Medicare Advantage (otherwise known as Medicare Part C) has an open enrollment period during the first quarter of 2025.
Many retirees choose Medicare Advantage (offered by private insurance companies) over Original Medicare because they find plans that offer additional benefits with better coverage, such as dental, vision and hearing care.
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They can also offer out-of-pocket limits, lower premiums, coordination of care through a network of providers and prescription drug coverage.
TheStreet Retirement Daily's Robert Powell, CFP (Certified Financial Planner), and Jae Oh, also a CFP and the author of Maximize Your Medicare, discuss some key nuances of the open enrollment period.
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When is the Medicare open enrollment period in 2025?
Powell notes that the Medicare Open Enrollment Period begins Jan. 1 and runs through March 31. He asks Oh what people need to know about it.
"Among all of these windows that you have to change plans, for existing Medicare Advantage plan members, you do have the right to change plans once during the first quarter," Oh said.
The windows Oh refers to are the Medicare Initial Enrollment Period, which is during the three months before one reaches age 65 and during the three months after. From there, the Annual Enrollment Period is Oct. 15 to Dec. 7.
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Other circumstances people face can also lead to allowable changes, such as moving to a new location and losing current health care coverage, including for prescription drugs.
Oh explained further one reality of which Medicare Advantage enrollees need to be aware.
"You first need to be an existing plan member," Oh said. "You cannot newly enroll in Medicare Advantage during that time."
Can I cancel Medicare Advantage during open enrollment?
Oh discussed an additional important fact about open enrollment.
"This is also the period that people can cancel their Medicare Advantage plan, meaning that they can cancel their plan and return to Original Medicare if they so choose. These are the outstanding characteristics," Oh said.
"There are additional nuances," he continued. "For example, if you are trying to enroll in a five-star plan, that is rolling, meaning not subject to this particular three-month period."
A five-star Medicare Advantage plan is a premium plan that has received the highest possible rating from Medicare.gov. Quality of care, member satisfaction, customer service, preventive care and management of chronic conditions are among the factors considered for evaluation of the plans.
Demystifying Medicare Advantage election choices
About 67 million Americans are enrolled in Medicare. Just more than half are currently enrolled in Medicare Advantage plans. That is a big change from 2010, when only about 25% of recipients chose Medicare Advantage, reflecting its growing popularity.
Acknowledging that choosing Medicare plans can be a confusing process, Powell brings up a key point.
"During Medicare's annual election period, you can sort of choose whatever Medicare Advantage plan you want, however frequently you want," he said. "But the last one you choose is the one that you get. But during Medicare Advantage's open enrollment, you only get the opportunity to do it once."
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Oh agreed with Powell, and offered some further thoughts.
"As part of the ability to cancel your Medicare Advantage plan, if you want to return to Original Medicare, again, much like whenever people try to transition from Medicare Advantage to Original Medicare, I always tell people that the order matters and that if they are attempting to apply for Medigap, or Medicare Supplement, that securing acceptance is of primary importance and should be done first," Oh said.
Powell explained that when he thinks about the opportunity to redo one's Medicare Advantage choice, some of the reasons seem as if they may be obvious.
For example, one might recognize that a doctor is not in their network or that a drug is not covered that they thought was covered.
Oh offered some thoughts about other situations where a Medicare recipient might decide to change their plan.
"There are additional enhanced dental and vision plans that certain Medicare Advantage carriers may offer," Oh said. "And for example, raising the out-of-pocket maximum benefit limit is an outstanding one."
"If someone knowingly has very expensive dental work to come in the calendar year," Oh continued, "That can be enough to change from Medicare Advantage Plan number three to Medicare Advantage Plan number nine. Certainly these combinations do exist."
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Medicare Advantage plans for hearing aids and prescription eyeglasses
Powell mentioned that, regarding hearing and prescription eyeglasses coverage, there are sometimes caps placed on the amounts that are "so-called free."
Oh added his thoughts on the subject.
"This is kind of like a fundamental misunderstanding about dental, vision, hearing coverage," he said. "To call them insurance is a little odd to me. I would call them savings plans, meaning that all of these will have a maximum benefit limit that someone can get."
"That can be a limit on the allowance for new frames, for example," Oh added. "Under dental, that will be called the maximum benefit limit. That amount is capped. Once exceeding the cap, you are responsible for 100% of the cost."
For more of this discussion, and to view the video, see Retirement Daily's coverage of the conversation.
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