Plans Begin Marketing Oct. 1, Beneficiaries Can Start Making Changes on Oct 15
Overview
The Medicare Annual Coordinated Election Period (AEP) – the period during which individuals with Medicare can make certain coverage choices for the coming year – starts on October 15th and ends December 7th. During this time, people can enroll in, switch, or get out of Medicare Advantage (MA) and Part D prescription drug plans. They can also retain, or leave an MA plan, and enroll in traditional Medicare. Elections made during the period will be effective January 1st.
The AEP, often called “open enrollment”, is not generally a time when people can make changes to Part A or B enrollment, and in most states people do not have a right to purchase a Medigap (or Medicare Supplemental Insurance) plan.
Insurance companies can begin marketing their MA and Part D products on October 1st. As discussed in a previous CMA Alert, several MA insurers have stated that they are scaling back extra benefits and pulling out of certain geographic areas in 2025, incorrectly blaming insufficient payment rates.
As discussed below, there are some additional, but limited, opportunities to change MA and Part D plans outside of the AEP.
Medicare Advantage Open Enrollment Period (MA-OEP)
People who begin 2025 enrolled in a Medicare Advantage (MA) plan will have an additional opportunity to switch MA plans or disenroll from an MA plan and enroll in traditional Medicare with a Part D prescription drug plan during the first 3 months of the calendar year, ending on March 31st. Note that this enrollment opportunity, called the Medicare Advantage Open Enrollment Period (MA-OEP), is only available to people enrolled in an MA plan – not to individuals who are in traditional Medicare and a stand-alone Part D plan.
Special Enrollment Periods (SEPs)
Outside of the AEP and MA-OEP, there are opportunities to use a Special Enrollment Period (SEP) to change or get out of an MA or Part D plan in certain circumstances. There are a number of SEPs, including when someone receives inaccurate or misleading information from the Medicare Plan Finder, customer service representatives at 1-800-MEDICARE, or an MA or Part D plan (or its agents). For a full list of available SEPs, see, e.g., “The Medicare Advantage and Part D Enrollment and Disenrollment Guidance” (Chapter 2 of the Medicare Managed Care Manual has been merged with the corresponding Part D guidance into one document starting 2025).
Note that effective 2025, there are changes to SEP rights for individuals who are dually eligible for Medicare and Medicaid, and/or have the Part D Low Income Subsidy (LIS, or Extra Help). Instead of the current right to make quarterly changes to their MA or Part D plans during the first 3 quarters of the calendar year, dual eligibles and LIS enrollees will be able to change stand-alone Part D plans on a monthly basis. There is also a new “integrated care” SEP to allow dual eligibles to elect an integrated dual eligible special needs plan (D-SNP) monthly when the individual also receives Medicaid services through an affiliated managed care plan. Note that dual eligibles and others with the Part D LIS cannot use this SEP to elect a non-integrated D-SNP or other MA plan (in other words, there is no longer a quarterly right to change non-integrated MA plans). For a good summary of these changes, see Justice in Aging’s “Upcoming Changes for Dually Enrolled Individuals: The Final 2025 Medicare Advantage Rule” (July 2024).
General Advice
Determining the coverage that is best for your specific health care needs can be complex, but here are several simple tips to help beneficiaries with their coverage decisions.
- If you are currently in an MA or Part D plan, look for and read carefully any notices from your plan about how your benefits might be changing next year (Annual Notice of Change, or ANOC).
- Be ready with a list of all your health care conditions, prescription needs, and desired/necessary providers when you review your options.
- Make a note of any changes to income that might help you qualify for extra help with drug costs or Medicare co-pays.
- Watch your email for important notices from Medicare and Social Security. Read them carefully to be sure they are legitimate notices, and not private plan marketing junk mail.
- Review the 2025 Medicare & You handbook.
- If you are considering private plans for your coverage, rather than the universally accepted traditional Medicare program, be sure to review plan options on the Medicare Plan Finder.
- Finally, there is help available to navigate these decisions from your State Health Insurance Assistance Program (SHIP). Find contact information for your SHIP program at https://www.shiphelp.org/ (In CT, known as CHOICES, at (800) 994-9422.)
Above all, be sure to make the decisions that will best meet your health care coverage needs for the coming year. Remember that your status in October may not be where you find yourself next July.
September 26, 2024 – D. Lipschutz