Should I Change my Medicare Coverage During the Open Enrollment Period?

Every year, the Centers for Medicare & Medicaid Services gives Medicare enrollees the opportunity to make changes to their Medicare insurance coverage during the Open Enrollment Period (OEP). 

Changing your Medicare benefits isn’t mandatory. If you’re satisfied with your coverage, you can keep the plan you have, whether it’s Original Medicare Parts A and B or a Medicare Advantage (Part C) plan. But if you aren’t totally satisfied, CMS gives you the right to switch your coverage without penalty. 

Medicare Benefits Solutions

Oct 28, 2021

 4 minutes read

If you’re thinking that this year is a good time to replace your current plan with one that fits your health care needs and budget better, here’s a closer look at reasons to do so during OEP. 

When is OEP and what changes can enrollees make to their Medicare benefits?

The Medicare Open Enrollment Period – or OEP – begins on October 15th and ends on December 7th every year. Any changes you make to your Medicare insurance during this period kick in on January 1st of the following year. 

During OEP, beneficiaries can do the following: 

  • Change coverage from Original Medicare to Medicare Advantage 
  • Drop a Medicare Advantage plan and return to Original Medicare Parts A and B
  • Switch from their current Medicare Advantage plan to another one 
  • Switch from a current Medicare Part D plan to a different one

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Why should I make changes during OEP?

If you switch coverage during OEP, you won’t pay any penalties, and you won’t have to pay higher monthly premiums for Medicare insurance. 

Here’s a look at some reasons you should change your Medicare coverage during OEP:

You need more comprehensive coverage

You may need additional benefits like dental, hearing, and vision care services that Original Medicare doesn’t cover. Enrolling in a Medicare Advantage plan that includes extra benefits is a good idea if you’re paying too much for expenses like eyeglasses, hearing aids, dentures, and fitness club memberships. 

You find a less expensive plan with similar coverage

Even if your current plan isn’t increasing its monthly premium or prescription drug costs, you may find a less expensive alternative available in your area. 

During OEP, use online search tools to look for plans. Compare costs and benefits to find a plan that offers coverage equivalent to what you have now. Getting the same benefits at a lower cost is a winning situation.  

Your prescription medications are no longer covered, or they are too expensive

If you are enrolled in a stand-alone Part D (prescription drug) plan, or in a Medicare Advantage plan with prescription drug coverage, every fall you get an Annual Notice of Change (ANOC) letter. This is an announcement from your plan provider about changes in coverage and costs for the upcoming year. 

Carefully review your ANOC to see if your prescription drugs are still on the plan’s formulary for the new year and whether the out-of-pocket expenses increase. If you aren’t happy with the report, you should have a look around for other Part D plans that cover your drugs at a cost you can afford. 

You also have the option to switch from Original Medicare plus Medicare Part D over to a Medicare Advantage plan that includes prescription drug coverage. But do your homework and ensure that the plan includes your prescription drugs on its formulary. 

Your preferred health care providers are no longer included in your plan’s provider network

Having a Medicare Advantage plan may mean that you must use health care providers, medical facilities, and medical suppliers – like pharmacies – within a set network. This isn’t the case with Original Medicare which allows you to use all health care providers and facilities that accept Medicare assignment. 

If your Part C plan makes changes to the people in the network and you lose access to a trusted doctor or can’t go to your neighborhood pharmacy, you can look for a different Medicare Advantage plan that includes your providers. You can also switch back to Original Medicare. Just make certain that your health care providers accept Medicare assignment if you choose the latter option.

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