Stuck on a Medicare Advantage plan and unhappy?
Don’t worry, we can help with options!
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Medicare Open Enrollment for Medicare Advantage and Medicare Part D rx is held each year from October 15th through December 7th. We think of it as an 'open enrollment' but it's formal name is Medicare 'Annual Election Period.'
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Although options are many, there are two main open period events where Medicare Products which hold annual ‘open enrollments’ each year which allows plan changes.
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Fall Medicare Annual Election Period= Oct 15th- Dec 7th: Encompasses enrollees of Medicare Advantage, Medicare Part D Rx, includes applicants with any prior coverage status including Original Medicare only. You simply need Medicare Parts A & B in place.
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Medicare Advantage Open Enrollment. Jan 1st to March: Duration is for Medicare Advantage Existing Enrollees only
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Other open enrollment qualifying events also exist for existing Medicare Advantage enrolless & SEP or loss of coverage events on a smaller scale which we will discuss further as well.
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FALL MEDICARE ANNUAL ELECTION PERIOD
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Each year in the fall Medicare holds an Annual Election period, commonly thought of as an Open Enrollment from October 15th to December 7th. You can make several types of enrollments and changes at this time:
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MEDICARE ADVANTAGE
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-Enroll in Original Medicare if you are currently enrolled in a Medicare Advantage plan
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Switch from Medicare to Original Medicare + Medicare Supplement plan can apply but not guaranteed issue
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Part D Prescription Drug application is allowed guaranteed issue
-Newly enroll in Medicare Advantage if you have elected Original Medicare Parts A+ B
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-Switch to any Medicare Advantage plans if you are currently a Medicare Advantage member
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-Change Medicare Advantage plans to a plan with a Part D RX plan bundled, or move to a Medicare Advantage plan without a Part D RX bundled.
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Medicare Part D RX Prescription Plans
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Medical issues come and go. Your health situation is always changing.
That is the constant!
Doctors try different prescriptions and remedies so your prescription plan has to adapt.
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We can try to help you fix this! You can shop Medicare Part D RX plans each year at this time at the AEP open enrollment searching out a plan and insurance carrier which may cover your new prescriptions (or alternatives).
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If you are enrolled in Original Medicare A&B with Supplement you can enroll in a new Part D RX plan whether or not you are a late enrollee or not.
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ou can also cancel your Medicare Part D RX coverage but buyer beware!
There is a penalty on individuals who drop Part D RX coverage for greater than 63 days if you re-enroll at at later time with the coverage gap.
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Here is more great information on the Part D RX penalty.
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The penalty isn’t a huge percentage but unfortunately stays with you for life.
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Plan changes and new enrollments processed during the Fall Medicare Open Enrollment (AEP) Oct 15th to Dec 7th period are effective January 1st.
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It is important to note if you are happy with your Medicare health plan and your Part D RX plan there is no need to do ANYTHING. Your plans will automatically renew.
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Medicare Advantage Open Enrollment Window Jan 1st -March 31st (the second one)
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Are you enrolled on a Medicare Advantage plan and missed the Fall Medicare Annual Election Period?
Fear Not.
From January 1st to March 31st each year there is a Medicare Advantage Open Enrollment period for exsiting Medicare Advantage enrollees.
This 2nd Open Enrollment Period is actually called Medicare Open Enrollment.
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During this period you can disenroll from Medicare Advantage plan and switch to Original Medicare A+B with Supplement PPO, or simply switch your Medicare Advantage plan within your same insurance carrier or at another.
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Within the Medicare Advantage Open Enrollment window Jan 1st – March 31st you can make one plan change (not 2), but you CAN switch you plan if you just recently made an open enrollment change in the Fall Medicare Annual Election Period Oct. 15th – Dec. 7th with effective date January 1st.
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You can only take advantage of this second Medicare Advantage Open Enrollment if you are currently enrolled in a Medicare Advantage plan.
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Also don’t forget, Medicare Supplements or Medi-Gap plans don’t have an annual ‘open enrollment’ window each year after the initial eligibility window or qualifying event so keep this in mind if switching from Medicare Advantage to Original Medicare.
You may qualify for a new Medicare Supplement plan but it’s medically underwritten based on health status.
Contact us if you have any questions on this!
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Auto Renewal​
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If you are happy with your Medicare Supplement plan and just want to keep your coverage, you can do so by just paying your bill and the plan will ‘auto-renew’.
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This also works for a Medicare Advantage plan ONLY if your current plan is going to continue to stay on the market.
Missed Original Medicare Enrollment?
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If you missed your original eligibility election window to elect Medicare Part A & B you can use the Medicare Open Enrollment period spanning Jan 1st to March 31st, with coverage effective July 1st each year.
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There is a penalty for late enrollees of Original Medicare A & B. Typically Part A is not the issue, as you are generally automatically enrolled in Part A unless you had to ‘buy-in’ for Part A.
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Penalty for late enrollment into Original Part B is 10% for each year you are late enrolling vs. your original eligibility date.
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Effective date of the late enrollment for Original Medicare Part B is July 1st if the Jan 1st – March 31st Medicare Advantage open enrollment is utilized.
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Common Mistakes
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What if you’re happy with your current plan, should you just ‘auto-renew?’
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It’s a mistake to ignore the Medicare Open Enrollment and not review your options.
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Even if you are happy with your health plan coverage and costs, each year it’s possible there are changes on plan co-pays, premiums, and covered medical expenses…particularly with Medicare Advantage.
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CMS released the base beneficiary premium amount for Medicare Part D plans in 2025 is $36.78, up from $34.70 in 2024. This means there was an upward trend on some Medicare Part D prescription plans and it's best to shop the market to make sure you're on the best plan that could be found on Part D drug plans.
