Medicare Open Enrollment Guide

Medicare provides healthcare coverage for many Americans age 65 or older. The annual Medicare open enrollment period allows beneficiaries to change their coverage. Knowing when the Medicare open enrollment window opens and closes is important for managing coverage from year to year.

Medicare Basics

Medicare enrolls seniors 65 and older and younger people with certain qualifying health conditions or disabilities. Separate parts of Medicare cover particular categories of healthcare services.

Medicare Part A and B

Parts A and B are sometimes called Original Medicare to distinguish them from privately administered Medicare Advantage plans. An estimated 65 million people are enrolled in Medicare Part A and B.

Medicare Part A covers inpatient care in a hospital, skilled nursing facility, or nursing home care that’s not required long-term, hospice care, and some home healthcare. Medicare Part B covers doctor visits, other outpatient services, mental health care, ambulance transport, durable medical equipment, laboratory tests, and preventive screenings.

Medicare Part C / Medicare Advantage

Medicare Advantage plans are an alternative to original Medicare, offered by private insurance companies under Medicare guidelines. Participants typically have lower out-of-pocket costs, but coverage is generally limited to network providers.

Around 33.8 million are projected to have a private Medicare Advantage plan in 2024.

Medicare Part D

Medicare Part D provides prescription drug coverage. You must have traditional Medicare coverage or a Medicare Advantage plan to enroll in Medicare Part D.

Medigap

Medigap, or Medicare Supplement insurance, is sold by private companies and pays some of the costs original Medicare doesn’t cover, including deductibles, coinsurance, and copays.

What Is Medicare Open Enrollment?

Medicare open enrollment is a designated time window each year when you can make changes to your Medicare coverage. There are two windows—one for Original Medicare, and one for Medicare Advantage.

The fall open enrollment period for Medicare begins Oct. 15 and runs through Dec. 7 each year. Open enrollment is primarily for people who already have Medicare. So, this enrollment period is open to people who are covered by Medicare parts A or B.

You can change your coverage under Medicare Parts A or B during the Medicare open enrollment period. Changes made during fall open enrollment for Original Medicare recipients take effect on Jan. 1 of the following year.

A separate Medicare open enrollment period (Jan. 1 to March 31) applies to people in private Medicare Advantage plans. Medicare Advantage open enrollment changes take effect on the first day of the month after your request is received.

What Can You Change During Medicare Open Enrollment?

During the Medicare open enrollment period, you can make a number of changes to your existing coverage.

Specifically, you can use the Medicare open enrollment window to:

• Switch from Original Medicare (Parts A and/or B) to a Medicare Advantage plan (Medicare Part C)
• Switch, drop, or join a Medicare Advantage plan
• Enroll in, add, change or remove Medicare Part D prescription drug coverage

If you have a Medicare Advantage plan, you can switch Medicare Advantage plans during the open enrollment period that extends from Jan. 1 to March 31. During this time, you could also opt to switch to Original Medicare and enroll in Medicare Part D.

Original Medicare vs. Medicare Advantage

One of the biggest questions you might have during open enrollment is whether it makes sense to choose original Medicare or a Medicare Advantage plan. Understanding the coverage options and costs can help with deciding which one makes more sense.

Here’s an overview of how the two compare.

Comparing Medicare Costs

When comparing Original Medicare and Medicare Advantage plans, consider what’s covered and what you’ll pay.

Medicare Part A Costs

Most people don't pay a premium for Medicare Part A coverage. But both Parts A and B have deductibles and coinsurance. For Part A, here are 2024's costs for each benefit period:

• Hospital inpatient deductible: $1,632 
• Hospital days 1–60: $0 coinsurance
• Days 61–90: $408 coinsurance per day
• Days 91 and beyond: $816 coinsurance per “lifetime reserve day” (up to 60 days over lifetime)
• Beyond lifetime reserve days: patient pays all costs

Medicare Part B Costs

The standard monthly premium for Medicare Part B is $174.70 for 2024, though your premium may be higher based on income.

