Get Ready for Annual Enrollment
Medicare’s Annual Enrollment Period (AEP) runs from October 15 through December 7 each year.
During AEP, you can:
- Change Medicare Advantage plans
- Move from Original Medicare to Medicare Advantage
- Return to Original Medicare from Medicare Advantage
- Join, change, or drop a Medicare Part D prescription drug plan, depending on your coverage
Most changes made during AEP start on January 1.
You do not have to change plans each year. Still, it is wise to review your coverage. Your costs, benefits, drug list, and provider network may change.
Gather Your Medicare Papers
Start by gathering your Medicare and plan information. Look for:
- Your Medicare card
- Your current health or drug plan card
- Your Annual Notice of Change
- Your Evidence of Coverage
- Any notice that your current plan is ending or leaving your area
- Recent Explanation of Benefits statements
- Your plan’s list of covered drugs
Your Medicare card shows if you have Part A, Part B, or both. It also shows when that coverage began. It does not show your Medicare Advantage or Part D plan.
Your plan card has the name of your health or drug plan. It also has your member number.
Do not worry if you cannot find every paper. Start with your plan card. You can find many plan details online.
Keep your Medicare number and member number safe. Share them only when necessary with trusted people or organizations.
List Your Doctors and Other Providers
Make a list of the doctors and providers you use. Include:
- Your main doctor
- Any specialists you see
- Your preferred hospital
- Mental health providers
- Physical therapists
- Dentists and eye doctors
- Medical equipment suppliers
If you have a Medicare Advantage plan, check its provider network. Make sure your doctors and hospitals will still be in the network for the upcoming plan year.
Check with both the plan and the provider that they participate in the specific plan you are considering. Network lists can change.
If you have Original Medicare, ask if your providers still accept Medicare.
List Your Medicines
Make a list of each medicine you take. Include:
- The name of the drug
- The dose or strength
- How often you take it
- The amount you get with each refill
- The pharmacy you use
Try to include the full name of each drug. “A blood pressure pill” may not be enough to check plan coverage.
You can find the name on the drug label. You can also ask your pharmacy for a list of your medicines.
Read Your Annual Notice of Change (ANOC)
Your plan sends an Annual Notice of Change (ANOC) each fall. It explains what will change on January 1.
Review any changes to:
- Monthly plan premiums
- Deductibles
- Copays and coinsurance
- Medical benefits
- Drug coverage
- Drug tiers
- Pharmacy networks
- Referral rules
- Prior authorization rules
- Dental, vision, and hearing benefits
- Other extra benefits
Some drugs may move to a different tier. A drug may also have new rules or limits. These changes can affect what you pay.
The ANOC may not list every change to the provider network. Check with your plan and providers to confirm their participation for the upcoming plan year.
If your plan is ending or will no longer be offered where you live, you may receive a separate non-renewal notice. Review that notice carefully because your coverage options and enrollment rights may differ.
Staying in the same plan does not mean everything will stay the same.
Understand Your Costs
A plan may have a monthly premium. You may also pay part of the cost when you get care.
These costs may include:
- A deductible, which is what you pay before the plan starts to share certain costs
- A copay, which is a set amount you pay
- Coinsurance, which is a share of the cost you pay
Look at the services you use most. Review the costs for:
- Doctor visits
- Specialist visits
- Hospital care
- Urgent care
- Emergency room visits
- Lab work
- X-rays and scans
- Therapy
- Medical equipment
- Prescription drugs
If you have Medicare Advantage, check the plan’s yearly out-of-pocket maximum for covered Part A and Part B medical services. Prescription drug expenses under Part D do not count toward that medical maximum.
Do not look at the premium alone. A plan with a low premium may have higher costs when you need care. Try to look at your likely costs for the whole year.
Check Your Drug Coverage
A plan’s list of covered drugs is called a formulary.
Check each drug you take. Find out:
- If the plan covers it
- Which drug tier it is on
- If the plan needs to approve it first
- If there are limits on the amount covered
- If you must try another drug first
- If your pharmacy is in the plan’s network
- If another pharmacy may offer a lower plan cost
Do not assume all forms of a drug are covered in the same way. The dose, amount, and type of drug can affect the cost.
Check your prescriptions against the specific plan’s coverage for the upcoming year.
Know When You Can Make Changes
AEP runs from October 15 through December 7. But it is not the only time some people can change plans.
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 each year for people already enrolled in Medicare Advantage.
During this period, eligible members can generally make one change. They can switch to another Medicare Advantage plan or return to Original Medicare, with the option to join a separate Part D prescription drug plan.
Some people may also qualify for a Special Enrollment Period (SEP) after certain events, such as moving outside a plan’s service area or losing qualifying health coverage.
The changes you can make depend on your situation.
If you leave Medicare Advantage and return to Original Medicare, you may want a Medicare Supplement Insurance policy, also called Medigap.
Returning to Original Medicare does not automatically guarantee that you can purchase Medigap. Your eligibility may depend on your enrollment circumstances, applicable guaranteed-issue rights, and Colorado insurance rules. Medical underwriting may apply in some situations.
Compare Your Choices During AEP
When AEP begins, compare your current plan with other plans available in your area for the upcoming plan year.
Ask these questions:
- Are my doctors in the network?
- Is my preferred hospital in the network?
- Are my medicines covered?
- What will I pay for the care I use?
- What will I pay for my medicines?
- Does the plan require referrals?
- Does the plan require approval before some services?
- Is my pharmacy in the network?
- Are the extra benefits useful to me?
Look at the full plan. Do not choose based only on the premium or extra benefits.
When comparing plans, consider your health needs, medicines, budget, and preferred providers.
A Final Word
A little planning can make your Medicare review much easier.
Gather your plan papers. List your doctors and medicines. Read your Annual Notice of Change and any notice that your plan is ending. Then compare your choices based on the care you use.
You may find that your current plan still works well for you. If it does not, you will have the information you need to make a more informed choice.