What to Know About Medicare Open Enrollment

The rules are pretty strict and kind of complicated for when you can switch plans.

Written by Erin Gobler / April 8, 2022

Quick Bites

  • You can sign up for Medicare during your seven-month initial enrollment period, which is timed to your 65th birthday.
  • Miss that, and you can enroll during the Jan. 1 to March 31 general enrollment period or, in some cases, during a special enrollment period.
  • Every fall, Medicare beneficiaries can change plans during open enrollment, which runs from Oct. 15 to Dec. 7 each year.
  • During fall open enrollment, you can switch between Original Medicare and a private Medicare Advantage plan and pick a new Medicare Part D plan.
  • Those with Medicare Advantage plans have a second open enrollment period from Jan. 1 to March 31.

For the more than 60 million Americans who rely on Medicare coverage for doctor’s visits, hospital stays, prescription medications and other health care services, it pays to pay attention to the calendar.[1]

During an annual window known as open enrollment, Medicare recipients have a valuable chance to review and refine their health insurance. Understanding the options—and exactly what you can do when—is an essential part of making the most of this federal insurance plan for people 65 and older.

Keep reading to learn more about how Medicare open enrollment works, what kind of changes you might want to make, and what to do if you miss the deadline.

Inside this article

  1. The parts of Medicare
  2. What’s Medicare open enrollment?
  3. Medigap open enrollment
  4. What to keep in mind
  5. If you miss open enrollment
  6. Original Medicare enrollment

The parts of Medicare

Before you think about signing up or changing Medicare plans during open enrollment, make sure you understand the different types:

Medicare Part A

One half of the two parts known as Original Medicare, Part A covers stays in hospitals and skilled nursing facilities, plus home health services and hospice care.

Medicare Part B

The other half of Original Medicare, Part B is medical insurance and covers health care services like doctor visits, outpatient care, medical equipment and preventive care.

Medicare Part C (Medicare Advantage)

Medicare Advantage plans, also known as Medicare Part C, essentially bundle together all of the other parts of Medicare into a single plan. Advantage plans typically offer benefits that are not included with Original Medicare, such as dental, vision and hearing coverage.

Medicare Part D

Signed into law in 2003 and in effect since 2006, Part D covers prescription drugs.[2] While it’s a part of Medicare and regulated by the federal government, Part D plans are offered by private insurers.

Medigap

Offered by private insurers, these supplemental health insurance policies fill in some of the gaps in Medicare coverage.

What is Medicare open enrollment?

Medicare open enrollment is a window when you can join, switch or drop a Medicare plan. What’s tricky is that there’s more than one open enrollment period.

Medicare open enrollment, also known as Medicare’s annual election period, runs every fall, from Oct. 15 through Dec. 7.[3] During this time, you can:

  • Switch from Original Medicare to a Medicare Advantage plan

  • Switch from Medicare Advantage to Original Medicare

  • Change Medicare Advantage plans

  • Join Medicare Part D

  • Select a new Medicare Part D plan

  • Drop Medicare Part D

“Most of the time you will see people switch if their doctor is dropped from their current plan, there is a better plan out there, or if they are upset with their current plan,” says Kyle Devries, a Medicare advisor at Health Benefits Associates. “This is also the time someone can switch from a Medicare Supplement plan or Original Medicare to a Medicare Advantage plan.”

The Medicare Advantage open enrollment period runs from Jan. 1 through March 31. During that time, you can:

  • Change Medicare Advantage plans

  • Switch from Medicare Advantage to Original Medicare

During this winter open enrollment period, you can’t switch from Original Medicare to Medicare Advantage, change Medicare Part D plans or sign up for Medicare Part D.

Medigap open enrollment

If you’re considering signing up for Original Medicare and a Medigap policy instead of Medicare Advantage, that timing is important, too.

The six months after you sign up for Medicare Part B are your Medigap open enrollment period. During that time, you can enroll in any Medigap plan, no matter your health. After that window, some plans may not allow you to sign up, or, if they do, you may face higher premiums, since pricing can be based on your health status.[4]

What to keep in mind during open enrollment

When you first sign up for Medicare and then during open enrollment every year thereafter, your biggest choice comes down to Original Medicare versus a Medicare Advantage plan.

