Medicare Advantage Open Enrollment Guide

One of the two Medicare enrollment periods that start the new year is Medicare Advantage Open Enrollment. (The other is the General Enrollment Period.)

We've gathered the information you need to know about this enrollment period to help you determine whether or not you can participate and what action you want to take.

Key Facts

Eligibility: Currently enrolled in a Medicare Advantage plan
Enrollment Dates: January 1 through March 31 annually
Coverage Start Date: New coverage starts the first of the month after new plan receives notification
Action to Take: Choose a different Medicare Advantage plan or switch to Original Medicare with the option to enroll in a prescription drug plan.

What to expect

This enrollment period allows you to make changes if your current Medicare Advantage plan no longer meets your needs. Medicare Advantage plans are subject to change, and you may have switched to a new Medicare Advantage plan during the Annual Election Period without realizing the full implications.

Fortunately, you have from January 1 through March 31 to make one change. You can either enroll in a new Medicare Advantage plan or switch to Original Medicare.

As you decide whether or not to make a change, HMS director of quality programs and Medicare strategy Anne Davis suggests considering the following questions:

• "How has your experience been with your plan to date?
• Often the first few experiences will have been with your medications and prescription drug plan (if you enrolled in one) – are all of your medications covered? Are you having any trouble with accessing the care you need?
• Have you interacted with customer service or care management? How were those experiences?
• Did you experience a positive care transition? (Think about your relationships with your providers, medication transitions, any provider network changes).
• Have you reviewed your plan materials and had any questions answered?"

How to make changes

If you're switching to a new Medicare Advantage plan, you'll need to communicate with the private insurer sponsoring your plan. You can also work with a trusted insurance agent to help you with this process.

If you're switching to Original Medicare, you can work with your current Medicare Advantage plan to drop coverage or call Medicare.

When you make this change, you're also able to enroll in a prescription drug plan. Original Medicare does not offer prescription drug coverage, so purchasing a prescription drug plan can be a good idea. (Medicare Advantage plans offer qualifying drug coverage.)

Prescription drug plans are offered by private insurers. You can work directly with the insurance company offering the plan or with a trusted insurance agent to enroll.

Coverage offered

Medicare Advantage plans cover the same services Original Medicare does. These plans also offer qualifying prescription drug coverage, so you don't have to buy another plan. If you're planning to switch to a new Medicare Advantage plan, use our checklist to help you find a plan that meets your needs.

Original Medicare consists of two parts: Part A and Part B. Part A is hospital insurance. Part B is medical insurance. When you switch to Original Medicare, you'll want to look at Medicare prescription drug plans offered by private insurance companies to ensure coverage for medications. Check out our guide to evaluating a prescription drug plan.

Unlike Medicare Advantage plans, Original Medicare does not have annual out-of-pocket limits. Out-of-pocket limits help you control your spending on health care. Instead, you can purchase a Medigap plan from a private insurer to help with out-of-pocket costs for Original Medicare.

Since you're applying for Medigap coverage outside of its unique open enrollment period, your policy will go through underwriting to determine insurability.