What is Medicare open enrollment?
Medicare open enrollment – also known as the annual election period (AEP) or annual coordinated election period – refers to an enrollment window that takes place each fall, during which Medicare plan enrollees can reevaluate their existing Medicare coverage — whether it’s Original Medicare with supplemental drug coverage, or Medicare Advantage — and make changes if they want to do so.
This guide is all about Medicare’s annual election period. If you’re interested in learning about additional opportunities to enroll or change your Medicare coverage, we’ve covered those here.
What plan changes can I make during the Medicare open enrollment period?
During the Medicare open enrollment period – if you’re already enrolled in Medicare coverage – you can:
- Switch from Original Medicare to Medicare Advantage (as long as you’re enrolled in both Medicare Part A and Part B, and you live in the Medicare Advantage plan’s service area).
- Switch from Medicare Advantage to Original Medicare (plus a Medicare Part D plan (PDP), and possibly a Medigap plan, although medical underwriting might be required for Medigap, depending on the state and the person’s circumstances).
- Switch from one Medicare Advantage plan to another.
- Switch from one Medicare Part D prescription drug plan (PDP) to another.
- Enroll in a Medicare Part D plan if you didn’t enroll when you were first eligible for Medicare. If you haven’t maintained other creditable coverage, a late-enrollment penalty may apply.
If I change my coverage at the start of the AEP, can I change my mind before the December 7 deadline?
Yes. You can change your mind and pick a different plan later in the AEP. There’s no limit on the number of plan changes you can make during the AEP.
The last plan selection you make will be the plan that takes effect January 1.
If I make a mistake when I change my coverage during the AEP, what can I do to fix it?
If you realize that you’ve made a mistake while the AEP is ongoing, you can simply pick a different plan instead (by the December 7 deadline) and the new choice will take effect on January 1.
If the AEP has ended and you’ve enrolled in a Medicare Advantage plan but believe you should have picked a different plan, you can use the Medicare Advantage Open Enrollment Period (MAOEP) to pick a different Advantage plan or switch to Original Medicare and a Part D plan.
For instance, maybe you picked an Advantage plan that doesn’t cover an expensive medication you need, or that doesn’t include a conveniently located hospital in its network. Or maybe you let your existing Advantage plan auto-renew and didn’t realize that the premium or benefits would be changing as of January. Regardless of the reason, the MAOEP gives people with Medicare Advantage one “do-over” opportunity at the start of the year.
The annual MAOEP window runs from January 1 to March 31.
If the AEP has ended and you’ve enrolled in a stand-alone Part D plan that doesn’t fit your needs, your options are more limited. There is nothing like the MAOEP to make changes to a stand-alone Part D plan. Changes to these plans can generally only be made during the fall AEP.
However, if you believe that you were given inaccurate or misleading information that led you to make the wrong plan choice, you can call 1-800-MEDICARE and explain the details. Depending on the circumstances, the call center may allow you to make a plan change at that point.
Who’s eligible to make coverage changes during Medicare open enrollment?
If you’re currently covered by Original Medicare or Medicare Advantage, then you’re eligible to make changes during open enrollment.
However, the annual Medicare open enrollment period does not apply to Medigap plans, which – in most states – are only guaranteed-issue during a beneficiary’s initial enrollment period, and during limited special enrollment periods. So to clarify, you cannot use the annual Medicare open enrollment period to enroll in a new Medigap plan on a guaranteed-issue basis. You can certainly apply for a new Medigap plan during this window – just as you can at any time of the year. But if your six-month initial enrollment period for Medigap has ended and you’re not in a trial right period, the Medigap insurer will use medical underwriting to determine your eligibility and premium.
(Note that as of 2024, there are 14 states that allow for at least some guaranteed-issue access to new Medigap plans, although in most cases it’s limited to switching from one Medigap plan to another with equal or lesser benefits.)
