Medicare’s open enrollment runs from October 15 to December 7. It is the yearly window to switch Medicare Advantage plans, move between Medicare Advantage and Original Medicare, or join, change or drop a Part D drug plan. The plan you are enrolled in when the window closes is the one that covers you from January 1.
Staying in your current plan is allowed, and often it is the right call. Make it a decision rather than a default. Plans can change their premiums, drug lists and networks every year. If you have a Medicare Advantage or Part D plan, its Annual Notice of Change should have reached you by September 30, and it lists what changes for you.
Start with your prescriptions. The Plan Finder on Medicare.gov can estimate each plan’s yearly drug cost only after you enter your drugs, doses and pharmacy. Without them it mostly compares premiums, which for someone on regular medication can be the smaller part of the bill.
- Mark October 15 and December 7 on your calendar
- Find the Annual Notice of Change from your current plan — It lists what changes on January 1, including the premium, deductible, copays and the drug list.
- Check whether any notice says your plan is ending or leaving your area — If it is, you will need to choose new coverage for January.
- List every prescription with its dose and how often you take it
- List your doctors, specialists, hospitals and pharmacy
- Add up what you spent on premiums, copays and drugs this year — A low premium is not a low total if your drugs or visits cost more under that plan.
- Check that each drug is still on your plan's drug list next year — Check its tier too, and whether it now needs prior authorization or step therapy.
- On Medicare Advantage, confirm your doctors and hospitals stay in network
- Compare plans in the Plan Finder on Medicare.gov — Enter your drug list and pharmacy so it can estimate each plan's yearly drug cost.
- Compare the yearly out-of-pocket maximum on Medicare Advantage plans
- Check whether a plan needs referrals or prior authorization for the care you use
- Compare preferred pharmacy and mail-order prices — Many Part D plans charge less at their preferred pharmacies.
- Look at each plan's star rating
- If you have retiree coverage from an employer or union, ask them before changing anything — Joining a different plan can end that coverage, and you may not be able to get it back.
- If you have a Medigap policy, know that this window does not cover it — In most states, buying or switching a Medigap policy later can mean answering health questions, and the insurer can turn you down or charge more.
- Check whether you qualify for Extra Help with drug costs — Extra Help is a federal program that lowers Part D costs for people with limited income and resources.
- Book a free session with your State Health Insurance Assistance Program (SHIP) — SHIP counselors give free one-on-one help and do not sell plans.
- Never give your Medicare number to someone who calls you uninvited
- Enroll in your new plan by December 7 — Use Medicare.gov, 1-800-MEDICARE or the plan itself. Joining a new Medicare Advantage or drug plan usually ends the old one, but a Medigap policy does not end on its own.
- Save the confirmation number and the date you enrolled
- Watch for the new plan's welcome letter and member card — If nothing has arrived by late December, call the plan.
- Show the new card at your first pharmacy visit in January
- Know about the second window from January 1 to March 31 if you are on Medicare Advantage — It allows one switch to another Medicare Advantage plan, or back to Original Medicare, where you can also join a Part D drug plan.