Did you know that you can’t always make Medicare coverage changes? That’s why it’s important to learn about Medicare’s Annual Election Period (AEP), where you may be able to enroll in a Medicare Advantage plan or a stand-alone Medicare Part D Prescription Drug Plan or even make other changes to your current coverage.
AEP takes place from October 15 to December 7 every year.
Here are the types of changes you can generally make during AEP:
- Switch from Original Medicare to a Medicare Advantage plan
- Switch from a Medicare Advantage plan back to Original Medicare
- Switch from a Medicare Advantage plan to a different Medicare Advantage plan
- Switch from a Medicare Advantage plan that doesn’t include prescription drug coverage to one that does, and vice versa
- Enroll in a stand-alone Medicare Part D Prescription Drug Plan
- Switch from one stand-alone Medicare Part D Prescription Drug Plan to another
- Drop your prescription drug coverage
To help you prepare for AEP, we’ve made a comprehensive checklist of steps to take:
2022 AEP Checklist
1. Confirm your eligibility to enroll.
In order to enroll in a Medicare Advantage plan, the first item on your checklist should be to verify your eligibility. Eligible applicants are those who have Medicare Part A and Part B and live in the service area of the Medicare Advantage plan.
Additionally, if you’d like to enroll in a stand-alone Medicare Part D Prescription Drug Plan, you must have Medicare Part A and/or Part B and live in the service area of the plan.
2. Review your current coverage. Decide if it meets your needs.
Carefully review your current Medicare coverage to see if it still meets your healthcare needs. Have a good understanding of what healthcare services you typically use and whether your coverage for these services is within your budget. Look at it as a check-up for your Medicare coverage.
If you’re currently enrolled in Original Medicare Part A and Part B, consider signing up for a plan that offers coverage not included in Original Medicare, such as routine vision or dental benefits. Medicare Advantage plans may differ in specific benefits, but are required to offer the same coverage as Original Medicare (except hospice care, which Medicare Part A covers). Some Medicare Advantage plans offer extra benefits like routine vision or dental care.
Original Medicare generally doesn’t include prescription drug coverage. It must be obtained separately through a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan.
If you’re enrolled in Medicare Advantage or a Medicare Prescription Drug Plan, carefully review the plan’s Evidence of Coverage (EOC) and Annual Notice of Change documents (mailed out in the fall before AEP). These documents provide details on your plan’s coverage for the upcoming year and any changes in benefits or costs. Review the EOC to see if the plan will meet your health care needs.
If you don’t currently have Medicare prescription drug coverage, but you do have other prescription drug coverage, you can verify that your coverage is still “creditable”— meaning coverage that’s expected to generally pay as much as standard Medicare prescription drug coverage. If not, you may want to sign up for Medicare prescription drug coverage during AEP.
Important: If you go without creditable drug coverage for 63 or more consecutive days after your Initial Enrollment Period, you may receive a Medicare Part D late enrollment penalty if you sign up later.
3. Be aware of how enrolling in a Medicare plan may impact your other insurance.
If you have coverage such as retiree or veterans’ benefits, check to see if that insurance covers additional services that Medicare does not. Consult your benefit administrator to see how your insurance works with Medicare. Some coverage types may require you to have Medicare to maintain eligibility. In other cases, a Medicare Advantage plan or a Medicare prescription drug plan enrollment may cause you to lose your other coverage. Always ensure you understand the rules and how a Medicare enrollment may affect your existing insurance before enrolling in a new Medicare plan.
4. Find the best price for your coverage.
All AEP checklists require a complete and thorough review of your present and projected health costs. Even if you are satisfied with your current plan’s coverage, it’s a good idea to compare prices each year. Medicare plans can vary widely in what they pay out for services and prescription medications. You may find better coverage and/or a more affordable option.
Keep in mind: most Medicare Advantage plans charge a separate monthly premium for coverage in addition to the Medicare Part B premium you must keep paying. However, total cost-sharing expenses for Medicare Advantage plans are generally lower than Original Medicare.
- Provider networks: Do you have certain doctors you’d like to keep? When comparing Medicare Advantage plans, be sure the provider is in a plan’s preferred network. If not, they are considered an out-of-network provider and you could end up paying more.
- Prescription medications: To be a good fit, a plan needs to cover all of your prescription drugs. Medicare-covered prescription drugs are often separated into tiers, with higher or lower copayments/coinsurance depending on the tier in which they fall. Why does this matter? The same prescription may have different costs plan-to-plan.
- Total cost-sharing expenses: When comparing plan costs, don’t just look at the premiums, but at cost-sharing expenses as a whole. A plan with a lower premium could cost more overall if it’s offset by:
- Expensive copayments
- High deductibles
- A high out-of-pocket maximum
- Ratings — All Medicare Prescription Drug Plans and Medicare Advantage plans are rated on a scale of 1 to 5 stars for quality and customer satisfaction (with a 5-star rating indicating excellence).
Medicare doesn’t need to be complicated. This checklist provides a good outline of helpful steps to take for a simplified Annual Election Period.