Guide to the Medicare Advantage Open Enrollment Period

The annual Medicare Open Enrollment Period (OEP) that occurs every fall can feel busy and hectic. You probably received countless calls from Medicare professionals—meanwhile, you may have been more focused on enjoying the holidays with friends and family. So what should you do if you made a mistake and are on a Medicare Advantage plan that doesn’t quite fit your needs?

Because Medicare Advantage plans result in more aggressive marketing tactics from Medicare professionals, some Medicare beneficiaries, bombarded by phone calls, make unfavorable Medicare plan selections that can negatively affect their health and money. The good news is that, if you’re unhappy with your current Medicare Advantage plan, you have a one-time opportunity to fix things during the Medicare Advantage Open Enrollment Period (MA-OEP), which occurs from January 1 - March 31 every year. 

Key takeaways:

• The Medicare Advantage Open Enrollment Period exists to protect you from enrollment in a plan that doesn’t fit your needs. 

• Some people may want to switch from their Medicare Advantage plan because their current coverage doesn’t minimize their drug costs, doesn’t cover the providers they prefer, or isn’t affordable.

• You can switch to another Medicare Advantage plan or back to Original Medicare during the Medicare Advantage Open Enrollment Period.

• The Medicare Advantage Open Enrollment Period occurs every year from January 1 to March 31.

What is the Medicare Advantage Open Enrollment Period?

The Medicare Advantage Open Enrollment Period is intended to protect consumers who may have chosen a bad Medicare Advantage plan that doesn’t fit their needs. Medicare beneficiaries may want to pay specific attention to their prescription drug coverage. This enrollment period might matter for you if your prescriptions aren't covered well by your Medicare Advantage plan. Another reason you may want to switch plans during this time is if you realize that one of your doctors isn’t in your plan’s network. If you're unsatisfied with your Medicare Advantage plan, you can make a one-time change during this period.

If you’re enrolled in a Medicare Advantage plan, then during the Medicare Advantage Open Enrollment Period, you can:

• Switch to a different Medicare Advantage plan

• Switch to Original Medicare (and join a separate Medicare prescription drug plan)

How is the Medicare Advantage Open Enrollment Period different from the Medicare Initial Enrollment Period?

The Medicare Initial Enrollment Period is a seven-month period of time surrounding your 65th birthday during which you can first enroll in Medicare. It’s the best time to sign up for Medicare to avoid late enrollment penalties. During this time, beneficiaries who are new to Medicare can enroll in Original Medicare. Once enrolled in Original Medicare, they can choose to switch to a Medicare Advantage plan or enroll in a Medicare Supplement plan. People may also choose to add a prescription drug plan. 

How is the Medicare Advantage Open Enrollment Period different from the Medicare Open Enrollment Period?

During the Medicare Open Enrollment Period, which occurs every year from October 15 - December 7, you are able to add or switch your Medicare Advantage plan and/or your Medicare Part D (prescription drug) plan. You can also switch back to Original Medicare. During Medicare's annual Open Enrollment Period, you may switch your plans any number of times—the last plan you switch to will be the one that will take effect on January 1 of the following year. 

The Medicare Advantage Open Enrollment Period, however, is intended for those who are unsatisfied with their plan during the months following the Medicare Open Enrollment Period. Because the enrollment period is intended to protect consumers from poor plan selections made during the Medicare Open Enrollment Period, you’re only eligible to switch if you’re currently on a Medicare Advantage plan—and you may only switch once during the period.

Original Medicare vs. Medicare Advantage

During both the Medicare Open Enrollment Period and the Medicare Advantage Open Enrollment Period, you can switch between Original Medicare and Medicare Advantage (also called Medicare Part C). Understanding the key differences between Original Medicare and Medicare Advantage can help you make the right choice for your needs.

Out-of-pocket limits

Medicare Advantage has an out-of-pocket maximum, while Original Medicare does not. You can, however, limit your out-of-pocket costs significantly with a Medigap plan. You can pair a Medigap plan with Original Medicare, but not with Medicare Advantage.

Network restrictions

With Original Medicare, you can see any doctor who accepts Medicare, which is about 90% of doctors nationwide. If you enroll in a Medicare Advantage plan, you'll be restricted to a network of providers local to you.

Prior authorization

Medicare Advantage plans require prior authorization for many services and equipment, which can delay the care that you need. If you’re denied prior authorization, you may have to cover all of the cost of the service you need.

Added health benefits

Medicare Advantage plans provide coverage for the same services as Original Medicare and often come bundled with additional health and wellness benefits. These benefits may include dental, vision, hearing, and prescription coverage and wellness perks like free gym memberships and flex cards.

Out-of-pocket costs

Neither Original Medicare nor Medicare Advantage provide the best solution for limiting out-of-pocket costs. Medicare Advantage at least has an out-of-pocket limit. On the other hand, if you pair a Medicare Supplement plan with Original Medicare, your costs will be greatly reduced—and in some cases, almost completely eliminated.

When is the Medicare Advantage Open Enrollment Period?

The Medicare Advantage Open Enrollment Period occurs every year between January 1 and March 31. Because the period is at the beginning of the year, we recommend you use your plan to make sure everything is covered as expected. This will help you catch a problem when you’re still able to fix things.

What should beneficiaries with new Medicare plans do during this period?

If you recently enrolled in a new Medicare Advantage plan—either during your Initial Enrollment or during Medicare Open Enrollment—these steps will help set you up for success! You’ll not only know where to access your plan details and benefits, but you’ll also get a jump start on a healthy year by knocking out some of your annual appointments.

1. Set up your online login with your carrier

Each insurance carrier has an online portal that shows your plan details and claims info, helps you find in-network doctors, and more. 

2. Set up your ancillary (additional) benefits

One of the reasons Medicare Advantage plans are popular among beneficiaries is because of their ancillary benefits, including over-the-counter benefits, flex spending cards, grocery benefits, and fitness programs. Many of these ancillary benefits need to be set up—and we recommend doing this sooner rather than later to better utilize them throughout the year.

5. See if you can save on prescriptions

Many people are unaware that prescription prices vary from pharmacy to pharmacy. Especially if one or some of your prescriptions are more expensive than you think they should be, check to see if you can save at another convenient pharmacy. 

The Medicare Advantage Open Enrollment Period is only important if you are unsatisfied with your Medicare Advantage plan during the first few months of the year. If you are happy with your plan, then no action is necessary. 

If you ever have any questions or feel uneasy about your Medicare, get in touch! Our licensed Medicare Advisors are here to help you find comfort in knowing you have the best Medicare coverage for your needs. And our Member Support Advocates can help you navigate the ins and outs of your specific plan to ensure you receive all of your benefits and minimize costs by using your insurance plan to its fullest. Call us at 855-900-2427 or schedule a time to chat to get started.

Frequently asked questions