Medicare open enrollment is underway. Enrollment opened today, October 15, and runs through December 7, making now the perfect time to make any necessary changes to your coverage.
Open enrollment is the time of year when experts recommend you review your Medicare coverage to see if you need to make a change. It’s also the time when Medicare beneficiaries can find themselves under siege from various insurance companies seeking their business and scammers looking to steal vital personal information.
Here's what you need to know about Medicare open enrollment.
When does Medicare open enrollment run?
Open enrollment runs from October 15 through December 7, giving beneficiaries a window in which to review options, including traditional Medicare and Medicare Advantage, the private insurance alternative to the government insurance plan. It's a good idea, then, to brush up on some Medicare basics.
During this open enrollment, you may change your Part D or Medicare Advantage plan for 2025, or switch between Medicare Advantage and original Medicare or vice versa.
On January 1, another open enrollment is held only for Medicare Advantage enrollees. During that enrollment period, which ends March 31, Medicare Advantage enrollees can change to a different Advantage plan or to original Medicare.
Starting January 1, if you pay for Part A and sign up for Part B during the General Enrollment Period that runs from January 1 through March 31, you can also join a Medicare drug plan when you sign up for Part B. Your drug coverage would start the month after the plan gets your request to join.
Authorities advise consumers to be wary of promises made by people promoting Medicare Advantage plans, making sure to get anything in writing and to check with medical providers to confirm they are part of the particular plan’s network. Medicare Advantage plans may restrict patients to using in-network providers, while traditional Medicare will cover any provider nationwide who accepts Medicare.
Authorities also warn Medicare enrollees to be alert to possible scams.
How to compare Medicare plans
Medicare offers a plan finder to help enrollees compare Medicare health and drug plans. The plan finder provides information about costs and covered drugs, as well as star ratings of various Medicare Advantage and Part D prescription drug plans. The star ratings are updated annually and incorporate the experiences of people who use the plans.
What’s new for Medicare in 2025
There are a few Medicare changes on the horizon for 2025.
For one, there will be a new $2,000 annual cap on out-of-pocket prescription costs. Beginning in 2025, people with Part D plans won’t have to pay more than $2,000 in out-of-pocket costs, thanks to a provision in the Inflation Reduction Act of 2022. The $2,000 cap will be indexed to the growth in per capita Part D costs, so it may rise each year after 2025.
Additionally, there will now be a personalized “Mid-Year Enrollee Notification of Unused Supplemental Benefits” sent to Medicare Advantage policyholders in July. It will list all supplemental benefits the person hasn’t used, the scope and out-of-pocket cost for claiming each one, instructions on how to access the benefits and a customer service number to call for more information.
And finally, a crackdown on agents and brokers who sell 3 types of Medicare policies is coming. The coming rule change is meant to disincentivize steering people to insurance plans to earn perks and not serve the best interests of Medicare beneficiaries. The new rule prohibits offering incentives to salespeople to enroll people and limits compensation to fixed caps. The new rule also says it will stop brokers and agents from receiving “administrative fees” above Medicare’s fixed compensation caps.
Different Medicare options
People who chose to keep traditional Medicare may also enroll in a supplemental plan, known as Medigap, to help cover costs like copays. (Note that as of January 1, 2020, Medigap plans sold to people new to Medicare can no longer cover the Part B deductible.)
Traditional Medicare, when not paired with Medigap, does not have a limit on out-of-pocket expenses in a year. Open enrollment is an opportunity to review Medigap coverage to determine if you have the best option for your needs, as well as the one that makes the most sense financially.
Medicare Advantage plans, which are offered by private insurance in place of traditional Medicare, do have yearly limits on out-of-pocket costs.
Medigap policies can’t be paired with Medicare Advantage. If you switch from original Medicare with Medigap to Medicare Advantage and then change your mind, you may not be able to get the same Medigap coverage and may have trouble getting any Medigap policy again.
In general, your first time enrolling in Medicare is your opportunity to get a Medigap policy. After that, you may not be able to buy a Medigap policy, or if you are able, it may cost more because of pre-existing health conditions.
Medicare Savings Programs help people with lower incomes pay Part B premiums and Part A and B deductibles, coinsurance and copayments. According to the Medicare Rights Center, if you qualify for one of the three main Medicare Savings Programs, your Part B monthly premium will no longer be deducted from your Social Security.
You will also automatically get the benefit of a program called Extra Help, which helps with Part D prescription drug costs. For information about open enrollment, you can visit Medicare.gov, call 1-800-MEDICARE, or contact your State Health Insurance Assistance Program, which can help you review and compare your coverage and any possible changes.
What if you want to skip Medicare open enrollment?
While authorities urge an annual review of your coverage, you don’t have to do anything if you’re happy with what you have. If you want to maintain your current Medicare coverage, you do not need to re-enroll.
