The Medicare Annual Enrollment Period (AEP) runs from October 15th to December 7th each year. It’s a critical time for Medicare beneficiaries to review their healthcare coverage options and decide whether to make changes. Coverage goes into effect on January 1 of 2025 for any changes made during AEP 2024. Let’s look at what steps people can take during AEP to ensure they have the right level of coverage in place for the upcoming year.
What Changes Can Be Made During AEP?
The answer to this question depends on whether you have Original Medicare or Medicare Advantage and how satisfied you are with your current benefits.
Enroll in a Medicare Advantage (Part C) Plan from Original Medicare.
Seniors who need comprehensive coverage beyond the basic care provided by Original Medicare often turn to Medicare Advantage (Part C) plans. Medicare Advantage (MA) plans are offered by private companies that are approved and contracted by Medicare. MA plans include all the benefits offered by Parts A and B and may include extra benefits to support your total health.
Some MA plans also come with prescription drug coverage. prescription drug coverage (Part D) bundled together in one plan. These are known as Medicare Advantage Prescription Drug (MAPD) plans. During AEP, you can join either an MA plan or an MAPD plan. You can also choose to make no changes and keep your current Original Medicare coverage as is.
It's important to note that if you're currently enrolled in Original Medicare and you switch to a Medicare Advantage plan, you must continue to pay your Part B premium.
Switch from one Medicare Advantage (MA) Plan to another.
Perhaps you've shopped around and identified a Medicare Advantage plan that would serve your healthcare needs more effectively than your current one. During AEP, you can switch between Medicare Advantage products.
If you don't have prescription drug coverage bundled in with your MA plan, you can make the switch into an MAPD plan that includes prescription drug coverage. You could also go from an MAPD plan to an MA plan.
Add a standalone Prescription Drug Plan (PDP) to your Original Medicare coverage.
If you are satisfied with Original Medicare but want to add prescription drug coverage, you can enroll in a standalone Prescription Drug Plan (PDP). PDPs offered by private companies may require a monthly plan premium, but may offer more predictable costs for your medicines, lower deductibles, or no cost for certain drugs.
Switch or drop your Medicare prescription drug coverage.
You can switch from one Medicare prescription drug plan to another or enroll in an MAPD plan that includes prescription drug coverage.
You can also drop your prescription drug coverage altogether. Keep in mind that if you do not have other creditable drug coverage and you wait too long (63 days or more) to enroll in a private Part D plan, you could pay a late enrollment penalty.
Drop your Medicare Advantage Plan and return to Original Medicare.
If you’re unhappy with your Medicare Advantage plan but don’t want to enroll in another one, you can go back to Original Medicare.
Make no changes and keep your existing coverage.
There is no requirement to make changes during AEP. If your current coverage meets your needs and is still offered for the following year, you can choose to keep it without any action.
What to Consider Ahead of AEP
Review Your Current Coverage: Take stock of your current health needs and the coverage you have under Medicare or Medicare Advantage. Information for the next year’s sent out plans is made available at the beginning of October. Be sure to review the Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) documents carefully. Consider any changes in your health or prescriptions that may affect your needs for the upcoming year.
Evaluate Costs: Compare premiums, deductibles, copayments and coinsurance across different Medicare Advantage plans or between Original Medicare and Medicare Advantage.
Coverage Benefits: Assess the benefits offered by different plans, including services like vision, dental, hearing and fitness programs that may be included in Medicare Advantage plans but not in Original Medicare.
Provider Networks: Check if your doctors, hospitals and other healthcare providers are in the network of the Medicare Advantage plan you are considering. Out-of-network care may result in higher out-of-pocket costs.
Prescription Drug Coverage: Make sure that the MAPD plan or standalone prescription drug plan you choose covers your medications at a reasonable cost. Compare formularies (lists of covered drugs) to see which plan offers the best coverage for your prescriptions.
We’ll help you confidently prepare for and enroll in a Medicare Advantage plan that fits your needs and budget. Contact Wellcare and our team of experts can help.
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Medicare Open Enrollment Frequently Asked Questions
Is the Medicare AEP the same as the Medicare Advantage Open Enrollment Period (OEP)?
No, they are different. The Medicare Advantage Open Enrollment Period (OEP) runs from January 1st to March 31st each year. During this period, individuals enrolled in a Medicare Advantage Plan can switch to another Medicare Advantage Plan or switch back to Original Medicare.
If you have Original Medicare with or without prescription drug coverage, you can’t enroll in Medicare Advantage during this time.
What happens if I miss Medicare AEP?
Missing the AEP deadline may limit your options for making changes to your Medicare coverage for the upcoming year. However, there are certain circumstances that may you for a Special Enrollment Period (SEP) (e.g., you move, you are diagnosed with specific chronic conditions, you qualify for or lose eligibility for Medicaid, and others).
Can I enroll in Medicare for the first time during the AEP?
No, the AEP is primarily for beneficiaries who are already enrolled in Medicare to make changes to their existing coverage. You can sign up for Medicare for the first time during your Initial Enrollment Period (IEP), which is the 7-month period that starts 3 months before and ends 3 months after the month of your 65th birthday.
Will my current healthcare providers accept my new plan if I switch during the AEP?
It depends on the plan you choose. Medicare Advantage Plans often require beneficiaries to use providers within a specific network. Before switching plans, it's important to check if your preferred providers are in-network to ensure continuity of care.
What if I need help deciding how to get my Medicare benefits?
Visit the Medicare Plan Finder at medicare.gov/plan-compare to find and compare plans in your area. Call 1-800-MEDICARE (TTY 1-877-486-2048) for details 24 hours a day, 7 days a week. Or visit medicare.gov/talk-to-someone.
Interested in Medicare Advantage? Contact Wellcare to find a plan that fits your needs.
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