In addition, if you didn’t enroll in Medicare Part B when you were first eligible, you may not use the AEP to sign up. Instead, you’ll use Medicare’s general enrollment period, which runs from January 1 to March 31. The general enrollment period is also for people who have to pay a premium for Medicare Part A and didn’t enroll in Part A when they were first eligible. (Most people do not have the pay a premium for Part A.)
Learn more about Medicare’s general enrollment period.
Can I sign up for Medigap during the AEP?
You can certainly apply for a Medigap (Medicare supplement) plan during the AEP or at any other time of the year. But unlike Part D and Medicare Advantage plans, there is not a federally required annual enrollment opportunity for Medigap plans.
If you apply for a Medigap plan after your six-month initial enrollment period has passed, however, the Medigap insurer is likely to use medical underwriting to determine your eligibility and premium.
There are 14 states (as of 2024) that offer an annual window during which existing Medigap enrollees can select from at least some other plans without medical underwriting, and a few of those states also extend that option to people who are newly enrolling in Medigap.
How will plan availability, costs, and benefits change for 2025 Medicare coverage?
As we get closer to open enrollment, you’ll be able to see a detailed summary of Medicare premium and out-of-pocket changes here. But in general:
- The Inflation Reduction Act will continue to cap the cost of insulin products at $35/month in 2025, and ensure that Part D enrollees do not have to pay for recommended vaccines.
- More people will continue to be eligible for the full Medicare Part D Low-Income Subsidy (Extra Help).
- Out-of-pocket costs for drugs covered under a Medicare Part D plan will be capped at $2,000. This applies to stand-alone Part D plans as well as Part D coverage integrated with a Medicare Advantage Plan.
- People with Medicare Part D will have the option to have their drug costs spread out over the full year in equal monthly payments, instead of having to meet their out-of-pocket limit early in the year.
- The standard Medicare Part B premium for 2025 won’t be finalized until the fall of 2024. But according to the Medicare Trustees Report, it is projected to be $185/month (up from $174.70/month in 2024), and the Medicare Part B deductible is projected to be $257 (up from $240 in 2024).
- The 2025 Social Security COLA is 2.5%, resulting in Social Security benefits being an average of $50/month higher in 2025. For most Medicare beneficiaries, Part B premiums are withheld from Social Security checks, and net checks (after Part B is deducted) generally can’t decrease from one year to the next. But the COLA for 2025 will be more than enough to cover the projected increase in Part B premiums.
- 2025 Medicare Part A premiums (for those who have to pay for Part A) will also be finalized in the fall of 2024. But the Medicare Trustees Report projects that it will be $281/month for those with at least 30 quarters of work history (up from $278/month in 2024), and $510/month for those with under 30 quarters of work history (up from $505/month in 2024).
- The 2025 Medicare Part A deductible will also be finalized in the fall of 2024. But according to the Trustees Report, it’s projected to increase to $1,684 (up from $1,632 in 2024). The daily copays for inpatient days 61-90, lifetime reserve days, and skilled nursing facility care are also projected to increase.
- The total number of available PDPs is declining by 26% nationwide in 2025. There will be a total of 524 PDPs available across the 34 PDP regions, which is the smallest number of PDPs since the Part D program began in 2006. But average PDP premiums will decrease slightly in 2025, from an average of $41.63/month in 2024 to an average of $40/month in 2025. There had previously been concerns about premium increases for 2025, due in part to the Inflation Reduction Act changes that are shifting some costs from enrollees to the Part D plans. To address this issue and help to ensure that Part D coverage remains stable and affordable, the federal government announced a voluntary PDP premium stabilization program for 2025. Participating insurers will receive additional funding from the federal government to reduce the premiums that enrollees would otherwise have to pay. CMS subsequently announced that 99% of PDP enrollees are in plans that opted into the premium stabilization program for 2025.
- Average Medicare Advantage premiums will also decrease slightly, from $18.23/month in 2024 to $17/month in 2025.
- The maximum Medicare Part D deductible will be $590 in 2025, up from $545 in 2024. (Part D plans can have lower deductibles, or no deductible at all. But if they have a deductible, it can’t exceed $590 in 2025.)
