Medicare Open Enrollment: How to Shop

Two Medicare-related open enrollment periods offer a chance to switch your coverage. Here's how to compare plans.
Written by Kate Ashford
Reviewed by Marcia Mantell
Apr 4, 2022
Medicare Open Enrollment: How to Shop

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As with most health care plans, Medicare plans have an annual open enrollment period. During this time, current Medicare users get a chance to evaluate their coverage and potentially make changes.

Medicare has one main open enrollment window from Oct. 15 to Dec. 7 each year. However, there’s also a Medicare Advantage open enrollment period annually from Jan. 1 to March 31.

What is Medicare open enrollment?

Open enrollment is a specific period of time each year when a person on Medicare can evaluate the plan they have, take a look at what’s on the market and update their coverage for the coming year. Open enrollment is for consumers who already have Original Medicare or Medicare Advantage.

During the main open enrollment period, from Oct. 15 to Dec. 7, any changes you make will take effect on Jan. 1. During the Medicare Advantage open enrollment period, any change you make (you can only make one change) will take effect on the first of the month after the plan receives your request.

What you can change during Medicare open enrollment

There are several things you can alter during open enrollment. From Oct. 15 to Dec. 7, you can do the following things:

  • Switch from Original Medicare to a Medicare Advantage plan.

  • Switch from a Medicare Advantage plan back to Original Medicare.

  • Move from one Medicare Advantage plan to a different one.

  • Switch from one Medicare prescription drug plan to another one.

  • Drop your Medicare prescription drug coverage.

From Jan. 1 to March 31, Medicare Advantage open enrollment, existing Medicare Advantage beneficiaries can do the following things:

  • Switch from one Medicare Advantage plan to another.

  • Quit your Medicare Advantage plan and go back to Original Medicare, with the option to join a Medicare prescription drug plan.

While it’s possible to switch from a Medicare Advantage plan and go back to Original Medicare during both periods, it’s possible to do the reverse (move from Original to Advantage) only from Oct. 15 to Dec. 7.

The reason for these confusing options? Some people who change their Medicare Advantage plans at the end of the year often find once the plan takes effect that it doesn't work: Their doctor doesn’t take the new plan, for instance, or their drugs aren’t covered at the same price. Without this Medicare Advantage open enrollment period, they would be stuck for a full year in a plan that doesn’t work for them. This January-to-March open enrollment allows them to trade in their Medicare Advantage plan for one that works for them.

The parts of Medicare

Read more about the different parts of Medicare and what they cover.

Comparing Original Medicare and Medicare Advantage

If you have an Original Medicare plan, you’re enrolled in Medicare Part A and Medicare Part B, and you may also have a supplement plan, like Medigap, and a Part D plan. Open enrollment is the time when you might consider switching to a Medicare Advantage plan. For some people, purchasing a Medicare Advantage plan feels simpler.

“Some people prefer the sense of a one-stop shop,” says Deborah Gordon, author of “The Health Care Consumer’s Manifesto: How to Get the Most for Your Money.” “Like, ‘I cannot deal with A, B, D, I just want a health plan.’”

Here’s what you should know:

  • Medicare Advantage plans offer all the benefits of Part A and Part B. You won’t get less coverage with an Advantage plan.

  • Most Medicare Advantage plans provide prescription drug coverage. If you stick with Original Medicare, you’ll have to sign up for Medicare Part D for prescription drug coverage.

  • Medicare Advantage plans usually offer coverage for things that aren’t included under Original Medicare, such as dental, vision, hearing and wellness programs.

  • With a Medicare Advantage plan, you must use health care providers who are in the plan’s network, and you may need a referral to see a specialist. With Original Medicare, you can use any health care provider in the U.S. that takes Medicare, and you usually won’t need a referral.

  • Some Medicare Advantage plans may have lower out-of-pocket costs than Original Medicare. Original Medicare users may have to purchase supplemental coverage to help cover out-of-pocket costs.

  • Under Original Medicare, there's no limit on your out-of-pocket costs each year. However, with a Medicare Supplement plan in place, you’ll generally have only a monthly premium to pay. With a Medicare Advantage plan, once you spend a certain amount ($7,550 in 2022), the plan will cover 100% of the costs for the rest of the year.

