5 Answers that Clear Up Medicare Open Enrollment Period Confusion

Updated September 10, 2021.

Just when you started to think health insurance made sense, you became eligible for Medicare!

Medicare has its own processes, rules, and enrollment periods that can be tricky to understand at first.

“Medicare has several different enrollment periods, so it can be confusing to keep track of everything and remember which enrollment period is for what,” says Lindsay Engle, Elite Insurance Partners, LLC Marketing Manager.

The Medicare Open Enrollment is one of those periods.

Here are five things you should know about the Medicare Open Enrollment:

• What is the Medicare Open Enrollment Period?
• Who does it apply to?
• What are the dates?
• What’s with the advertising?
• What do I need to do?

What is the Medicare Open Enrollment Period?

Over the years, you may have gotten used to the Open Enrollment Period for enrolling in health insurance every November. The Medicare Open Enrollment Period overlaps with those dates, so it may seem like it’s the same thing but for Medicare.

The short answer: It’s not.

If the Medicare Open Enrollment Period isn’t for enrolling in a plan, what is it for?

The Medicare Open Enrollment Period gives you an opportunity to review and make changes to your current Medicare coverage:

• Switch between Original Medicare (Parts A and B) and a Medicare Advantage Plan (Part C).
• Change to a new Medicare Advantage Plan.
• Change your prescription drug coverage by switching to a new plan, dropping coverage, or enrolling in a plan for the first time.

If you have a Medicare Advantage plan that offers qualifying prescription drug coverage, you do not need to enroll in Part D. If you do, you’ll be automatically disenrolled from your Medicare Advantage plan and enrolled in Original Medicare.

As you evaluate your prescription drug coverage, check the formulary (drug list) to make sure the medications you need are covered. This will help you decide if you need to enroll in a new plan or keep your old one.

Before opting out of prescription drug coverage, be aware that there is a late enrollment penalty if you are without creditable prescription drug coverage and enroll in a Part D plan later.

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Who does it apply to?

While you can switch from Original Medicare to a Medicare Advantage plan during the Annual Election Period (AEP), the Annual Election Period primarily affects people with Part C (Medicare Advantage Plans) or Part D (Prescription Drug Plans). The Medicare Open Enrollment Period does not apply to Medicare Supplement Plans (Medigap).

“While it is critical that they examine their Part D (drug) plan at this time every year, it is important that they understand that the Medigap, otherwise called Medicare Supplement plans, do not change and do not need to be changed during this time period. Each Medicare Supplement plan automatically renews on the policy anniversary and nothing can change with those policies,” says Christopher L. Westfall, Sr., from Senior Savings Network.

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What are the dates?

The Medicare Open Enrollment Period runs each year October 15th through December 7th. Keep these dates in mind, especially because they are different from health insurance Open Enrollment dates, even though the periods overlap.

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What’s with the advertising?

Health insurance companies do a lot of advertising during the Medicare Open Enrollment Period and during health insurance Open Enrollment. Because the dates overlap, you may feel like you’re being bombarded with health insurance ads.

The Medicare Open Enrollment Period is a money-making opportunity for Medicare providers. During this time, Medicare beneficiaries can enroll in a new plan and switch health insurance companies.

“I think the Open Enrollment Period (OEP) can be very confusing sometimes. There is so much advertising EVERYWHERE. It makes clients think that they have to change their plan or sign up for it again,” says Katherine Adams, founder of Creative Legacy Group.

Don’t be confused by the ads. Make sure you understand your Medicare plans and how the Open Enrollment Period works. Review your current coverage to make sure that it will continue to meet your needs next year.

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What do I need to do?

Now that you have a better understanding of what the Open Enrollment Period is, the next thing to figure out is what to do.

Melissa Negrin-Wiener, Genser Cona Elder Law Partner, suggests taking these steps:

1. “Read your Annual Notice of Change mailed to you every September informing you of any changes to your plan, such as changes in premiums, co-pays, pharmacies and prescription drug coverage.
2. Review your coverage, costs, and doctors to determine if you should switch from traditional Medicare to a Medicare Advantage Plan.
3. Review your medications and change your Part D plan if your prescriptions are no longer covered or your costs have increased.”

Following these steps if you have a Medicare Advantage or Prescription Drug Plan will help you ensure that your Medicare coverage will be sufficient for next year.

Doing nothing during the Open Enrollment Period does not mean that you won’t have coverage next year. In most cases, you'll be automatically re-enrolled in your current plans. However, if you want to be on the safe side, it doesn’t hurt to contact your health insurer to double-check your enrollment.

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Want more insight into the Medicare Open Enrollment Period? Check out these articles and our downloadable guide:

"Ways to Prepare for Medicare Open Enrollment"

"Pitfalls to Avoid During Medicare Open Enrollment"