a specific medication.
Question #3: How Should I Compare My Options?
Whether it makes sense to have Medicare Advantage or Original Medicare with Medigap depends on your situation and preferences.
Price—how much you pay in premiums, copayments, coinsurance, and other out-of-pocket costs—is an important factor. Also important: which doctors you can see, which tests and services are covered, and if there are any extra benefits included.
Often, it’s a trade-off. For example, Medicare Advantage Plans generally charge lower premiums, but you typically need to use doctors in a specific provider network. Medigap, on the other hand, is accepted anywhere that accepts Original Medicare, which means a wider selection of providers. But that larger array of providers generally means higher premiums.
What else to keep in mind: Many Medicare Plans include SilverSneakers, a health and fitness program designed for adults 65+. Learn more with this handy guide to SilverSneakers.
Question #4: When Do Changes Take Effect?
Any changes to your coverage take effect on January 1 of the following year, whether you:
- Change plans.
- Keep your current plan, but it has coverage, cost, or other changes.
Question #5: What If I Want to Keep My Current Plan?
If you don’t do anything during Open Enrollment, your current plan will automatically renew unless it is no longer participating in Medicare.
Question #6: Are There Any Limitations to What Changes I Can Make?
From October 15 to December 7, you can switch between Medicare Advantage Plans. You can also switch from Medicare Advantage to Original Medicare, but you may not be able to buy a Medigap policy.
Here’s the deal: You can sign up for a Medigap policy within six months of turning age 65 and being enrolled in Medicare Parts A and B. But after this initial enrollment period, you may not be able to buy a Medigap policy—or it may cost more.
Depending on your situation, there may be additional limitations or guidelines. Consult any documents your current plan sends you, and check the resources below.
Question #7: Where Do I Start?
Remember, Open Enrollment runs from October 15 to December 7. Even if you’re happy with your current Medicare health and prescription drug coverage, it’s a smart idea to review your health needs and costs, and your Annual Notice of Change document.
Plus, check out these resources:
- Get the official Medicare handbook from the Centers for Medicare and Medicaid Services.
- Find a Medicare counselor through your State Health Insurance Assistance Program.
- Learn more about SilverSneakers, a health and fitness program included in many Medicare Plans.
Check Your SilverSneakers Eligibility Instantly
SilverSneakers members can go to thousands of gyms and fitness locations across the nation, plus take SilverSneakers LIVE online classes that are designed for seniors of all levels and led by supportive instructors. If you have a Medicare Plan, it may include SilverSneakers—at no additional cost. Check your eligibility instantly here.
Not eligible for SilverSneakers? You can still get 200+ free SilverSneakers On-Demand videos and stay in touch with us by creating your online account.