- The threshold for having to pay Medicare’s IRMAA (high-income surcharge) for Medicare Part D and Part B will increase again. For a single individual, it will start at an income of $106,000 (up from a threshold of $103,000 in 2024).
- The maximum allowable cap on out-of-pocket costs for Medicare Advantage plans (not counting prescription costs) will increase to $9,350 for in-network costs ( from $8,850 in 2024). But average out-of-pocket caps are typically well below the allowable maximum.
- Some insurers that currently offer Medicare Advantage plans or stand-alone Part D plans have said they are exiting the market or reducing their plan offerings for 2025., Others are eliminating broker commissions, which could potentially reduce their enrollment volume. And others have said that they will make changes to their benefits for 2025, which could include higher deductibles, coinsurance instead of copays, reductions in supplemental benefits, or provider network changes. However, CMS projects that total Medicare Advantage enrollment will continue to increase in 2025. It’s always important for Medicare beneficiaries to open and read the mail they get from their plan each fall, but that’s especially true as we head into 2025. If your plan’s benefits or premium are changing in a way that won’t fit your needs — or if the plan is being eliminated altogether — you’ll want to comparison shop for alternatives during the October 15 to December 7 open enrollment period.
How many people change their coverage during the AEP?
Most Medicare beneficiaries do not switch plans during Medicare’s AEP. An analysis by KFF found that over the course of a decade, the percentage of beneficiaries who switched to a different Part D plan ranged from 10% to 13% per year. And for Medicare Advantage beneficiaries it was even lower, ranging from 6% to 11%.
More troubling is the fact that seven out of ten beneficiaries didn’t even compare their coverage options during a recent open enrollment period. It may well be that the plan you already have will continue to be the best option for the coming year. But there’s no way to know that without actively comparing the available alternatives, and the majority of Medicare beneficiaries aren’t doing that.
What will happen if I don’t change my Medicare coverage during the annual election period?
If you don’t make a plan change, your existing coverage will renew for 2025, assuming it will continue to be available. But that could come with cost and benefit changes. The plan you have might have changes to its drug formulary (covered drug list) or its provider network, meaning that a specific medication or doctor may no longer be covered under the plan. And the plan could also have premium and/or cost-sharing structure changes.
This is why it’s so important to actively compare the available options each fall. You’ll want to check to see how your doctors and prescription will be covered in the coming year, both by the plan you already have and by the other plans that are available in your area.
After the annual election period ends, you will not be able to make a change to your stand-alone Part D plan until the next annual election period. If you have a Medicare Advantage plan, you will still have an opportunity to use the Medicare Advantage Open Enrollment Period (MAOEP) that runs from January through March. You can make just one plan change during this window.
But it’s important to note that the new plan selection would take effect in February at the earliest (and as late as April, depending on when you make the plan selection). This means your out-of-pocket costs for the year would reset to zero when the new plan starts, regardless of how much you had spent in the early part of the year under your old plan.
So, if there’s any chance you’ll want to make a plan change, the best approach is to select your new plan by the annual election period deadline (by December 7) so that the coverage takes effect January 1 and covers you for the entire year.
What do I have to do during open enrollment if I just want to keep my current coverage for next year?
If your current Medicare plan will still be available in 2025 and you want to keep it, you don’t have to do anything. It will automatically renew on January 1. But it’s important to pay attention to any mail you get from your plan, as it might not be available next year or there might be changes to the coverage. Any changes will be communicated to you by your plan in an Annual Notice of Change letter, which your Part D or Medicare Advantage insurer will send to you in September. Those could include changes in the premium, deductible and other cost-sharing, provider networks, prescription benefits, etc.
Even if you’re happy with your current plan and nothing about it will change significantly for 2025, it’s still important to comparison shop during the open enrollment period that runs from October 15 to December 7. There may be another plan that might be a better fit, and that window is your opportunity to switch plans. But as long as your plan will continue to be available next year, it will automatically renew on January 1 if you make no changes during open enrollment.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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