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Health Insurance Literacy for Medicare Beneficiaries: Open Enrollment

Lindsay Malzone, Medicare expert, Medigap.com

How is health insurance literacy associated with coverage choices between traditional Medicare and Medicare Advantage, as well as within Medicare Advantage? This was the question researchers investigated in a study published in JAMA Open Network in February 2022. Results of the study suggest higher health insurance literacy—particularly, annual review and comparison of coverage choices—is associated with higher Medicare Advantage enrollment and choice of a particular Medicare Advantage plan.

During Medicare enrollment periods, reviewing your coverage is wise and can ensure it's still the best option for your situation.

Some things that should be evaluated during this enrollment period are:

  • Plans Network: Are your healthcare providers still in the network for the upcoming year?
  • Prescription Drugs: Is your plan still the right coverage for the prescription medications you're taking?
  • Benefits: Your plan will send you the annual notice of the change. Review this document for changes in your coverage. Consider other plan options if you notice something you don't like or agree with.
  • Plan Extras: Medicare Advantage plans have additional benefits not covered by Original Medicare. Review your current and other programs in your area if there is a benefit you would like to add to the coverage.

Evaluating these items will help ensure you have the best coverage for your situation.

Here is some information to help you make sense of Medicare Open Enrollment Periods.

With many different types of coverage ─ each with its own enrollment periods ─ things can get pretty confusing. Let’s break it down…

Medicare Supplement (Medigap) Enrollment Periods

Medicare Supplement Insurance, also known as Medigap, is an additional insurance plan that can be purchased to help cover your portion of the Original Medicare cost share. These policies can cover most, if not all, of your medical expenses. Since they're secondary coverage to Medicare, there isn't a need for referrals or networks.

  • Open Enrollment Period: Medicare Supplement plans have an open enrollment period when Medicare Part B starts, or you turn 65. In your Medicare Supplement open enrollment period, you can choose any Medigap plan or change to another Medigap without needing to medically qualify. This period starts when your Medicare Part B begins, or you turn 65 and continues for 6 months.
  • One unique aspect of a Medicare Supplement plan is that you can change plans anytime throughout the year. The catch is that, in most cases, you must be able to medically qualify. Some states provide additional open enrollment periods.
  • Guaranteed Issue Rights: If you're outside your Medicare Supplement open enrollment period (described above) and aren't healthy enough to change or start Medigap coverage, review the Guaranteed Issue Rights (also called Medigap Protections) to see if you qualify. You can switch to specific plans during these periods even if you can't pass underwriting. Most of these guaranteed issue rights will revolve around losing coverage at no fault of your own. One typical example is moving out of the area of your Medicare Advantage plan.

Medicare Advantage Enrollment Periods

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage and many plans include drug coverage (Part D). 

  • Open Enrollment Period: Medicare Advantage also has an open enrollment period, and it starts on January 1 and continues through March 31. During the Medicare Advantage open enrollment period, any individual already enrolled in a Medicare Advantage plan can:
    • Change to another Medicare Advantage plan
    • Drop their plan and return to Original Medicare A and B
    • Drop their plan and enroll in a Part D drug plan
  • Note: Only one change is allowed, and the new program starts at the beginning of the following month. This open enrollment period is commonly mistaken for Medicare’s Annual Enrollment Period, which runs from October 15 through December 7.
  • Annual Enrollment Period: Unlike its counterpart, Medicare Advantage Annual Enrollment Period applies to anyone on Medicare. Plans changed during this period beginning on January 1 of the following year. During the Annual Enrollment Period, any Medicare beneficiary can enroll or disenroll to or from a Medicare Advantage Plan or Part D Drug plan or return to their Original Medicare only if they choose.
  • Special Enrollment Period: You can change your Medicare Advantage or Part D drug plans in certain situations outside the annual enrollment windows. Below are a few examples of situations that will allow you a Special Enrollment Period.
    • If you have a lower income, have state or federal assistance with your Medicare costs
    • Moved out of your coverage area
    • Have access to a 5-star rated plan in your area

Affordable Care Act Open Enrollment Period

For people not yet on Medicare, the Affordable Care Act Marketplace plans have an open enrollment that begins November 1 and continues until January 15. This is the only time you can change or enroll in a marketplace plan unless you have a qualifying special enrollment period.

Work with a licensed insurance agent to ensure you can use these enrollment periods to your advantage.

Review this information with an agent representing multiple plan types and insurance companies to ensure you'll be provided with all plan options. Then compare the available plans against your current insurance and enroll in the one that best fits your needs and situation.

Prepare yourself by having a list of your healthcare providers, medications, and any concerns or shortcomings of your current plan.

 

About Medigap.com

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Medigap.com, a non-government entity, is owned and operated by Excel Impact, LLC. It consists of a team of Medicare professionals with over a decade of experience in helping beneficiaries get their Medicare sorted, as they understand that it can be a confusing and time-consuming process. The team stays on top of everything related to Medicare. That means keeping pace with ever-changing laws, rules, and regulations that determine the benefits beneficiaries have access to and are entitled to. Additionally, they keep track of trends in the private sector of Medicare, including Medicare Advantage, private prescription drug plans, Medigap plans, and more.

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