With Original Medicare, you’ll also want Medicare Part D. Together those will provide you with hospital, medical and prescription drug insurance. But instead of signing up for Original Medicare, you could go with a Medicare Advantage plan, which will likely include prescription drug coverage and potential extras like vision and dental.

Keep in mind that Medicare Advantage plans often limit you to working with in-network medical providers. Original Medicare, on the other hand, is accepted at nearly every hospital and doctor’s office in the United States.

If you’re deciding between Original Medicare and an Advantage plan, you may want a Medigap policy as well.

“Original Medicare only covers 80% of your approved medical services,” says Devries. “The Medicare beneficiary will be responsible for 20% of the cost, regardless of the price. When I meet with people, I will always recommend either a Medigap or a Medicare Advantage plan for them.”

Tip: Medicare offers a plan finder tool that can help you pick a plan based on all the available options in your area. Because of how complicated the selection process can be, you may also want to consult a financial planner.

Since Medicare Advantage plans may limit coverage to a certain area, geography is important too. “Medigap plans are great for those who live in different areas of the country for longer periods of time,” says Devries. “For example, if someone lives in a warmer state for the winter and goes back to another state during summer, I will recommend a Medigap plan for them.”

Medigap plans are accepted nationwide by any doctor who accepts Original Medicare.

What happens if you miss Medicare open enrollment?

Medicare has strict guidelines on when you can sign up for a new plan or make changes to your existing coverage. To sign up or change plans, you must pay attention to your initial enrollment, general enrollment and open enrollment periods.

In general, if you miss your initial window to enroll in Medicare, you are likely out of luck until the following year. The exception is if you’ve lost access to your existing coverage, in which case you should be able to sign up during a special enrollment period.

If you aren’t eligible for a special enrollment period and don’t have other coverage, consider signing up for a private health insurance plan—even if it’s a temporary one—to protect yourself until the next enrollment period for Medicare.

Original Medicare enrollment periods

If you haven’t signed up for Medicare at all yet, keep in mind that there are specific enrollment periods for that, too.[5] They are:

Initial enrollment period: The three months before you turn 65, your birthday month and the three months after are known as your initial enrollment period. This is when you can enroll in Original Medicare for the first time. Unless you’re covered by another drug plan, you would also sign up for Medicare Part D during this time.

General enrollment period: Each year, a general enrollment period runs from Jan. 1 through March 31. During this window, anyone who missed their initial enrollment period can sign up for Medicare.

Special enrollment period: You may be able to sign up for Medicare during a special enrollment period if you lost other coverage or your previous Medicare plan because you moved or the plan contract changed.[6]

Note that if you don’t sign up for Medicare as soon as you’re eligible, you may be liable for a late penalty. For instance, if you’re not eligible for free Medicare Part A and you sign up late, you’ll have to pay a 10% higher premium for double the amount of time you waited after you first became eligible (if you qualify for free Medicare Part A, there are no penalties for signing up late). For Medicare Part B, for each year after eligibility you wait, your premium will increase 10%. You’ll pay that higher premium for the rest of the time you’re enrolled in Medicare Part B.

Article Sources
  1. “CMS Fast Facts,” Centers for Medicare & Medicaid Services, https://www.cms.gov/research-statistics-data-systems/cms-fast-facts/cms-fast-facts-mobile-site.
  2. “CMS Program History,” Centers for Medicare & Medicaid Services, https://www.cms.gov/About-CMS/Agency-Information/History.
  3. “Joining a Health or Drug Plan,” Medicare.gov, https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan.
  4. “When Can I Buy Medigap?” Medicare.gov, https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap.
  5. “Medicare Enrollment Periods: When to Sign Up,” Medicare.gov, https://www.medicare.gov/blog/medicare-enrollment-period-2020.
  6. “Special Circumstances (Special Enrollment Periods),” Medicare.gov, https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances-special-enrollment-periods.

About the Author

Erin Gobler

Erin Gobler

Erin is a personal finance expert and journalist who has been writing online for nearly a decade. Erin’s work has appeared in major financial publications, including Fox Business, Time, Credit Karma, and more.

Full bio

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