  • While neither plan covers you if you travel outside of the U.S., you may be able to purchase a Medicare Supplement policy that covers foreign travel emergency care if you have Original Medicare. With either Original Medicare or Medicare Advantage, you can purchase additional travel insurance.

How to compare Medicare Advantage plans

Choosing a Medicare Advantage plan can be a little intimidating because there are so many plans available. “The average Medicare beneficiary has something like two dozen choices,” Gordon says. “That seems great, like, ‘Oh, you have so many options,’ but it can be really overwhelming to consumers.”

In fact, the number of options has risen for most. This year, the typical Medicare beneficiary will have 39 Medicare Advantage plans available in their area, according to the Kaiser Family Foundation.

Types of Medicare Advantage plans

  • Health maintenance organization, or HMO, plans: This kind of plan requires you to see an in-network provider unless it’s an emergency situation. Most require you to get a referral to see a specialist. As these plans change and adapt to expand, some people may have access now to HMO-POS (or point of service) plans that offer some out-of-network benefits at higher copays or coinsurance rates.

  • Preferred provider organization, or PPO, plans: This kind of plan allows you to see both in-network and out-of-network health care providers, although it typically is more expensive to go out of network, and monthly premiums are typically higher than most HMOs.

  • Private fee-for-service, or PFFS, plans: This kind of plan allows you to see any Medicare-approved health care provider as long as they accept the plan’s payment terms and agree to see you, and they haven’t opted out of Medicare. You may also have access to a network of providers. You can see out-of-network doctors who don’t accept the plan’s payment terms, but you might pay more. And even if an out-of-network doctor or hospital has treated you before, they can decide not to do so again.

  • Special needs plans, or SNPs: This kind of plan provides benefits only to people with certain severe diseases, such as cancer or HIV; living in an institution, such as a nursing home; or dually eligible for both Medicare and Medicaid. Not all types of SNPs are available in all areas or to handle every type of severe disease.

  • Medical savings account, or MSA, plans: These combine a high-deductible insurance plan with a medical savings account that can be used for health care costs.

Comparing Medicare Advantage plans

Choosing between Medicare Advantage plans will require you to understand your health care needs and think about what each type of plan offers. If you have a chronic health condition and you love your doctors, you’ll want health coverage that they accept. If you take prescription drugs, some plans may result in lower out-of-pocket costs than others. Here are some questions to ask:

  • Do you have to get a referral? Some plans require you to get a referral from your primary care physician in order to see a specialist. If that’s not your preference, you’ll want to choose a plan with more freedom.

  • What benefits do they include? Do you need vision and dental coverage? Look for a plan that offers the benefits you want.

  • How much will your drugs cost? If you’re taking regular prescription drugs, compare costs within each plan to make sure you understand what you’ll be paying. If you’re taking specialty or Tier 4 or 5 drugs, make sure they’re covered in the plan you’re considering and are less expensive than in a stand-alone Part D plan.

  • Are your doctors covered? If you like your providers, find out whether they’re included in the networks of the plans you’re considering.

  • What’s their rating? Each Medicare Advantage plan comes with a star rating that ranges from 1 to 5 stars, with 5 being best. Each year, Medicare scores how well Medicare Advantage plans perform in several categories, including quality of care and customer service. “I talked to a consumer in Massachusetts who essentially [won't consider] any plan below a 4-star plan,” Gordon says.

For additional help, try the Medicare plan finding tool on Medicare’s website.

Medicare Advantage providers

Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.

How to switch Medicare Advantage plans

If you’re already in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan during either open enrollment period: Oct. 15 to Dec. 7, or Jan. 1 to March 31. After you join a new plan, you’ll be automatically unenrolled from your old plan once your new one starts.

If you're in Original Medicare with a Medicare Supplement plan, or Medigap, and want to consider switching to a Medicare Advantage plan, you can do so during the annual open enrollment period from Oct. 15 to Dec. 7. Your new plan will start on Jan. 1. You’ll want to disenroll from your Medigap and Part D plan in January.

If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).

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