The 2023 Medicare “Open Enrollment” period starts on October 15 and runs to December 7. The period exists because the private companies offering Medicare Advantage and Medicare Part D prescription drug plans are allowed to change their benefits yearly, which can affect your plan’s benefits and its premium.
During this period, you can make certain changes to your Medicare health care plans if you want, most of which go into effect on January 1, 2023. However, if you don’t want to change anything, your plan will renew automatically.
Your reasons for wanting to make changes are very personal. But here are some typical ones:
Your regular doctor has dropped out of your existing plan.
Your prescription costs have gone way up, or a medication has been dropped.
You want to go to a specialist who is not in your plan’s network.
You have a chronic condition that will require far more specialists and medications.
Your existing plan no longer fits your budget.
You aren’t using your plan as much as you expected, making it feel overpriced.
The company you retired from has changed or ended its retiree benefit coverage.
You want to become a snowbird and spend your winters somewhere else.
The most efficient way to know if you want to make any changes during this period would be to keep notes throughout the year about any issues you have with your health care plan. But it’s never too late. The alternative is to sit down and list all the issues, inconveniences and disappointments you remember about the past year’s care.
Open Enrollment and Original Medicare Beneficiaries
If you have Original Medicare, two situations can make this Open Enrollment period vital for you:
If you want to shift from Original Medicare to a Medicare Advantage plan.
If you want to switch your Medicare Part D prescription drug plan.
You may have added a Medicare supplement insurance (or Medigap) plan to Original Medicare. If so, you can change Medigap plans throughout the year, so you don’t have to address that issue during the Open Enrollment period.
Open Enrollment and Medicare Advantage Beneficiaries
With Medicare Advantage plans, everything can be revisited and changed during Open Enrollment each year. This flexibility is a significant benefit of these plans, especially since it’s hard to know at age 65 what your medical needs will be when you’re 75 or 80.
Also, Medicare Advantage plans continue to add benefits. For example, starting in 2023, many plans are offering supplemental home health benefits in the form of personal in-home support, meal delivery, telehealth appointments, transportation to medical appointments and back, adult day care and allowances for over-the-counter supplies.
Let’s look at each type of change you might like to make.
How Do I Switch Medicare Advantage Plans?
You can change Medicare Advantage plans each year during Open Enrollment, and you will only be asked if you have End Stage Renal Disease (ESRD). As of January 1, 2021, Medicare Advantage covers ESRD, but you would require a Special Needs Plan.
Your existing Medicare Advantage plan provider will send you an Annual Notice of Change letter in September, before the Open Enrollment period. You need to read through the letter carefully, where all 2022 and 2023 changes are shown clearly. You might find changes to your premium, copays or preferred pharmacy network. The doctors and hospitals in your network may have changed, too.
You will also want to examine any changes to the drugs covered on the plan’s listing (or formulary), looking specifically at medications you presently take.
Takeaway action step: To research your options, visit the Medicare.gov website, and focus on the type of plans you prefer, plus your priorities in terms of doctors, hospitals, medications, premiums, deductibles and other shared costs. Once you make your choice, apply as required before December 7. And when you receive your new ID cards, present them to the plan’s pharmacy to be sure you are ready to start using that pharmacy for your drugs on January 1.
How Do I Switch My Medicare Part D Prescription Drug Plan?
If you have Original Medicare, you will likely have a standalone Medicare Part D plan. You can switch prescription drug plans each year during Open Enrollment without any health questions being asked. All plans are available to all beneficiaries.
Takeaway action step: Make a list of all the medications you take. Use this list as you research available plans through the Medicare.gov website and use the Drug Finder Tool to find the best combination of premiums, deductibles and copays for your medications. Then follow the instructions to apply for that Part D plan before December 7.
Whether your prescription drugs are covered under a standalone Medicare Part D plan or bundled into your Medicare Advantage plan, in 2023, these plans are required to offer insulin to their beneficiaries at a cost under $35 per month. However, plan providers can choose the insulin provided through their plan, so you will want to search for the insulin you use when researching plans.
How Do I Switch From Original Medicare (With or Without Medigap) to a Medicare Advantage Plan?
If you feel Medicare Advantage meets your needs better than Original Medicare, whether you have a Medigap plan or not, you can shop for a Medicare Advantage plan at the Medicare.gov website.
Follow the action step for changing Medicare Advantage plans (above). Once your Medicare Advantage plan is confirmed, be sure you are disenrolled from your standalone Part D and your Medigap plan (if you have one).
How Do I Switch From a Medicare Advantage Plan to Original Medicare?
Returning to Original Medicare (Part A and Part B) is relatively easy. In addition to the Open Enrollment period, you can also make the change during the Medicare Advantage Open Enrollment Period – from January 1 to March 31 each year. You can call 1-800-MEDICARE (1-800-633-4227) and ask the representative to disenroll you from Medicare Advantage. You will be returned automatically to Part A and Part B.
Since Original Medicare does not cover prescription drugs, you can enroll in a private Part D prescription drug plan by following the instructions for switching Part D plans (above).
You may want to add a supplement insurance (or Medigap) plan. However, it may not be easy in most states to find a new plan that does not require you to undergo medical underwriting and possibly penalize you for any preexisting conditions. (Some special circumstances can make you eligible for “guaranteed issue” without underwriting.)
Where can I get help?
The Medicare.gov website provides a detailed, step-by-step action plan as follows:
Log in or create an account with Medicare.
Find and compare health and drug plans available in your area.
Find and compare providers, including hospitals, nursing homes and more.
Here are more options for support in this important process:
Talk to someone at Medicare at 1-800-MEDICARE (1-800-633-4227).
Get free counseling from your State Health Insurance Assistance Program (SHIP).
Contact a licensed agent for help in selecting and signing up for plans.