Medicare Open Enrollment: Questions and answers you need to know
General Enrollment Information
When is the Open Enrollment period for Medicare?
The Medicare Open Enrollment period runs from Oct. 15 through Dec. 7 each year. During this period, people on Medicare have the opportunity to make a change in their coverage. If you are covered by Medicare, and you are interested in reviewing and comparing your Medicare coverage options, make sure the plans you are considering during the Medicare Open Enrollment period are Medicare plans, not Marketplace plans. Medicare plans are not sold through the federal or state Marketplace websites.
You can review and compare your Medicare options on the Medicare Plan Finder, a searchable tool on the Medicare.gov website, or by calling 1-800-MEDICARE (1-800-633-4227). You can also contact the State Health Insurance Assistance Program (SHIP) in your state. SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. You can call 877-839-2675 to get the phone number for the SHIP in your state.
What is the Medicare Plan Finder?
The Medicare Plan Finder is an online searchable tool on the Medicare.gov website that allows users to compare Medicare plan options, including Medicare Advantage plans, Medicare Part D plans and Medigap supplemental policies. You can get information about the coverage, costs, and benefits of different plan options in your area using the Medicare Plan Finder.
You can also enroll in a Medicare Advantage plan or a Medicare Part D plan on the Medicare Plan Finder.
My husband and I are retired. He just turned 65 and is now covered by Medicare, but I am 62 and I don’t have health insurance. As the spouse of a Medicare beneficiary, can I enroll in Medicare during the Medicare Open Enrollment period?
No. Although your husband now qualifies for Medicare, you will not qualify for Medicare until you turn age 65. If you do not have health insurance now, you can consider signing up for health insurance coverage through a Marketplace plan under Obamacare.
If your household income is less than 400 percent of the federal poverty level (about $66,000 for a couple in 2018), you may qualify for premium tax credits to reduce your cost of a Marketplace policy. If your household income is at or below 138 percent of poverty (about $22,700 for a couple in 2018), you might be eligible for Medicaid if you live in a state that has expanded its Medicaid program. (Gov. Rick Scott chose not to expand Florida’s Medicaid program.)
I am in traditional Medicare and don’t want to make any changes to my coverage. How does the Medicare Open Enrollment period affect me?
If you are happy with your coverage under traditional Medicare, you do not need to take any action during the Medicare Open Enrollment period. If you do nothing during the Medicare Open Enrollment period, your coverage under traditional Medicare will continue next year.
I have Medicare Part A and Part B. I’ve heard about Part C and Part D, but I don’t know what those are. Do I need to sign up for those during the Medicare Open Enrollment period?
Medicare Part C plans, also known as Medicare Advantage plans, are private health insurance plans, mainly HMOs and PPOs, for people enrolled in Medicare. If you enroll in a Medicare Advantage plan, you still have Medicare, but you get all of your Medicare-covered benefits through a private plan.
Most Medicare Advantage plans also cover prescription drugs and may cover other services, such as vision, dental, and hearing benefits. If you have Part A and Part B already, and are covered under the traditional Medicare program, then you do not need to sign up for a Medicare Advantage plan during Open Enrollment unless you want to get your Medicare benefits through a private plan.
Medicare Part D is the Medicare prescription drug benefit that is offered by private stand-alone prescription drug plans, sometimes called PDPs, and Medicare Advantage plans that cover drugs. If you are covered under traditional Medicare and you want drug coverage, you can enroll in a stand-alone drug plan during the Medicare Open Enrollment period.
If you did not sign up for a Part D plan when you got your Part A and Part B coverage and you do not have another source of drug coverage that is at least as good as Part D coverage, be aware that you may be charged a late enrollment penalty. Once you are enrolled in a Part D plan, you can switch drug plans during the Medicare Open Enrollment period.
To learn more about the Medicare Advantage plans and the Medicare Part D plans in your area, you can use the Medicare Plan Finder, a searchable tool on the Medicare.gov website. You can also call 1-800-MEDICARE (1-800-633-4227) or speak to someone at your local State Health Insurance Assistance Program (SHIP). SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. You can call 877-839-2675 to get the phone number for the SHIP in your state.
What changes can I make to my Medicare coverage during the Medicare Open Enrollment period?
