Missed Medicare’s Open Enrollment Period? Here Are Some Options

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Contributor, Benzinga
December 14, 2022

The Medicare Open Enrollment Period ended Wednesday, December 7. Here’s what that means and what you might still be able to do.

Also known as the Annual Election Period (AEP), this is the yearly opportunity for millions of seniors to review their current Medicare Advantage and prescription drug plans. Those who find better coverage or a lower price are able to freely switch for the coming year.

When you are first eligible for Medicare, you can enroll in a Medicare Advantage (MA) plan or just stick with Original Medicare. Those who go with basic Medicare may also add a Medicare Supplement (Medigap) as well as a stand-alone prescription drug plan (Part D). Once you have enrolled, you generally can’t switch plans anytime you want. That’s what makes the Medicare Open Enrollment period such a unique opportunity. For the 26 million Americans with MA coverage as well as the 23 million with stand-alone drug plan coverage, it’s the opportunity to find a better or less expensive option.

If You Failed To Act, A Money-Saving Tip

If you missed Open Enrollment, don’t worry. You are not alone. You will continue to be covered by your current Medicare plan choices in 2023. 

According to the American Association for Medicare Supplement Insurance, most people with Medicare plans fail to act during Open Enrollment. Here’s what experts suggest you can still do.

Sometime during the Fall, you would have received a notice regarding changes to your 2022 plan. It’s a smart move to review that document again to avoid any coverage surprises in the coming year. If you are unable to find a copy, most plans make their documents available online.

Medicare prescription drug plans tend to change each year. What you’ll pay for your prescription medications will typically increase. If the plan has announced higher pricing, consider refilling current prescriptions prior to the end of the year. Sometimes the savings will be small. Other times acting before December 31st could result in a significant cost difference.

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Options For Those Who Missed Open Enrollment

If you discover that you are unhappy with changes made to your Medicare Advantage plan coverage in 2023, there’s one more chance to switch.

Between January 1 and March 31, you can generally make a change in plans. You are limited to one change during this time period.

Similarly, during this time period, you can drop your MA plan and return to Original Medicare. This is particularly valuable for those who may find themselves wanting medical services outside of their plan’s coverage. For example, you want to see non-participating specialists or seek care at the Mayo Clinic which recently announced it would no longer accept MA plan participants.

If you drop your Medicare Advantage plan during this time, you can enroll in a stand-alone Medicare Part D Prescription drug plan. Most seniors have as many as 20 different plans available. To find the best Medicare drug plan coverage, be certain to compare all plans available in your Zip Code.

Did Your Plan Receive A 5-Star Rating?

Medicare rates Medicare Advantage and drug plans by assigning 1 through 5 stars. The rating is based on information Medicare collects from member satisfaction surveys, healthcare providers and the plans themselves.

If your plan received 4 stars or less, you can switch to a 5-star plan if one is available in your area. The window for switching is nearly a yearlong beginning immediately after the conclusion of Medicare Open Enrollment.

The 5-Star Special Enrollment Period applies to Medicare Advantage and stand-alone drug plans. It generally pays to speak to an independent Medicare Advantage agent in your area to inquire about plan star ratings and your opportunity to switch.

Other Qualifying Events Permit Switching

There are other situations when you may be able to make coverage changes outside of the Medicare Open Enrollment Period. Here are a few examples:

  • You moved out of your plan’s service area.
  • You are moving back to the United States after living abroad.
  • You left/lost your employer or union-based health insurance.
  • You used to be eligible for Medicaid, but now you are not.
  • You just got out of jail.

With over 62 million Americans on Medicare, the program has grown enormously complex. While the annual Open Enrollment Period has ended, it’s never too soon to connect with knowledgeable specialists. Many are well trained in the intricacies of the program and only too happy to assist by answering your questions.

About Jesse Slome

Medicare Expert – Director Long Term Care Insurance Association, Medicare Supplement Insurance & Critical Illness Insurance Association