When, What & Why of Medicare Open Enrollment

Navigating the nuances of health insurance while also managing lung cancer can be a lot to juggle. In order to simplify the information, outlined below is the when, what and why of Medicare Open Enrollment.

When is Medicare Open Enrollment?

Medicare Open Enrollment runs from October 15-December 7. Any changes to plans or new coverage will begin on January 1.

What is Open Enrollment?

Open Enrollment is the period each year when you can make changes to certain parts of your Medicare coverage. These are the changes you can make during open enrollment:

  • If you have original Medicare (Parts A and B), you can enroll in a Medicare Advantage Plan (also known as Part C or Medicare HMO or PPO). Most Medicare Advantage Plans now include prescription drug coverage.
  • If you have a Medicare Advantage Plan, you can switch back to original Medicare Parts A & B.
  • If you have a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan.
  • If you have Medicare Parts A or B, you can join or drop a Medicare prescription drug plan (also known as Part D).
  • If you are enrolled in a Medicare prescription drug plan, you can change to a different plan.

Why would I need to make changes to my coverage?

There are many different reasons why someone might make changes to their Medicare plan coverage during open enrollment. These include:

  • Your health changes and you will require new or frequent doctor or hospital visits. For someone with only original Medicare Parts A & B, the out of pockets costs for frequent outpatient office visits or hospital stays can be quite high. In these situations, enrolling in a Medicare Advantage Plan or purchasing supplemental insurance can be beneficial.
  • You change doctors and your new doctor is not in-network with your current plan. Before making any changes to a Medicare Advantage Plan always make sure that your doctors are in-network. Also, some plans provide only regional coverage, which limits your ability to receive care out of your state. For some people that is not a problem, but for others it is.
  • You are on a new medication(s). Your prescription drug needs may change throughout the year. In addition, the formulary (list of covered drugs) for your current Medicare Advantage Plan or Part D coverage may change year to year. It is important each year to review your current prescriptions and compare them to your plan’s formulary to make sure your plan covers the prescriptions you need.

Additional enrollment period through March 31

New in 2019, an additional Medicare Advantage open enrollment period was added. From January 1 to March 31 you can make some additional limited changes to your Medicare coverage. These changes include the following:

  • If you are enrolled in a Medicare Advantage Plan, you can leave it and return to original Medicare, and buy a Medicare prescription drug plan.
  • If you are enrolled in a Medicare Advantage Plan, you can change to a different Medicare Advantage Plan.

During this period from January 1 to March 31, you cannot:

  • Change from original Medicare to a Medicare Advantage Plan.
  • Make more than one change.

Looking for more information?

For more information, visit the Medicare website, call 1-800-MEDICARE (1-800-633-4227), or contact the State Health Insurance Assistance Program (SHIP) in your area.

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