Open Enrollment, also known as the Annual Election Period (AEP), is the period each year during which you may change your Medicare Advantage plan and/or Part D coverage, and/or return to Original Medicare. The AEP is October 15 – December 7. Any plan changes you make during the AEP are effective January 1.
Each year, Medicare health plans and Part D prescription drug plans can change their premiums, deductibles, cost-sharing and some benefits, or discontinue their coverage altogether. You need to be aware of how your plan may change, and prepare accordingly.
- Review your plan’s changes for 2016. If you’re in a Medicare Advantage and/or Part D plan, your plan should have mailed you an Annual Notice of Change by September 30, explaining its changes for 2016. For example, the Annual Notice of Change would include information such as your premium and copayment, if your plan’s provider network will change, and/or a list of drugs (called a formulary) that will be covered. Even if you like your current plan, review your plan’s changes for 2016 and compare other options to determine which 2016 plans have the coverage you need.
- Look for other options. If your health plan or drug plan is terminating its coverage, you should receive a notice by October 2 informing you of your rights and options for other coverage. See When Medicare Advantage Plans Terminate Coverage.
- Be on the alert. Medicare health plans and prescription drug plans can start marketing their 2016 plans as of October 1, 2015. Agents and brokers selling these plan must follow strict guidelines when marketing to you. Review Medicare Marketing Do’s and Don’ts and report any suspected marketing fraud or abuse to the Senior Medicare Patrol at 1-855-613-7080.
What can I do during Open Enrollment?
You can make changes involving your Medicare Advantage or Part D plan.
During the AEP, if you are now in a Medicare Advantage or a stand-alone Part D plan, you can change to a different Medicare Advantage plan or stand-alone Part D plan. If you’re now in a Medicare Advantage plan, you can return to Original Medicare and join a stand-alone Part D plan for prescription drug coverage. If you have Original Medicare currently, you can enroll in a Medicare Advantage plan. If you are not in a Medicare Part D, you can join one.
What are my coverage options?
You can learn more about your coverage options by:
- Contacting your local Health Insurance Counseling & Advocacy Program (HICAP), also called State Health Insurance Assistance Program (SHIP). Your local HICAP has county-specific information on the Medicare advantage and Part D plans available in your area, as well as info on Medicare supplement plans known as Medigap.
- Using the Plan Finder on Medicare.gov to find Medicare Advantage and Part D plans in your area and to see what Part D plans cover the drugs you use.
- Reading the official U.S. government Medicare handbook: Medicare & You 2016 (PDF). The section in the back lists Medicare Advantage and Part D plans available in your area. Hard copies were mailed to beneficiaries between September 16-30, and it is also available online. (See the “Go Paperless” option on Medicare.gov for more info.)
I receive the Part D low-income subsidy (Extra Help) and currently don’t pay any premium or deductible. Can I stay in my same plan or do I need to switch plans to continue with no premium or deductible?
In 2016, you can stay in your current plan. All 6 benchmark plans for 2015 will continue in 2016 (see list below). Benchmark plans are plans whose premiums are at or below the weighted average of premiums in California ($31.05 for 2016). If you are already in one of these 6 plans, you can stay in your plan and not pay a premium or deductible. (Reminder: You are still responsible for your copays which will be up to $2.95 for generic drugs or $7.40 for brand name drugs.) You may join a non-benchmark plan but you may have to pay a premium.
For 2016, California has 6 benchmark plans:
- AARP Medicare Rx Saver
- Aetna Medicare Rx Saver
- EnvisionRxPlus Silver
- Humana Preferred Rx
- SilverScript Choice
- Symphonix Value Rx
What if I miss the AEP and still want to make a change? Are there other times during the year I can change my health plan and/or Part D coverage?
The AEP is the main time most Medicare beneficiaries can change plans. However, some Medicare beneficiaries may change plans at other times:
Medicare Advantage Disenrollment Period (MADP)
If you’re in a Medicare Advantage plan with or without Part D coverage, you can disenroll from your plan and return to Original Medicare anytime between January 1 – February 14. You are also given a Special Election Period (SEP) to enroll in a Part D plan during this time. But you may not enroll in a Medicare Advantage plan at this time.
Your MA plan disenrollment becomes effective the first day of the following month. For example, if you disenroll from your MA plan in January, your change becomes effective February 1. If you diseroll in February, your change becomes effective March 1.
We also encourage you to enroll in a Part D plan as close to the time of your MA plan disenrollment as possible in order to avoid any gap in drug coverage. For example, if you disenroll from your MA plan on January 28 and enroll in a Part D plan on February 1, you would return to Original Medicare on February 1, but wouldn’t have drug coverage until March 1.
Plan Non-Renewal Special Election Period
If your MA or Part D plan is not renewing next year, you should have received a notice from your plan by October 2 telling you of this change and your rights and options for other health coverage.
One of your rights is that you have a Special Election Period (SEP) to join a new plan. The SEP is from December 8 to February 29 the following year. Your new coverage will become effective the first day of the following month.
Ongoing Special Election Period Right for Certain People with Low-Incomes
People who receive the Part D Extra Help (which includes people with full Medi-Cal or in a Medicare Savings Program) can change their Medicare Advantage and/or Part D coverage on a monthly basis.
5-Star Medicare Advantage or Part D Plan Special Election Period
If you live in an area with a Medicare Advantage and/or Part D plan(s) that has an overall plan performance rating of 5 stars, and you’re otherwise eligible to enroll in the plan, you have a Special Election Period (SEP) to join that plan. Medicare releases plan performance ratings each fall and the ratings apply for the following calendar year. Your SEP is from December 8 through November 30. Your new coverage will become effective the first day of the following month. You can use this SEP to enroll in a 5-star plan only once during the SEP.
Other Special Election Periods (SEPs)
There are certain events/situations that allow a SEP to enroll in, switch, or disenroll from a Part D or Medicare Advantage plan. Some of these events include relocation – if you move out of your plan’s service area; contract violation – if your plan violates its contract with Medicare (including marketing misconduct); change in care setting – if you move into or out of a nursing facility. See our list of events triggering an SEP for more information.
Can I switch plans more than once during the AEP?
You may, but the choice that will be effective will be the last one received by a plan by December 7. Your new coverage becomes effective on January 1.