Each year, the Medicare Annual Election Period (AEP) runs from October 15th through December 7th. This is a special time frame when Medicare beneficiaries have the option to make changes to certain types of Medicare health insurance plans. Any changes made during AEP will take effect January 1st of the upcoming year.
Insurance carriers are required to provide a detailed update each year by September 30th regarding your existing Medicare Advantage Plan or Part D Prescription Drug Plan. This notice is called the Annual Notice of Change (ANOC). Since these Medicare insurance plans run on a calendar year basis, there are usually some sort of changes in plan benefits and features from year-to-year. This is exactly why the Medicare AEP exists. It provides you with the “option” to change your plan, if it’s beneficial.
Here are some of the scenarios that can take place during AEP:
Take No Action
If you’re happy with your plan and wish to accept the new plan provisions for next year, no action is required. Your plan will automatically be renewed as of January 1st.
Change your Part D Prescription Drug Plan
If you feel your stand-alone Part D prescription drug coverage is no longer suitable for you, a plan change may be appropriate. Your current Part D plan might no longer cover your particular list of prescriptions as well as before (i.e. formulary changes)…OR…you may have several new prescriptions causing you to question whether you’re still in the right plan…OR…the plan premium is increasing more than you’d like. Regardless, you can switch to another Part D drug plan during AEP — with your current insurance carrier, or another carrier.
There are no health history questions to enroll in or switch your Part D prescription drug plan during AEP.
Change your Medicare Advantage Plan
If you feel your Medicare Advantage plan coverage is no longer suitable for you, a plan change may be appropriate. Since many Medicare Advantage plans include both medical and drug coverage, you might consider a plan switch during AEP if the medical and/or drug coverage changes to your detriment. It could be a drug formulary change, or one or more of your medical providers are no longer in-network with the plan. Additionally, the medical benefits can be impacted each year. For example, certain medical services may have increased copayments, or the plan’s medical maximum out-of-pocket limit may increase to a level that is out of your comfort zone. And of course, a plan premium increase can affect the affordability of the plan.
There are no health history questions to enroll in or switch your Medicare Advantage plan during AEP.
Switch from Original Medicare to Medicare Advantage (Part C)
When you have Original Medicare and a Medicare Supplement Insurance Plan (Medigap), you use Medicare Part A (hospital) and Part B (medical/outpatient) as your primary coverage…and then your Medigap plan as your supplemental plan for medical services. And you usually also have a stand-alone Part D drug plan, unless you have creditable prescription drug coverage from another source (i.e. VA, TriCare). What if you aren’t happy with your plan coverage, pricing, or have other issues with the plan?
You can switch entirely from Original Medicare to Medicare Advantage during AEP. If you switch to a Medicare Advantage plan that includes Part D coverage in this scenario, you will automatically be disenrolled from your existing stand-alone Part D drug plan with a January 1st effective date. However, you will still need to request cancellation of your existing Medigap plan as of January 1st.
There are no health history questions to switch to a Medicare Advantage plan during AEP.
Switch from Medicare Advantage to Original Medicare
In this reverse scenario, you would first need to see if you can be approved medically for a Medicare Supplement (Medigap) Plan. In this situation, insurance carriers are normally allowed to ask you health history questions, and could deny you from purchasing the plan. If you get the approval for a January 1st start date, then you know you can enroll in a stand-alone Part D prescription drug plan during AEP (do so no later than December 7th). Everything will start January 1st, and your existing Medicare Advantage plan will automatically be cancelled, due to the stand-alone Part D plan enrollment.
There are typically health history questions to switch to a Medicare Supplement (Medigap) plan. Though, certain states have special rules surrounding Medigap plan purchases that can avoid medical underwriting.
We have a complete summary of the Parts of Medicare on our website.
Reference Links
medicare.gov
Joining a Health or Drug Plan
Annual Notice of Change (ANOC)
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