The annual Medicare Part B deductible in 2024 is $240. After your deductible is met, you typically pay 20% of the Medicare-approved cost for most services, including doctor visits, outpatient therapy, and durable medical equipment.

Medicare Advantage Costs

Medicare Advantage plan (Medicare Part C) costs depend on the plan you choose. Medicare Advantage members remain responsible for paying their Medicare Part B premiums. Some plans may pay some or all of those on members' behalf, a practice known in the industry as a Medicare giveback benefit.

Some Medicare Advantage plans may charge an additional monthly premium, but most don't. The amounts you pay for deductibles, copayments, and coinsurance can also vary.

Medicare Part D Costs

The price of Medicare Part D drug coverage depends on the plan and your income. But here are generally the pieces you may pay for:

• Premium: Medicare recipients can enroll in a basic Part D plan. But around 75% of recipients also pay for "enhanced supplemental" drug coverage, providing more robust drug benefits. The projected average Part D premium across these two coverage types in 2024 is $55.50.
• Premium monthly adjustment amount: Higher-income Medicare recipients pay a monthly adjustment of $69.90 to $419.30 in 2024.
  
• Yearly deductible: In 2024, your annual deductible can't be more than $545.
• Copayment or coinsurance: Varies by plan and drug.
• Out-of-pocket spending limits: Once your out-of-pocket spending reaches $8,000 in 2024, you don't pay covered Part D drug copayments or coinsurance for the rest of the calendar year. This is also called catastrophic coverage.

Some Inflation Reduction Act changes arrived in time for the 2024 enrollment. As of 2024, Part D plans must not apply the deductible to any Part D covered adult vaccine or insulin product. In general, Part D plans can't charge more than $35 for a month's covered insulin product supply. Part D plans also can't charge cost-sharing for vaccines.

How to Choose a Medicare Advantage Plan

Medicare offers a plan finder tool to help you compare Part C plans. But in general, Medicare Advantage plans can be structured as:

• Health maintenance organization (HMO)
• Preferred provider organization (PPO)
• Private fee-for-service (PFFS)
• Special needs plans (SNPs)

Less common types of Medicare Advantage plans include HMO point-of-service plans and Medicare Medical Savings Account (MSA) plans.

When shopping for a Medicare Advantage plan, consider whether you'll be able to see out-of-network providers, whether a referral is required to see a specialist, and how much you’ll pay in premiums and out-of-pocket costs.

If You Miss Medicare Open Enrollment

If you miss the Medicare open enrollment period, you generally can’t change your coverage until the next one rolls around. There are, however, some exceptions. Special Enrollment Periods (SEPs) allow you to change your Medicare plan outside the open enrollment period.

You can learn more about special enrollment periods on the Medicare website, but you may qualify if any of the following apply to you.

Relocation or Moving Facilities

You could qualify to enroll in Medicare If you move to a new home that isn’t in your current plan’s service area. You could also qualify if you move back to the U.S. after living outside the country.

If you move into or out of a skilled nursing care facility or are released from prison, you may also qualify for a SEP.

Losing Coverage

If you lose employer or COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, you'll likely be able to enroll in Medicare.

You could also qualify if you drop coverage under the Program of All-Inclusive Care for the Elderly (PACE), are no longer eligible for Medicaid, or are enrolled in a Medicare Advantage plan or Part D plan that isn’t renewed.

Qualifying for New Coverage

You could qualify if you're now eligible for both Medicaid and Medicare, or if you qualify for the Extra Help program to pay for Medicare Part D prescription drug coverage.

The Bottom Line

During the Medicare open enrollment period, you can change your current Medicare coverage under parts A or B. Open enrollment runs from Oct. 15 to Dec. 7. A separate Medicare open enrollment period of Jan. 1 to March 31 applies to Medicare Advantage plans. If you miss your open enrollment period, you’ll generally have to wait until the following year to make changes, although there are some exceptions.