When is Medicare Open Enrollment?

Louise Norris December 13, 2019

Medicare open enrollment dates

·         The annual Medicare open enrollment period runs from October 15 to December 7.

·         NEW as of 2019: Medicare Advantage open enrollment (January – March)

·         Medicare changes for 2020

Q: When is Medicare Open Enrollment?

A: The annual Medicare open enrollment period begins on October 15 and ends December 7. (Open enrollment for 2020 coverage has ended.) Open enrollment will begin again on October 15, 2020, for coverage changes effective in January 2021.

What is Medicare open enrollment?

Medicare open enrollment – also known as the annual election period or annual coordinated election period – refers to the annual period (October 15 through December 7) during which Medicare plan enrollees can reevaluate their coverage — whether it’s Original Medicare with supplemental drug coverage, or Medicare Advantage — and make changes if they want to do so.

During the annual enrollment period (AEP), a beneficiary can make changes to various aspects of coverage. If you’re enrolled in Medicare, you can:

·         Switch from Original Medicare to Medicare Advantage, or vice versa.

·         Switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another.

·         And if you didn’t enroll in a Medicare Part D plan when you were first eligible, you can do so during the general open enrollment, although a late enrollment penalty may apply.

·         If you want to enroll in a Medicare Advantage plan, you must meet some basic criteria.

·         You must be enrolled in Medicare Part A and B.

·         You must live in the plan’s service area.

·         You cannot have End-Stage Renal Disease (some exceptions apply; ESRD patients will be able to enroll in Medicare Advantage plans as of 2021, under the terms of the 21st Century Cures Act).

The annual open enrollment does not apply to Medigap plans, which are only guaranteed-issue in most states during a beneficiary’s initial enrollment period (a one-time, six-month window which begins when they’re at least 65 and enrolled in Medicare Parts A and B), and during limited special enrollment periods.

As of 2019, beneficiaries are able to utilize another open enrollment period that only applies to people who have coverage under Medicare Advantage plans. The Medicare Advantage open enrollment period runs from January 1 to March 31, and allows Medicare Advantage enrollees to either switch to Original Medicare (plus a Part D plan if they want one) or switch to a different Medicare Advantage plan.

Enrollees are only allowed to make one change during this three-month window — they can’t switch to a Medicare Advantage plan in February and then switch to a different one in March, for example.

Suggested read: Three Medicare open enrollment mistakes to avoid at all costs

Is auto-renewal available?

If you’re already enrolled in a Medicare Part D prescription plan or a Medicare Advantage Plan and you don’t want to make changes to your coverage for the coming year, you don’t need to do anything during open enrollment, assuming your current plan will continue to be available. If your plan is being discontinued and isn’t eligible for renewal, you will receive a non-renewal notice from your carrier prior to open enrollment. If you don’t, it means you can keep your plan without doing anything during open enrollment.

But be aware that your benefits and premium could change from one year to the next. So even if you’re confident that you want to keep your current coverage for the coming year, it’s important to make sure you understand any changes that may apply, and that you’ve double-checked to make sure that your current plan is still the best available option.

The available plans and what they cover changes from one year to the next, so even if the plan you have now was the best option the last time you shopped, it’s important to verify that again before you lock yourself in for another year.

Changing Medicare Advantage coverage after the annual enrollment period

Between January 1 and March 31 each year, if you are enrolled in a Medicare Advantage plan, you can leave your plan and return to Original Medicare, and buy a Part D prescription drug plan to supplement your Original Medicare. As of 2019, you also have the option to switch to a different Medicare Advantage plan during this time. From 2011 through 2018, there wasn’t an option to switch to a different Medicare Advantage plan outside of the fall open enrollment period unless you had a circumstance that allowed you a Special Enrollment Period. But the 21st Century Cures Act (Section 17005) expanded the timeframe of the window (from one and a half months to three months) starting in 2019, and allows people to switch from one Medicare Advantage plan to another.

Only one switch during this time frame is allowed each year — you can change your mind multiple times during the enrollment period in the fall, but can only switch to a different Medicare Advantage plan (or back to Original Medicare) once in the first quarter of the new year. But if you signed up for a Medicare Advantage plan in the fall and then decide you don’t like it once it takes effect in January, you have until the end of March to make a change.

You can only sign up for Part D coverage during the first three months of the year if you’re switching from a Medicare Advantage plan back to Original Medicare. You cannot, for example, be enrolled in Original Medicare with a Part D plan and then switch to a different Part D plan during the January — March enrollment period. Instead, you’d need to make that change during the fall election period (October 15 to December 7).

Enrolling in Original Medicare

If you didn’t sign up for Medicare A and B when you were first eligible, you have a chance to do so each year from January 1 to March 31, with coverage effective July 1.  But you may be subject to a late enrollment penalty. For Medicare Part B, the penalty is an additional 10 percent of the premium for each 12 month period that you were eligible but not enrolled.

There’s a late enrollment penalty for Medicare Part A as well, but it only applies to people who have to pay premiums for Part A. Most people get Part A for free, based on their work history or a spouse’s work history.

