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The Ultimate Guide to Open Enrollment

You keep up with the times, but does your Medicare plan keep up, too? Medicare plans change every year, and your current plan may not be the best plan for you. Make sure your coverage is keeping up with your medication and health changes by reevaluating your existing Medicare coverage during the fall open enrollment period.


Everything you need to know about open enrollment.

What is Medicare open enrollment?

Open enrollment is an annual coordinated election period where you can join, switch, or drop a plan depending on your Medicare eligibility. The open enrollment period for Medicare Part D begins on October 15 and lasts until December 7 each year. During this time, you can join, switch, or drop a plan, with coverage beginning on January 1 of the following year. There is no limit on how many plan changes you can make during the open enrollment period.¹


When can I enroll in a Medicare plan?

Anyone 65 or older is eligible for Medicare, but when can you enroll?


Initial Enrollment Period

Your first chance to enroll in a Medicare plan is during the initial enrollment period. This is a seven-month period that begins three months prior to your 65th birthday and extends three months after the month you turn 65. If you sign up before the month you turn 65, your coverage will begin the month you turn 65. If you sign up the month you turn 65 or during the three months after, your coverage will begin the following month.²


Annual Enrollment Period

The open enrollment period for Medicare Part D begins on October 15 and lasts until December 7 each year. During this time, you can join, switch, or drop a plan, with coverage beginning on January 1 of the following year. If you didn’t enroll in Medicare when you were first eligible, you cannot use the fall open enrollment period to enroll. Instead, you must use the Medicare general enrollment period.¹


General Enrollment

Medicare general enrollment and Medicare Advantage open enrollment is from January 1 through March 31 every year. If you enroll during the general enrollment period, your coverage will take effect July 1.


What plan changes can I make during the Medicare open enrollment period?

If you are already enrolled in Medicare coverage, you do the following during the annual enrollment period:¹

  • Switch from Original Medicare to Medicare Advantage

  • Switch from Medicare Advantage back to Original Medicare

  • Switch between Medicare Advantage plans

  • Join a Medicare drug plan

  • Switch between Medicare drug plans

  • Drop Medicare coverage

Ensure your Medicare plan meets your needs.

Are your medication and health needs covered? Medicare plans change every year; what worked for you last year may not be the best option moving forward. Plans can be confusing, but here there are simple strategies that can help you find the best for you.


Check your Medicare Advantage plan.

If you have a Medicare Advantage plan, you usually have to receive your drug benefits through the plan rather than a separate Part D insurer.³ You may need to switch Medicare Advantage plans if your plan’s cover drug list changes. When choosing a new Medicare Advantage plan be sure to choose a plan that covers both your healthcare needs and your medications.


Check covered drugs and drug costs.

Plans change their lists of covered drugs and drug costs each year. Your medication needs also often change over time. Whether you have switched to a new medication, are taking an additional prescription to treat something new, or no longer need to take a medication that you had been taking last year, reviewing which plans are best for your current medication needs is crucial. There is a chance that your current plan offers great coverage for your needs but reviewing your plan options is recommended as there is a chance you may be eligible for coverage with a lower premium.


Check in-network pharmacies.

Choosing the best pharmacy for you and your family is as important as choosing the right doctor as pharmacists play a crucial role in helping gauge the best plan for your health and you need a pharmacy that can fulfill your healthcare needs. Part D plans typically require you to fill prescriptions at in-network pharmacies. When changing Medicare plans, check that your current pharmacy is in-network with the plan you choose to enroll in. If you have a good relationship with your current pharmacy and the pharmacy meets your healthcare needs, consult with your pharmacy to ensure that you are able to use them or if there is another plan that will work that also allows you to keep your current pharmacy.


Take a closer look at your premiums.

When comparing Medicare plan options, it’s easy to be compelled to go to the cheapest premium, but premiums shouldn’t be the only focus when considering Medicare plan prices. Also consider each plan’s out-of-pocket cost, including copayments, deductibles, and coinsurance costs.⁴


Check if you qualify for better benefits.

If you have a lower income, you may qualify for better benefits. Low-income members, including those who have both Medicare and Medicaid, can apply for different benefits. It is important to know all your options. Click here for more information on the “Extra Help” program. Part D members with Extra Help are not only eligible for lower copays, but members also have the ability to change plans up to once a month outside of open enrollment. This gives flexibility just in case something changes your financial situation and the Medicare plans need to be changed.³


Your Open Enrollment Resource

Make sure your coverage is keeping up with your medication and health changes by reviewing your Medicare Plan during the annual open enrollment period from October 15 through December 7. You can review your options independently by comparing your Medicare plan options online using Medicare.gov’s online plan finder.


If all the Medicare plans and options are overwhelming and confusing, you are not alone. Your pharmacy can help you review your Medicare options. As your trusted pharmacy resource, we want you to be able to leave with the confidence that the plan you pick is suited to your specific medications and needs.


Sources:

  1. https://www.medicareresources.org/medicare-open-enrollment

  2. https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start

  3. https://www.medicareresources.org/medicare-benefits/seven-rules-for-shopping-medicare-part-d-plans/

  4. https://www.medicareresources.org/newsroom/press-releases/avoid-these-costly-mistakes-during-medicare-open-enrollment/

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