1 October 2015

2016 Medicare Open Enrollment

Each year, the Medicare Annual Open Enrollment Period (AEP) runs from October 15th through December 7th.  This is the special time frame when Medicare beneficiaries have the option to make changes to certain types of Medicare health insurance plans.  Any changes made during AEP will take effect January 1st of the upcoming year (January 1st, 2016 in this case). 


Insurance carriers are required to provide a detailed update each year prior to October 1st on their existing Medicare Advantage Plans and Part D Prescription Drug Plans.  Since these Medicare insurance plans run on a calendar year basis, there are usually changes in plan benefits and features from year-to-year.  This is exactly why the Medicare AEP exists.  It provides you with the “option” to change your plan, if it is beneficial.


Here are some of the common scenarios that can take place during AEP:


Take no action

If you are happy with your plan(s) and wish to accept the new plan provisions for next year, no action is required.

Change your Part D Prescription Drug Plan

If your prescription drug coverage changes, a Part D drug plan change may be appropriate.  Your current Part D drug plan may change to an extent that it doesn’t cover your particular list of prescriptions as well as before (i.e. plan formulary changes)…or…you may have several new prescriptions causing you to question whether you are still in the right plan.  Either way, you can switch to another Part D drug plan during AEP – with your current insurance carrier, or another carrier.    

Change your Medicare Advantage Plan

If your medical and prescription drug coverage change, a Medicare Advantage plan change may be appropriate.  Since many Medicare Advantage plans include both medical and drug coverage, you may consider a plan switch during AEP, if either or both of these changes to your detriment.  Sometimes drug formulary changes can create the need to make a plan switch.  Other times, doctors, hospitals and other medical providers may leave your plan’s network.  Also, the medical benefits can be impacted negatively from year-to-year.  For example, certain medical services may have increased copayments, or the plan’s medical maximum out-of-pocket limit may increase to a level that is out of your comfort zone.


As you can see, there are a multitude of reasons a Medicare Advantage plan change may be warranted.  And just like Part D drug plans, you can switch to another Medicare Advantage plan during AEP – with your current insurance carrier, or another carrier.

Switch from Original Medicare to Medicare Advantage

When you have Original Medicare and a Medicare Supplement Insurance Plan (Medigap), you use Medicare Part A (hospital) and Part B (medical/outpatient) as your primary coverage, and your Medigap plan as your supplemental plan for medical services.  And you usually will also have a Part D drug plan, unless you have creditable prescription drug coverage from another source (i.e. VA benefits).  But what if you aren’t happy with your plan coverage, pricing, or have customer service issues?  


You can switch entirely from this plan setup to Medicare Advantage during AEP.  If you switch to a Medicare Advantage plan that includes Part D coverage in this scenario, this will automatically dis-enroll you from your existing stand-alone Part D drug plan with a January 1st effective date.   However, you will still need to request cancellation of your existing Medicare Supplement plan as of January 1st of the upcoming year.

Medicare’s Annual Open Enrollment Period is a critical time for Medicare beneficiaries.  Even if a plan change is not beneficial, it is a good idea to first understand your plan’s provisions for the new plan year, as well as spend some time collecting information on other plans available in your area.  At Fiduciary Insurance Group, we are always available to guide you through this important time frame.


Neither Fiduciary Insurance Group nor its agents are connected with the Federal Medicare program.


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