2020 Medicare coverage changes

·         Medigap plans that cover the Part B deductible (Medigap Plans C and F) will no longer be available for purchase by newly eligible Medicare beneficiaries as of January 2020. This rule change was part of MACRA (the Medicare Access and CHIP Reauthorization Act of 2015), and it was made because politicians felt that imposing the Part B deductible on all enrollees would help to avoid over-utilization of health care. When a person has Medigap Plan C or Plan F, they can receive all Part B services without any out-of-pocket costs. But if they have a Medigap plan that doesn’t cover the Part B deductible, they have to pay at least $198 for Part B services in 2020 (the Part B deductible increases over time, but it’s much smaller than the deductible under Part A, which can continue to be covered under Medigap plans sold to newly-eligible enrollees in 2020 and beyond). People who already have Medigap Plans C and F will be able to keep them, and people who are already eligible for Medicare prior to 2020 will still be able to buy those plans. But for newly-eligible enrollees, Plan C and Plan F will be discontinued after the end of 2019.

·         The donut hole is being eliminated in 2020 for generic drugs. (It was eliminated one year ahead of schedule, in 2019, for brand-name drugs). The gap in prescription drug coverage (the donut hole) starts when someone reaches the initial coverage limit ($4,020 in 2020), and ends when they have spent $6,350 (this limit for 2020 is significantly higher than it was in 2019). Prior to 2011, Medicare Part D enrollees paid the full cost of their medications while in the donut hole. But the ACA has been steadily closing the donut hole, and it will be fully closed by 2020, when enrollees in standard Part D plans will pay just 25 percent of the cost of their drugs all the way up to the catastrophic coverage threshold (insurers have the option to offer plans with lower cost-sharing, and many do). Although the donut hole is closing in terms of the maximum amount that enrollees pay at the pharmacy, it continues to be relevant in terms of how drug costs are counted for the purpose of reaching the catastrophic coverage level, and in terms of who actually covers those costs: Before the enrollee reaches the donut hole, the Part D plan covers the majority of the cost. Once they reach the donut hole, the drug manufacturer covers the majority of the cost. The Medicare Part D maximum deductible is $435 for 2020, up from $415 in 2019 (it increases each year, although some plans don’t have deductibles and others have deductibles below the maximum allowed).

·         Medicare Advantage plans will continue to see changes. Medicare Advantage plans continue to gain in popularity. 34 percent of Medicare recipients were enrolled in a Medicare Advantage plan in 2019—a significant increase from the enrollment total in 2010 when the ACA was signed into law (as of 2019, CMS reports that about 37 percent of Medicare beneficiaries have private coverage instead of Original Medicare; virtually all of those enrollees have Medicare Advantage, although a very small fraction have Medicare Cost Plans). Most people continue to have numerous Medicare Advantage plans as well as Part D plans available to them. However, these providers can change the coverage options they offer from year to year so it’s important to stay up-to-date.

·         Medicare Part B premiums are increasing. The standard Part B premium is $144.60/month in 2020, up from $135.50/month in 2019. And the Social Security cost of living adjustment (COLA) was enough to cover the full cost of the premium increase for most enrollees (this hasn’t always been the case in prior years).

·         The high-income threshold has been adjusted for inflation. Enrollees with high incomes pay higher premiums for Medicare Part B and Part D. For years, the threshold has been set at $85,000 for a single person, and $170,000 for a couple. But those numbers are being adjusted for inflation in 2020. The income-related monthly adjustment amount (IRMAA) will only be added to premiums when an enrollee’s income exceeds $87,000 ($174,000 for a couple).

Changes that took effect in 2019:

·         There’s a new premium bracket for the highest-income Part B and Part D enrollees. Under the terms of the Bipartisan Budget Act of 2018, enrollees with an income of $500,000 or more ($750,000 or more for a married couple) are paying a new, higher premium for Part B and Part D coverage in 2019 and future years. For reference, in 2018, the highest income bracket started at $160,000 ($320,000 for a married couple). The highest bracket now starts at $500,000 in income, and enrollees in that bracket pay $460.50/month for Part B (that’s increasing to $491.60/month in 2020). So when it comes to Medicare premiums, people earning $600,000 are no longer lumped into the same income bracket as people earning $200,000.

Each year, most Medicare beneficiaries should receive their Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from their existing Medicare Advantage and Medicare Part D plan providers by Sept. 30. CMS makes information available to the public on Medicare.gov in October. The Medicare website is also a tremendous asset for individuals with questions about Medicare rules, timelines, Medicare Part D, etc.

It’s important to carefully review the information sent to you by your plan provider, since this will cover any possible changes. For example, increasing co-pays, changes to drug formularies or changes to treatment coverage. Then during open enrollment, you can make changes that reflect your current health coverage needs.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Top of Form

Source: https://www.medicareresources.org/faqs/when-is-the-next-medicare-open-enrollment-period/
https://www.medicareresources.org/faqs/when-is-the-next-medicare-open-enrollment-period/  us: @EyeOnInsurance on Twitter | healthinsurance.org on Facebook