Medicare

Guide to Medicare AEP

People with Medicare can make changes to their coverage at specific times during the year. The Medicare Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year, is one of these opportunities. Read on to learn how the Medicare AEP works and what changes can be made during this time.

Guide to Medicare AEP

Medicare is a federal health insurance program for people 65 and older and younger adults with certain disabilities. The program can help enrollees pay for a variety of medically necessary and preventive health services, including surgeries, hospital stays, doctor visits, and lab tests. Like other types of health insurance, you can only make changes to your coverage at specific times during the year. The Annual Enrollment Period, sometimes known as Fall Open Enrollment, is one of those times.

When Is the Medicare Annual Enrollment Period?

The Medicare Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. When someone makes a change to their Medicare coverage during the AEP, their new coverage begins on January 1.

What Is the Medicare Annual Enrollment Period?

The Medicare Annual Enrollment Period is a yearly window when those who are already enrolled in Medicare can change their existing coverage. 

Medicare Parts A and B, also known as Original Medicare, is the traditional program managed by the federal government, and it offers coverage for medically necessary services like doctor visits and hospital stays. Medicare Advantage plans, on the other hand, are an alternative offered by private companies. These plans also cover Part A and B services, but may have additional coverages as well as different out-of-pocket costs and rules for accessing care. 

During the Annual Enrollment Period, those already enrolled in a Medicare Advantage plan or Original Medicare are eligible to make changes to their plans, such as switching from Original Medicare to a Medicare Advantage plan, or vice versa.

There are other enrollment periods for Medicare, but there are limitations as to what changes can be made during each period. For example, during the Initial Enrollment Period, newly eligible people can enroll in Medicare, and during the Medicare Advantage Open Enrollment Period, people who are specifically enrolled in a Medicare Advantage plan can make coverage changes. 

Who Can Use the Medicare Annual Enrollment Period?

The Medicare Annual Enrollment Period is a time when people who are already enrolled in Medicare can make changes to their existing coverage. Whether you have Original Medicare or Medicare Advantage, you could choose to join, switch, or drop a plan during this period.

If you don’t have Medicare yet but are eligible for the program, you could sign up at the following times, which may or may not overlap with the Medicare AEP:

  • Initial Enrollment Period: This 7-month window starts 3 months before you turn 65 and ends 3 months after your birthday month.
  • General Enrollment Period: People who didn’t sign up during initial enrollment can get Parts A and B between January 1 and March 31.
  • Special Enrollment Period: Certain personal circumstances, such as leaving a job that provides health insurance, may trigger a SEP at any time of the year.

What Can You Do During the Medicare Annual Enrollment Period?

During the Medicare Annual Enrollment Period, people with Medicare can make a variety of changes to their coverage. Some changes that may be permitted during this period include:

  • Switching from Original Medicare to a Medicare Advantage plan.
  • Leaving a Medicare Advantage plan and returning to Original Medicare.
  • Switching to a different Medicare Advantage plan.
  • Joining a Medicare prescription drug plan, also known as Part D.
  • Switching to a different Medicare prescription drug plan.
  • Leaving a Medicare prescription drug plan.

There may be some limitations depending on your current enrollment situation. For example, people with Medicare Advantage HMO or PPO plans that don’t offer drug coverage aren’t permitted to sign up for a stand-alone prescription drug plan. However, they could use the AEP to switch to a different Medicare Advantage plan that offers drug coverage.

There may be penalties for some changes made during the AEP, such as leaving a Medicare prescription drug plan. If you leave a Medicare drug plan and don’t have comparable coverage from another plan, you may pay the Part D late enrollment penalty if you decide to join another Medicare drug plan in the future.

The AEP does not apply to Medigap plans. Instead, there’s a separate open enrollment period for Medigap. The 6-month Medigap Open Enrollment Period begins the month you turn 65 and are enrolled in Part B. Outside of this open enrollment period, you could still apply for Medigap, but insurance companies may decline coverage or charge higher premiums.

Why Change Your Medicare Plan During the Annual Enrollment Period?

During the Annual Enrollment Period, people with Medicare may decide to make a variety of changes, such as switching from Original Medicare to Medicare Advantage or joining a different Medicare Part D plan. Some reasons you may consider changing your Medicare plan include:

  • Cost: Premiums, deductibles, copayments, and annual out-of-pocket maximums may vary from one plan to another. Medicare members who want to unlock money in their monthly budgets may consider switching to a different plan with lower out-of-pocket costs. 
  • Provider network: Doctors and other healthcare providers may choose to leave a Medicare Advantage plan’s network. If your doctor no longer accepts your plan, you could switch to a plan they participate in or return to Original Medicare.
  • Covered services: Medicare Advantage plans may cover services that Original Medicare does not, such as vision, hearing, and dental care. Original Medicare members who want these supplemental benefits may switch to a Medicare Advantage plan during the AEP. 
  • Drug formulary: Medicare drug plans and Medicare Advantage plans with drug coverage may periodically change the list of drugs they cover. If your plan no longer covers your drugs, you may choose to switch to a plan that does during the AEP.
  • Plan rules: Medicare Advantage plans may set rules about how members access care, such as requiring referrals for specialist visits or pre-authorization for certain services. If you don’t like your plan’s rules, you could switch to a different plan or go back to Original Medicare.

Making changes during the AEP is optional. Medicare members who are satisfied with their current coverage can continue their enrollment without changes so long as their plan is still being offered. 

Annual Enrollment Period (AEP) vs. Open Enrollment Period (OEP)

There are 2 recurring enrollment periods for people with Medicare: the Annual Enrollment Period, which runs from October 15 to December 7, and the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31.

Unlike the AEP, which is for anyone with Medicare, the Medicare Advantage Open Enrollment Period is only for people who are enrolled in a Medicare Advantage plan. Options during this enrollment period are limited to switching to a different Medicare Advantage plan or leaving Medicare Advantage and returning to Original Medicare. People who go back to Original Medicare could also buy a Medicare drug plan during this time.

During the Medicare Advantage Open Enrollment Period, people with Original Medicare are not permitted to make changes, such as switching to a Medicare Advantage plan or joining a Medicare drug plan. These changes can be made during the AEP instead.

What You’ll Need to Enroll in Medicare

Whether you’re newly eligible for Medicare and interested in signing up, or already enrolled and wanting to make changes during the AEP, there are some documents and information you may be asked to provide. 

If you’re eligible for Medicare and want to enroll in Parts A and/or B, you can sign up online, over the phone, or in person at a local Social Security office. Be prepared to provide documents that prove your identity, age, and citizenship and answer questions about your current employment and health insurance coverage.

If you’re already enrolled in Medicare and want to make changes during the AEP, be prepared to provide your Medicare number and the dates your Part A and/or Part B coverage began. You can find this information on your Medicare card. If you’ve misplaced your Medicare card, you can request a replacement by using your Social Security online account or calling 1-800-772-1213 (TTY 1-800-325-0778).

During the AEP, Medicare members may choose to switch between Original Medicare and Medicare Advantage or to enroll in a different Medicare Advantage plan or Medicare drug plan. These changes can be made by contacting Medicare or the plan provider.