Q: When is Medicare Open Enrollment?
A: The Medicare Open Enrollment period is from October 15 until December 7 each year (the dates changed in 2011, but have been the same ever since, and should remain as-is for the foreseeable future.). For 2018 Medicare coverage, open enrollment ended on December 7, 2017. For 2019 coverage, open enrollment will run from October 15, 2018, to December 7, 2018.
During the annual enrollment period (AEP) you can make changes to various aspects of your coverage.
- You can switch from Original Medicare to Medicare Advantage, or vice versa.
- You can also switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another.
- And if you didn’t enroll in a Medicare Part D plan when you were first eligible, you can do so during the general open enrollment, although a late enrollment penalty may apply.
If you want to enroll in a Medicare Advantage plan, you must meet some basic criteria.
- You must be enrolled in Medicare Part A and B.
- You must live in the plan’s service area.
- You cannot have End-Stage Renal Disease (some exceptions apply).
Is auto-renewal available?
If you’re already enrolled in a Medicare Part D prescription plan or a Medicare Advantage Plan and you don’t want to make changes to your coverage for the coming year, you don’t need to do anything during open enrollment, assuming your current plan will continue to be available. If your plan is being discontinued and isn’t eligible for renewal, you will receive a non-renewal notice from your carrier prior to open enrollment. If you don’t, it means you can keep your plan without doing anything during open enrollment.
But be aware that your benefits and premium could change from one year to the next. So even if you’re confident that you want to keep your current coverage for the following year, it’s important to make sure you understand any changes that may apply, and that you’ve double checked to make sure that your current plan is still the best available option. The available plans and what they cover changes from one year to the next, so even if the plan you have now was the best option when you shopped last year, it’s important to verify that again before you lock yourself in for another year.
Changing Medicare Advantage coverage after the annual enrollment period
Between January 1 and February 14 each year, if you are enrolled in a Medicare Advantage plan, you can leave your plan and return to original Medicare. You cannot switch to another Advantage plan unless you have a circumstance that affords you a Special Enrollment Period.
After you leave your plan, you will have until February 14 to enroll in a Part D plan that will begin the first day of the following month after you enroll.
Enrolling in Original Medicare
If you didn’t sign up for Medicare A and B when you were first eligible, you have a chance to do so each year from January 1 to March 31, with coverage effective July 1. You may be subject to a late enrollment penalty, however. For Medicare Part B, the penalty is an additional 10 percent of the premium for each 12 month period that you were eligible but not enrolled.
2018 Medicare coverage changes
Medicare changes to be aware of for 2018 include:
- Starting in April 2018, Medicare beneficiaries will begin receiving new Medicare ID cards that don’t have Social Security numbers on them. This change was announced in September 2017, and it’s an effort to combat identity theft and fraud. The new cards, which will be mailed out over the course of a year (all beneficiaries will have them by April 2019, as required by the Medicare Access and CHIP Reauthorization Act—MACRA—of 2015), will have randomly generated ID numbers instead of Social Security numbers. You can continue to use your current card until your new one arrives. Once it does, you’ll want to destroy and securely dispose of your old one, and begin using the new one instead.
Medicare recipients reaching the donut hole will benefit from better prescription drug discounts in 2018, and benefits will grow again in 2019. The gap in prescription drug coverage (the donut hole) starts when someone reaches the initial coverage limit ($3,750 in 2018), and ends when they have spent $5,000 (these thresholds are each $50 higher than they were in 2017). Prior to 2011, Medicare Part D enrollees paid the full cost of their medications while in the donut hole. But the ACA has been steadily closing the donut hole, and it will be fully closed by 2020. At that point, enrollees will pay just 25 percent of the cost of their drugs all the way up to the catastrophic coverage threshold. For 2018, while in the donut hole, enrollees pay 35 percent of the cost of brand-name drugs (down from 40 percent in 2017) and 44 percent of the cost of generic drugs (down from 51 percent in 2017). The Medicare Part D maximum deductible is $405 in 2018, up slightly from $400 in 2017.
In 2019, beneficiaries will pay 30 percent of the cost of brand-name drugs, and 37 percent of the cost of generics. The Centers for Medicare and Medicaid Services has proposed a maximum deductible of $415 for Part D plans in 2019. They have also proposed an initial coverage limit of $3,850 and an out-of-pocket threshold (ie, the top of the donut hole) of $5,100 for 2019, both slightly higher than they are in 2018.
- Medicare Part B premiums fluctuated again for 2018. In 2017, most Medicare Part B enrollees paid an average of $109/month for their Part B premium, although enrollees with income above $85,000 had higher premiums. But the standard premium for Medicare Part B was $134/month in 2017. The reason most enrollees paid an average of only $109/month was because the cost of living adjustment (COLA) for Social Security wasn’t large enough to cover the full increase in Part B premiums. For 70 percent of Part B enrollees, their premiums are deducted from their Social Security checks, and net Social Security checks cannot decrease from one year to the next (the “hold harmless” provision). The COLA for 2017 was only enough to cover about four dollars in additional Part B premiums, so the $134/month premium for 2017 only applied to enrollees to whom the “hold harmless” provision didn’t apply. The COLA for 2018 was larger, but still not quite high enough to cover the full increase to $134/month for all enrollees. So people who are “held harmless” pay an average of $130/month for Part B in 2018, while the standard premium remain at $134/month. So while there’s still a small difference between what people pay in Part B depending on whether they’re “held harmless,” the difference is not as stark as it was in 2016 and 2017. The difference has mostly leveled out for 2018 (except those with high incomes, who always pay more).
- New income brackets for Part B enrollees with high incomes. As part of the Medicare payment solution that Congress enacted in 2015 to solve the “doc fix” problem, new income brackets were created to determine Part B premiums for high-income Medicare enrollees. The new brackets took effect in 2018. For Medicare purposes, “high income” begins at $85,001 for a single individual, and $170,001 for a married couple. Enrollees with income between $85,001 and $107,000 ($170,001 and $214,000 for a married couple) didn’t see any changes to their bracket. But enrollees with income above those limits may have found that they were bumped into a higher bracket at the start of 2018. The highest bracket (ie, with the highest Part B premium) now applies to those with income above $160,000 ($320,000 for a married couple), whereas the highest bracket didn’t apply in 2017 until an enrollee’s income reached $241,000 ($428,000 for a married couple). The Medicare Part B premiums at each bracket level remained unchanged for 2018, but the income levels for most of the brackets have been reduced, meaning that some high-income Medicare beneficiaries are in a higher bracket than they were in during prior years, even with the same income.
- Medicare Advantage plans continue to see changes. While healthcare reform is slowly reducing rebates paid to Medicare Advantage plans, these plans continue to be popular. 33 percent of Medicare recipients were enrolled in a Medicare Advantage plan in 2017—a significant increase from the enrollment total in 2009 when the ACA was signed into law. Most people continue to have numerous Medicare Advantage plans as well as Part D plans available to them. However, these providers can change the coverage options they offer from year to year so it’s important to stay up-to-date.
Each year, most Medicare beneficiaries should receive their Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from their existing Medicare Advantage and Medicare Part D plan providers by Sept. 30. CMS makes information available to the public on Medicare.gov in October. The Medicare website is also a tremendous asset for individuals with questions about Medicare rules, timelines, Medicare Part D, etc.
It’s important to carefully review the information sent to you by your plan provider, since this will cover any possible changes. For example, increasing co-pays, changes to drug formularies or changes to treatment coverage. Once open enrollment gets underway, you can make changes that reflect your current health coverage needs.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.