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RECEIVE A PRICE REDUCTION AT RENEWAL?
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If you see a lower premium on a Medicare Advantage plan or Part D prescription plan our advice is to proceed with analysis and keep great caution.
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The cost of the plan is not just the monthly premiums.
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Total Cost Includes:
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-medical expenses out of pocket: co-pays or coinsurance cost sharing
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-the monthly premium of the Medicare Supplement, Medicare Advantage plan, or Part D premium
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-the cost of Medicare Part B premiums itself to the federal government.
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COVERED MEDICATIONS OR NOT?
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A common issue under Medicare Advantage or Medicare Part D is changes to the drug formulary list. It’s possible your existing prescription drug drops from the formulary list, which means covered drugs, in an effort to reduce cost.
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If this is the case you’d have to switch medications if you stay on the existing plan, or shop different Medicare Advantage plans or Part D plans which list the prescription on their formulary list.
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LOST DOCTOR ACCESS?​
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Another common issue with Medicare Advantage during a plan renew is getting mapped into a plan which your doctor isn't contracted with anymore.
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In this case you'd typically be informed of a plan cancellation back in August or September before the Annual Election Period.
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Then, if a replacement plan is offered which you are automatically 'mapped' to the contracted doctor networks change.
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Ufortunately too many people don't notice this until they try to visit their doctor in January or February of the new plan year.
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WONDERING IF YOU ARE ALREADY ON THE BEST PLAN?
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Often times we go on paying our monthly premiums year after year without a thought or care because checking the health insurance plan market is confusing and too overwhelming.
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Some people do a ton of plan analysis when they initially enroll in Medicare at age 65, but never review their options again.
This would be a mistake.
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It’s an error not to check the options to check if there is a better plan waiting for you.
The only constant in this world is change, particularly with health insurance.
For example, certain states have massively different percentages in eligible individuals enrolled in Medicare Advantage plans vs. those enrolled in Original Medicare + Supplements.
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As you can imagine, some of these folks are not enrolled in the most appropriate plan for their situation. There are market conditions which are different in each state.
The states with largely rural populations have very little Medicare Advantage enrollment due to lack of availability.
This is way below the national average of 30% population Medicare Advantage enrollment, or the current 54% Medicare Advantage plan enrollment based on Medicare Advantage vs. Original Medicare enrollment.
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Wait, say that again... Medicare Advantage plans are a staggering 54% of enrollment now!!
Kaiser Foundation Map below reflects recent Medicare Advantage enrollment growth by percentage.
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​​Why? The Medicare Advantage plans require larger populations and medical professionals to support the financial model. Some regions have hospitals which maintain near monopolies in select areas.
These can be more expensive for treatment and insurance contracting.
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The only real constant is change. There are new plans always coming on the market. Insurance carriers expand coverage areas for plans.
Drug lists change or get replaced.
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You may love your plan, but if you can get the exact same benefits from a different insurance carrier and save a few hundred dollars per year wouldn’t it be worth it?
Don’t presume your health will always be the same. It’s funny, some years back there was a study completed where most people when asked about the current state of health insurance market the replies were very negative. The market is terrible, the plans are too expensive, on and on.
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But, when asked about their own health plan, people often surprisingly respond….”But my health plan is fine. What I have is good.” It’s easy to talk yourself into thinking your health will never get worse.
But, the reality is, health situations change.
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Most people in bad health situations never thought they would be sitting in the boat they are in.
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Just add up the number of medications getting prescribed!
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80 percent of seniors ages 65+ take 2 prescriptions and 50 percent take four or even more.
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Most of your major health insurance bills will typically happen in this phase of life. Make sure you have coverage which suits you now but also helps just in case something large and unanticipated strikes!
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NEED HELP?!
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There are a lot of resources out there to get help. You are not alone!
Don’t sit there and pound your head against the wall.
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For starters, give us a call or email and we will answer your questions.
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1-866-486-6551 or help@plansforhealth.com
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To run an instant quote anytime click here:
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Make sure you run through a checklist of items before choosing the plan.
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Medicare Checklist
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Verify your doctors and hospitals are in network
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2. Check your prescription drugs with the plan drug formulary list on either
a) Part D RX prescription plan if choosing Original Medicare + Supplement
b) Medicare Advantage bundled Part D prescription plan
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3. Run quotes for all the available plans and insurance carriers in your area
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4. Talk to us, an experienced agency, to make sure you understand your options and your plan choice
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Check with Medicare.gov to make sure you’ve elected Medicare Part B. You can register your account on their website or just call them at 1-800-MEDICARE (1-800-633-4227).
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OTHER SEP SPECIAL ENROLLMENT PERIOD EVENTS
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There are other special enrollment period event where you can disenroll, enroll, or make changes to your coverage. We cover them in great detail here. But here’s a few of the more common ones:
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Move out of the Coverage Area
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Medicare Advantage plans have coverage areas or zones tied to medical groups and hospitals so if you move out of the coverage area it creates a qualifying event to enroll in a new Medicare Advantage plan or switch to Original Medicare.
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Loss of Coverage
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If you’ve recently lost an alternative health plan for example Employer sponsored coverage at your job, or become ineligible for a government program like Medi-Caid you earn a qualifying event to enroll in Medicare Advantage or Original Medicare.
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Medicare Chronic Special Needs Plan
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If you have a severely disabling condition which qualifies for SNP(special needs plan), and there is a Chronic Care Special Needs plan available in your area you may join it.
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Once you use this Special Enrollment Period and join a plan, your chance to change plans again ends.
It’s a one time only SEP.
