Navigating Medicare Open Enrollment

Medicare’s annual open enrollment period begins October 15 and extends through December 7.

During this time, people already on Medicare have the option to:

  • Switch from original Medicare (Parts A and B) to a Medicare Advantage plan.
  • Switch from Medicare Advantage to original Medicare.
  • Keep their Medicare Advantage plan or enroll in a new one.
  • Keep their Part D drug plan or enroll in a new one.

All changes, even those made as late as December 7, will be effective on January 1, 2021.

If you have original Medicare and a Medigap supplement plan, you will have to drop Medigap if you switch to Medicare Advantage. There is no open enrollment period for Medigap, and you are free to change this coverage anytime. However, if you do drop Medigap, it may be hard to find a reasonably priced Medigap plan should you later decide to switch back to original Medicare. Call your broker or your Medigap insurer before you drop your plan to find out about re-enrollment terms.

If you have a Medicare Advantage plan, there is an additional enrollment period during the first quarter of next year when you can select a different plan. You also can switch from Medicare Advantage to original Medicare.

Original Medicare is largely the same as last year, although the government is offering some beneficiaries a reduced-price insulin benefit. This benefit should be disclosed on the Medicare Plan Finder, which is loaded with details of all 2021 Medicare plans.

Part D Plans

Part D drug plans are offered by private insurers for those with original Medicare and Medicare Advantage. Plan costs, coverage rules, and covered drugs often change each year, so don’t assume your current drug plan will continue to be the best one for you next year.

You can enter your prescription drugs on Plan Finder and it should provide coverage and pricing details for all Part D plans offered where you live. Low-premium plans may not be the best choice. Look at total out-of-pocket costs for the plans that include your drugs.

Drug plans also may have rules requiring you to get prior approval from the plan before it will cover a drug your doctor has prescribed. Other rules may include “step therapy,” which can require you to first take a lower-cost generic drug before being covered for a brand drug for the same condition. Plans also may impose quantity limits on your prescriptions. Check with a plan on these matters before enrolling.

If you find Medicare shopping daunting, you can get free help with the process from the federally supported State Health Insurance Assistance Program (SHIP). It has offices in all states.

Medicare Advantage Plans

The Centers for Medicare & Medicaid Services (CMS) has long promoted private MA insurance plans over original Medicare, and projects that they now account for nearly 40 percent of all Medicare coverage.

CMS has approved a menu of MA benefits more extensive than original Medicare. MA plans often provide dental, hearing and vision benefits not covered by original Medicare. They also may include fitness benefits and, during the pandemic, expanded telehealth benefits that include behavioral health.

In recent years, MA plans have been authorized to cover non-medical benefits such as food, transportation to health appointments, and in-home safety features such as bathroom grab bars. Plans were slow to adopt these new benefits but they are becoming more common.

CMS has also encouraged plans to reduce the monthly premiums that most beneficiaries must pay in addition to the basic premium for Part B of original Medicare ($144.60 a month for most people in 2020). Many insurers are offering zero premium plans in 2021 but, as with drug plans, you need to make sure zero premium plans aren’t charging higher deductibles and co-pays than MA plans with higher premiums.

MA plans also require people to use doctors and other caregivers in the plans’ provider networks. In original Medicare, people are free to use any doctors that accept Medicare. Make sure your doctors are in your plan’s network before making your 2021 enrollment choice.

I do not provide individual answers to your questions but may publish selected answers in a future blog post. If your question is included, I will let you know via email.