Medicare Advantage open enrollment

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Medicare Annual Enrollment (AEP) runs in the fall each year, but there’s another time when you can switch plans. It’s called the Medicare Advantage Open Enrollment Period.

During the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31, beneficiaries who already have a Medicare Advantage plan may:

Switch Medicare Advantage plans
Swap a Medicare Advantage plan for Original Medicare (and add a part D plan if desired)
Plus, only one change can be made during this period

The Medicare Advantage Open Enrollment Period doesn’t allow you to make as many changes as during the Medicare Annual Enrollment Period. During the Medicare Annual Enrollment Period (October 15 – December 7 each year), you’re able to also:

Switch to a Medicare Advantage plan from Original Medicare
Change Part D prescription drug benefits

Read more about how Medicare Advantage plans work.

Key Takeaways

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31 and is when Medicare Advantage plan members can switch Medicare Advantage plans or swap a plan for Original Medicare.
Medicare Advantage beneficiaries can also change coverage during the annual Medicare Annual Enrollment Period between October 15 to December 7. Compare premiums, out-of-pocket costs, supplemental benefits, provider networks, prescription drug coverage, and the plan’s quality rating when comparing Medicare Advantage plans.
Costs for Medicare Advantage plans vary, but many insurance companies also offer zero-premium plans.

When can you sign up for Medicare?

You can sign up for Medicare three months before the month in which you turn 65, during the month you turn 65, and within three months after the month you turn 65 or, if you are younger than 65, if you have a qualifying disability, such as end-stage renal disease or ALS.

When you sign up, you can choose either Original Medicare or a Medicare Advantage plan. Original Medicare provides hospital and physician coverage through the federal government. If you want prescription drug benefits, you have to purchase a Medicare Part D plan, too.

Medicare Advantage (also known as Part C), on the other hand, provides hospital and physician coverage found in Original Medicare, but usually also offers prescription drug coverage and supplemental benefits, such as vision and dental. 

If you don’t choose Medicare Advantage when you become eligible, you have to wait until the annual Medicare Annual Enrollment Period, which runs from October 15 to December 7, to sign up for Medicare Advantage. You can’t sign up for Medicare Advantage for the first time during the Medicare Advantage Open Enrollment Period. Instead, only those who already have a Medicare Advantage plan can change Medicare Advantage plans or switch to Original Medicare.

Find out more about the differences between Original Medicare and Medicare Advantage.

How to compare Medicare Advantage plans

Private insurance companies offer Medicare Advantage plans. Insurers have flexibility when creating plans. These plans can range in premiums, deductibles, out-of-pocket costs, supplemental benefits and provider networks.

When comparing Medicare Advantage plans, you’ll want to think about and compare:

Premiums
Out-of-pocket costs
Supplemental benefits
Provider network
Prescription drug benefits
The plan’s quality rating

Medicare Advantage monthly premiums can vary by plan. However, many plans have zero premiums. Medicare Advantage plans also have an annual out-of-pocket maximum. An “out-of-pocket maximum” is considered the most money you’ll pay for services in a Medicare Advantage plan in 2023.

Usually, Medicare Advantage plans with the lowest premiums have the highest out-of-pocket costs. On the flip side, plans with higher premiums often have lower out-of-pocket costs.

So, when you’re comparing plans, make sure to compare premiums, deductibles and out-of-pocket costs and weigh the different costs.

Think about how much health care you needed over the past year and what you expect for the next year. If you regularly see doctors, you may want a plan with higher premiums but lower out-of-pocket costs.

If you don’t need to see a doctor except for an annual physician, a plan with low premiums and higher out-of-pocket costs could be a better fit.

You’ll also want to compare the plans’ supplemental benefits. The vast majority of Medicare Advantage plans have prescription drug benefits. Many also offer telehealth, vision and dental coverage. A growing number may provide supplemental benefits like home health care, palliative care and adult day health services. 

Medicare Advantage insurers also may offer plans geared to people living with specific health issues, such as diabetes and congestive heart failure. Some plans also help people with chronic conditions manage their diseases, including non-medical help with grocery shopping and meal delivery. There are even plans that offer reimbursement for transportation to doctor and other appointments.

Next, make sure your providers accept the specific Medicare Advantage plan. Providers may accept one plan from an insurer, but not another, so ask about the specific plan. Also, see if other local providers and your preferred hospital take the Medicare Advantage plan. You never know when you might see a specialist. Check whether there’s a network of nearby providers.

A plan will also dictate whether you can see a provider outside your network. A Health Maintenance Organization (HMO) plan won’t reimburse for care outside of your network. A Preferred Provider Organization (PPO) plan allows you to get care outside of your network, but you’ll likely pay more for that care. So, if you want more flexibility, a PPO might be better for you, but those plans are also usually more expensive than HMOs.

If you’re on medication, make sure the plan covers it and see how much you’ll pay for your prescriptions. Prescription drugs can be a major cost for Medicare beneficiaries. Make sure you’re comfortable with drug costs in the plan.

One other thing to check out is the plan’s quality rating. Medicare offers star ratings for each Medicare Advantage plan, which considers the quality of care and customer service.

You can compare Medicare Advantage plans by star ratings on the Medicare Plan Finder. The Plan Finder also includes cost estimates, including premiums, out-of-pocket and drug costs. The Centers for Medicare and Medicaid Services’ tool also asks you questions to help narrow your choices.

Source:

Medical News Today. “Medicare Advantage: Monthly costs and more.” Accessed August 2022.

Disclaimer:

Insure.com is not affiliated with or endorsed by the government or Federal Medicare program. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Currently we represent 10 organizations which offer 100 products in your area. Please contact Medicare.gov, 1800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Not all plans offer all of these benefits. Benefits and availability may vary by carrier and location. Limitations and exclusions may apply. Every year, Medicare evaluates plans based on a 5-star rating system. Part B Premium give-back is not available with all plans. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply. Enrollment in the described plan type may be limited to certain times of the year unless you qualify for a Special Enrollment Period.

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Les Masterson

Contributor

Les, a former managing editor, insurance, at QuinStreet, has more than 20 years of experience in journalism. In his career, he has covered everything from health insurance to presidential politics.

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