What to Know Before the Fall Open Enrollment Period

Guest Post by Lindsay Malzone

Medicare’s Fall Open Enrollment Period, also known as the Annual Enrollment Period (AEP), starts October 15 and ends December 7 each year. This is a chance for beneficiaries to make changes to their current coverage for the following year. If you or a loved one is a Medicare beneficiary, it helps to know a few things before this window begins. 

Changes you can make during the open enrollment period

Simply put, AEP allows you to enroll, switch, or disenroll from Medicare Part C (Medicare Advantage) and Part D prescription drug plans. Benefits on both types of plan are subject to change annually.

As a result, you could pay higher premiums, your doctor may leave your Advantage plan’s network, or your medication could be removed from the drug formulary on either a Part C or Part D plan. These are just a few reasons people switch or drop these plans. 

It’s important to understand that this enrollment window does not apply to Original Medicare (Parts A and B) or Medigap.

Learn more about the parts of Medicare

How to know what changes you want to make

Each September, before the start of AEP, beneficiaries get an Annual Notice of Change (ANoC) letter in the mail from their insurance carrier. This letter outlines changes to your current policy for the following year. It explains in full detail changes to your benefits, premiums, and other costs, or to the plan’s service area. Once you get your letter, it’s helpful to contact a licensed agent to go over your policy.

Beneficiaries enrolled in an Advantage plan should review their ANoC to ensure that their medications and dosages are still on the drug formulary and their practitioners are still in-network. Members of Advantage plans should also take note of maximum out-of-pocket costs and monthly premiums to make sure they’re still within their price range.

View Medicare Advantage Plan Checklist

Like Advantage plans, Part D plans inform beneficiaries of changes to their costs and formularies.

View Prescription Drug Plan (Part D) Plan Checklist

While reviewing your ANoC letter, it’s a good idea to consider any future doctor visits and procedures. This gives you a guesstimate about your potential out-of-pocket costs under your current plan.
 
Keep an eye out for this letter and make sure your coverage will still be sufficient and affordable for the next year. If you don’t receive your ANoC letter by the end of September, contact your provider.

Important things to remember

The effective date for your new plan will be January 1 of the following year. No matter when you make your changes during AEP, your new coverage will be effective on January 1 of the following year. Your next opportunity to make all the same changes will be this same enrollment period, the following fall. 

The last change you make is the one that goes into effect. AEP gives you multiple chances to make changes to your Advantage or Part D coverage; however, the last change you make is the one that will become effective on January 1. You have until the last day of AEP to make your final decision.

If you’re unhappy with your advantage plan, you have another chance to change it. It’s important to understand how each enrollment window works. If you’re not pleased with your Advantage plan, you have a three-month window to make changes.   

The Medicare Advantage Open Enrollment Period runs from January 1 through March 31. This enrollment period allows you to switch or disenroll from the Medicare Advantage plan you picked up during AEP.

Unlike AEP, you can only make changes one time, so it’s important to weigh all your options before this window kicks off. Further, if you’re unhappy with the changes you made during the Medicare Advantage Open Enrollment Period, you’ll need to wait until AEP next year, unless you qualify for a Special Enrollment Period.

Keep in mind that if you don’t already have a Medicare Advantage plan, you cannot enroll in a new one during the Medicare Advantage Open Enrollment Period.

Stay alert next fall

Regardless of whether you make changes to your coverage this year, you should check on your plan and ANoC every year to see if you’ll want to make changes during AEP.

To recap, here’s a few things to take into consideration: 

• Has my doctor been removed from my Advantage plan’s network of providers?
• Have my plan’s ratings changed? 
• Do I plan on traveling next year?
• Are my annual medical costs expected to rise?
• Will my monthly premiums increase? 
• Are my prescriptions still listed on my plan’s drug formulary?

Before AEP begins, it’s best to understand your health needs, the changes you can make, and how this enrollment window works. If you have more questions about AEP, contact a licensed agent who can walk you through the entire process.

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in Medicare since 2017. She is featured in many publications and has become the expert in the Medicare industry. Her passion is providing Medicare beneficiaries with the resources they need to make an educated decision on their healthcare needs and provide them the opportunity to learn about Medicare in a non-sales environment. You can also find her over on YouTube where she publishes Medicare-related video content regularly.