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Is Medicare open enrollment for everyone?

If you're currently covered by Original Medicare or Medicare Advantage, you're eligible to make changes during open enrollment – including a change from one prescription drug plan to another.

Reviewed by our health policy panel.

Q: Is Medicare open enrollment for everyone? Who can make changes, who can’t?

A: Medicare’s open enrollment period runs from October 15 through December 7 each year, and it’s a great opportunity to make changes to your coverage that save you money and time. But not everyone gets to participate in open enrollment.

Who can make changes during Medicare’s open enrollment?

If you’re currently covered by Original Medicare or Medicare Advantage, then you’re eligible to make changes during open enrollment. During this time, you can:

  • Switch from Original Medicare to a Medicare Advantage plan
  • Switch from Medicare Advantage to Original Medicare (This includes signing up for Parts A and B as well as getting a Part D drug plan.)
  • Switch from an existing Medicare Advantage plan to another
  • Switch from an existing Part D drug plan to another

Any changes you make during open enrollment will take effect on January 1 of the following year.

Who can’t participate in Medicare open enrollment?

There is no open enrollment period for Medicare supplement plans (ie, Medigap plans). Although some states allow Medigap enrollees to transition to a different Medigap plan without medical underwriting, most do not. And federal rules do not provide any sort of annual open enrollment window for people to change their Medigap coverage.

This is important for people to understand if they’re using the open enrollment period to transition from Medicare Advantage to Original Medicare. They’ll be allowed to pick a Part D plan at that point, but unless they’re within their trial right window, they will likely have to go through medical underwriting in order to purchase a Medigap plan.

And Medicare’s open enrollment window is meant for existing enrollees, not new ones. If you’ve yet to sign up for Medicare, your initial enrollment period begins three months before the month of your 65th birthday, and it ends three months after that month. All told, you get seven months to sign up, and if you didn’t do so during that time, you can’t sign up during open enrollment. Instead, you must wait until Medicare’s general enrollment period, which runs from January 1 through March 31 every year. If you sign up during that window, you’ll have coverage beginning July 1 of that same year.

Keep in mind that if you go too long without Medicare coverage upon being eligible (and assuming you don’t have qualifying coverage from another source), you’ll face lifelong penalties added to your premiums for Part B and/or Part D.

The Part B late enrollment penalty increases your premium by 10 percent for every 12-month period that you delayed coverage. So if you delay Part B for five years (and don’t have coverage from an employer-sponsored plan during that time), you’ll have to pay an extra 50 percent for your Part B coverage for as long as you have it.

For each month that you delay Part D, the late enrollment penalty adds 1 percent of the national base beneficiary premium. So if you delay for 36 months, a penalty equal to 36 percent of the national base beneficiary premium will be added to your Part D plan’s premium, for as long as you have Part D. Therefore, it pays to sign up on time and know when your initial enrollment period takes place.

Do you need to participate in open enrollment?

If you’re satisfied with your current Medicare Advantage or Part D drug plan and therefore don’t want to change your coverage, then there’s no need to take action during open enrollment. Keep in mind, however, that some plans get discontinued from year to year, so you may not have that choice. If that happens, however, you’ll be notified in advance that your plan isn’t eligible for renewal, at which point you’ll know to shop around during open enrollment.

But even if you like your existing plan and it’s still available, know that your costs and benefits under it could change from year to year. Therefore, even if you’re not planning to make changes during open enrollment, it pays to spend some time exploring your options. You may find that there’s a better plan out there for you — for example, a Part D plan under which your recurring prescriptions cost less, or a Medicare Advantage plan whose network of providers is more robust in your area.

It also pays to check out plan ratings during open enrollment and see how your current choice stacks up. You can access this information via Medicare’s Plan Finder tool. If you see that your plan is poorly rated, it could drive you to sign up for a new one while that opportunity still exists.

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