During the Medicare Open Enrollment period, from Oct. 15 to Dec. 7, you can make many changes to your Medicare coverage, depending on the coverage you already have. You can change from traditional Medicare to a Medicare Advantage plan (or vice versa).
If you prefer Medicare Advantage, you can choose among the Medicare Advantage plans offered in your area during this period. If you are in traditional Medicare, and want prescription drug coverage, you can choose among Medicare prescription drug plans.
Can immigrants enroll in Medicare?
It depends. Residents of the U.S., including citizens and permanent residents, are eligible for premium-free Medicare Part A if they have worked at least 40 quarters (10 years) in jobs where they or their spouses paid Medicare payroll taxes and are at least 65 years old. Legal immigrants who are age 65 or older who do not have this work history can purchase Medicare Part A after residing legally in the U.S. for five years continuously.
Legal immigrants (non-citizen permanent residents) under age 65 with disabilities may also qualify for Medicare, but typically first must meet the same eligibility requirements for SSDI (disability benefits) that apply to citizens, which are based on work history, paying Social Security taxes on income, and having enough years of Social Security taxes accumulated to equal between 20 and 40 work credits (5-10 years).
New immigrants are not eligible for Medicare regardless of their age. Once immigrants meet the residency requirements, eligibility and enrollment works the same as it does for others.
Is there a lifetime limit on the number of times a person can switch Medicare Advantage and Medicare Part D plans, or can I shop around and switch every year if I want to?
You may switch Medicare Advantage and Part D plans every year during the annual Medicare Open Enrollment period (Oct. 15 through Dec. 7), and, if you are enrolled in a Medicare Advantage plan, you can also switch during the Medicare Advantage Open Enrollment period (Jan. 1 through March 31).
It is generally a good idea to compare your plan options every year, even if you are happy with your current coverage, since plans often make changes to their benefits, cost sharing, premiums, and/or provider networks from one year to the next. In addition, you may find another plan that meets your needs better than your current plan if your health needs have changed during the year.
Medicare Advantage Plans
What is a Medicare Advantage Plan? How does it differ from traditional Medicare?
Medicare Advantage plans are private health plans, such as HMOs or PPOs, that are offered by health insurers that have contracts with the Medicare program to offer benefits to people with Medicare. The plans provide all Medicare-covered benefits under Parts A and B, and usually provide Part D prescription drug benefits as well. Some Medicare Advantage plans may also provide benefits that are not covered under traditional Medicare, such as eyeglasses, some dental care, or gym memberships.
The plans also have a limit on out-of-pocket spending for services covered under Parts A and B, and may have lower cost-sharing than traditional Medicare for Medicare-covered services. However, Medicare Advantage plans restrict the health care providers that their enrollees can see (provider networks) whereas beneficiaries in traditional Medicare may see any doctor that accepts Medicare, without needing prior authorization or a referral from their primary care doctor.
I’ve been enrolled in a Medicare Advantage plan for several years, but I want to switch to traditional Medicare. Can I make that change during the Medicare Open Enrollment period?
Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from Oct. 15 to Dec. 7 each year. Your coverage under traditional Medicare will begin Jan. 1 of the following year. You can also make this change during the Medicare Advantage Open Enrollment period, which runs from Jan. 1 through March 31. If you make this change and you want drug coverage, be sure to sign up for a Medicare stand-alone prescription drug plan (PDP), unless you have creditable drug coverage from another source. If you do not, and you decide to sign up for Part D coverage later on, you may face a penalty for late enrollment.
You may also want to consider purchasing a Medicare supplemental insurance policy, known as Medigap. Medigap policies help to pay your cost-sharing requirements under traditional Medicare. However, since you have been enrolled in Medicare Advantage for several years, Medigap insurers are not required to sell you a policy if you don’t meet the medical underwriting requirements. You may want to contact a few Medigap insurers directly to see if you will be able to purchase a Medigap policy when you switch to traditional Medicare.
How can I switch from Medicare Advantage to traditional Medicare? Is there a form I need to fill out?
If you’re already in a Medicare Advantage plan and you want to switch to traditional Medicare, you should contact your current plan to cancel your enrollment and call 1-800-MEDICARE (1-800-633-4227). Note there are specific enrollment periods each year to do this.
