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5 Things You Need to Know Before Changing Medicare Plans During AEP

By Lindsay Malzone September 18, 2021 Health and Fitness

Medicare’s Annual Enrollment Period (AEP) is just around the corner. It’s also commonly known as the Fall Open Enrollment Period. From October 15 to December 7, beneficiaries can sign up for Medicare Advantage or Part D plans, switch from their current plan to a new one, or cancel their existing coverage.

Leading up to this seven-week window, there are some things to know before making these changes.

Changes Made During AEP Go into Effect on January 1

Here’s a breakdown of some of the changes you can make during AEP:

  • Disenroll from Medicare Advantage and return to Original Medicare
  • Enroll in a new Medicare Advantage plan if you have Original Medicare
  • Swap from one Medicare Advantage plan to another
  • Sign up for a Part D prescription drug plan
  • Change from your existing Part D prescription drug plan to another, or cancel this coverage.

Keep in mind that you’ll need to enroll in Parts A and B (Original Medicare) before signing up for Part C (Advantage) or Part D. If you have been on Medicare for a while and are just now picking up a Part D plan, you may be subject to a late enrollment penalty for lacking creditable coverage.

Creditable coverage is coverage that’s as good as Medicare – the most common example being employer group plans for 20 or more employees.

While you can make multiple changes during AEP, the final change you make before December 7 will be effective on January 1.

Your Annual Notice of Change Letter Is Important

Each September, Medicare Advantage and Part D carriers mail out an Annual Notice of Change (ANoC) letter to their beneficiaries, summarizing changes to the plan for the following year. Contact your plan’s carrier if you don’t receive this letter by the end of the month.

For Advantage and Part D plans, the ANoC outlines changes to costs and coverage. For Advantage plans, the letter includes changes to out-of-pocket costs and whether your doctor will remain within your network. Also, changes to the plan’s drug formulary and preferred pharmacy are mentioned.

If Your Coverage Will Be Sufficient for Next Year

Along with any shortcomings you may have noticed in your Advantage or Part D plan throughout the past year, your Annual Notice of Change will help you determine if you should take action during AEP. Maybe you can find a drug plan with a more affordable monthly premium, or an Advantage plan with a lower maximum out-of-pocket amount.

Even larger financial concerns than your premium are prescriptions missing from the formulary or your preferred provider leaving your Advantage plan’s network. If either happens, you could be paying a lot more in the next year by remaining on the plan.

Keep in mind whether your health and medication needs have changed over the past year, or if you expect them to change within the next year. In this case, your current coverage may no longer be sufficient for the near future.

You Shouldn’t Fret if You Pick the Wrong Advantage Plan

Suppose you choose an Advantage plan during the Annual Enrollment Period that you think will fulfill your needs. Yet shortly after it goes into effect on the first of the year, you find that it isn’t what it was cracked up to be – or it’s just not for you.

Luckily, the Medicare Advantage Open Enrollment Period gives you a chance, from January 1 through March 31, to rectify such a situation. Available only to current Medicare Advantage enrollees, during this time you can switch to another Advantage plan or drop your current plan.

Further, if you drop Medicare Advantage and return to Original Medicare, you can also pick up a Part D prescription drug plan at the same time, so you don’t go without sufficient drug coverage.

If You Miss AEP, You May Qualify for a Special Enrollment Period

Now, Special Enrollment Periods (SEP) only apply following certain life events for people who have Medicare Advantage or Part D. Each SEP has different rules when it comes to the timeframes and changes you can make.

Life events that qualify you for a Special Enrollment Period include:

  • Moving outside your plan’s service area
  • Losing health insurance through your or your spouse’s employer
  • Moving back to the United States after living abroad.

Avoid Mistakes During the Annual Enrollment Period

The biggest mistakes to avoid during AEP include not doing your research or utilizing your resources. For instance, not understanding the late enrollment penalties or changes affecting your plan can lead to preventable out-of-pocket costs. The Annual Enrollment Period can seem complex, but if you understand the basics, you’ll be in good shape.

Are you currently on Medicare? Do you think you will need to change your plans this year? For what reasons? Did you know you could do that during the Annual Enrollment Period? Do you have specific Medicare questions?

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The Author

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare space since 2017. Lindsay has a passion for sharing her expertise on Medicare to beneficiaries so they can be better prepared for healthcare costs after retirement. Her YouTube channel features various videos that help Medicare beneficiaries discover all their options.

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