I want to switch from Medicare Advantage to traditional Medicare but I still want drug coverage. What do I need to do?
If you switch from a Medicare Advantage plan to traditional Medicare and you want drug coverage, you can sign up during the Medicare Open Enrollment period for a stand-alone prescription drug plan in your area. Your new coverage will take effect on Jan. 1.
You can also switch from Medicare Advantage to traditional Medicare during the Medicare Advantage Open Enrollment period between Jan. 1 and March 31, when you can sign up for a stand-alone drug plan to add drug coverage. In this case, coverage begins the first day of the month after the plan gets your enrollment form.
You can compare your plan options and enroll in a drug plan by going to the Medicare Plan Finder, a searchable tool on the Medicare.gov website, or by calling 1-800-MEDICARE (1-800-633-4227). You can also contact the State Health Insurance Assistance Program (SHIP) in your state. SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. You can call 877-839-2675 to get the phone number for the SHIP in your state.
Can I be charged a higher premium for Medicare Advantage plans if I have a pre-existing condition or if I smoke?
No, Medicare Advantage plans charge the same premiums to all enrollees; they are not permitted to vary premiums based on age, smoking history, gender, or pre-existing medical conditions.
How can I find out if my doctor is in a Medicare Advantage plan network?
There are a couple of ways to find out if your doctor is in a Medicare Advantage plan network. If you have a particular plan or insurer that you’re looking into, you can go to the plan’s website and look for their searchable directory or find a plan directory on the website, where you can search for your doctor. You may also contact your provider directly to see if they participate in any Medicare Advantage plans. You should then verify with the plan(s) that the doctor is, in fact, in their network.
Medigap coverage
What is Medigap?
Medicare supplemental insurance policies, or Medigap policies, help to pay the copayments, coinsurance, and deductibles for Medicare-covered benefits under traditional Medicare (Part A and Part B services). Some Medigap policies also cover services that traditional Medicare does not cover, such as medical care when you travel outside the country. Medigap policies do not work with Medicare Advantage plans and will not help to cover Medicare Advantage enrollees’ out-of-pocket costs.
Can I get information about Medigap policies on the Medicare Plan Finder?
Yes, you can find some information about Medigap policies on the Medicare Plan Finder, by going to the link to view and compare Medigap plans under “Additional Tools.” This tool produces a list of companies in your area that offer each type of Medigap plan.
You can find more information about the plans available in your state by contacting your state’s health insurance department or your State Health Insurance Assistance Program (SHIP). SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. You can call 877-839-2675 to get the phone number for the SHIP in your state.
Can I use the Medicare Plan Finder to sign up for a Medigap policy?
No. The Medicare Plan Finder, a searchable tool on the Medicare.gov website, provides basic information about insurance companies in your area and the Medigap policies they offer, but you will need to contact the insurance companies directly to get more information and purchase a Medigap policy. You can find more information about the plans available in your state by contacting your state’s health insurance department or your State Health Insurance Assistance Program (SHIP). SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. You can call 877-839-2675 to get the phone number for the SHIP in your state.
Employer/retiree coverage
I am 66 years old, work for a large employer, and have health insurance coverage through my job. I am planning to keep working for a few more years and keep the coverage that my employer offers. What are my coverage options when I stop working?
When you stop working and/or your group health insurance coverage ends, you should enroll in Medicare Part A and Part B. If you’re eligible for premium-free Part A, you can sign up any time after you’re first eligible for Medicare. Your Part A coverage will go back retroactively six months from when you sign up (but no earlier than the first month you were eligible). You have an eight-month Special Enrollment Period (SEP) to enroll in Part B after your employment (and/or group coverage) ends to avoid facing a penalty for late enrollment. You may want to sign up for Part B in the few months before your group coverage ends to avoid a gap in coverage.
If your employer does not offer retiree health benefits for former employees on Medicare, you will also want to sign up for a Medicare Part D plan. If you opt for traditional Medicare, you can purchase a Medicare supplemental policy, also known as Medigap, which helps pay your Medicare cost-sharing requirements. You can also choose to get your Medicare-covered Part A, Part B and, typically, Part D benefits through a private Medicare Advantage plan. In that case, you won’t need to enroll in a Medigap policy or a separate stand-alone Part D plan.