The Annual Enrollment Period (AEP) for Medicare beneficiaries begins on October 15 and runs till December 7. During this time, Medicare participants have many options available to them to sign up for or change coverage for the new year with the vast number of plans beginning on January 1, 2021. It is also possible for them to disenroll from a Medicare plan during this time.
Yes, it is indeed a crucial time to carefully review the details of your plan and your options and decide which insurance plans will best meet your healthcare needs for the upcoming year, especially since the rush of the holiday season has not begun yet and particularly because of the uncertainties of COVID-19.
But first, there’s an exciting piece of news! While there are several notable changes to Medicare benefits for 2021, a few are worth highlighting which may improve your Medicare benefits.
In this Open Enrollment, if you have End-Stage Renal Disease (ESRD), you can enroll in a Medicare Advantage Plan during the annual enrollment period. This change is important because previously there were strict guidelines limiting you from joining a Medicare health plan if you had ESRD.
It is also noteworthy that Medigap (also called Medicare supplement) Plans C and F are no longer available for purchase by newly eligible Medicare beneficiaries. So consider your options and see which Medigap plan best meets your healthcare needs.
Likewise, due to the Affordable Care Act, the Part D donut hole no longer exists, but a standard plan’s maximum deductible is increasing to $445 in 2021. and the threshold for entering the catastrophic coverage phase (where out-of-pocket spending decreases significantly) is increasing to $6,550. Previously, most plans with Medicare prescription drug coverage (Part D) had a coverage gap (called a “donut hole”). This meant that after you and your drug plan spent a certain amount of money for covered drugs, you had to pay all costs out-of-pocket for your prescriptions up to a yearly limit. This saved seniors a lot of money.
Moreover, Medicare Advantage plans will be increasing their telehealth services and coverages. This is primarily due to COVID-19. Telehealth allows you to organize a video conference from your home or office which provides both convenience and protection from unnecessary exposure.
Medicare Annual Enrollment Period
So now that you have had a chance to understand some of the exciting and beneficial changes to Medicare for 2021, what can you do during the AEP starting October 15? Among your options are:
joining a Medicare Advantage (a private alternative to Original Medicare) plan;
- joining a Medicare Advantage (a private alternative to Original Medicare) plan;
- enrolling in a standalone Part D prescription drug plan;
- switching from Original Medicare and joining a Medicare Advantage plan with or without Part D drug coverage;
- buying a Medigap policy, also known as a Medicare supplement plan, which helps pay Original Medicare costs, but it depends on where you live; conditions apply as to who can buy a Medigap and when.
Similarly, to those of you who currently have a plan, be sure to review your Annual Notification of Change (ANOC), a booklet that you should have received by late September or early October from your plan provider. You will be able to see if the plan you currently have will be available in your service area next year and review any changes to see if the Medicare plan still meets your health insurance needs.
For others new to Medicare or just looking for coverage options, there are various ways to learn about this coverage. Numerous insurance companies offer seminars, appointments with licensed sales agents, and guidance centers; or, they can simply access plan information on their plan’s website. Others who want to compare various plan options can talk to a health insurance broker or access the websites that are dealing with Medicare enrollment information.
The most notable among them is the government site medicare.gov where you can view all the Medicare Advantage choices, prescription drug plans, and enrollment options and receive up-to-date information about the changes I discussed earlier. You can even use the Medicare Plan Finder tools to see which insurance company covers your prescriptions or to make a side-by-side comparison of various plan options in your zip code.
Making changes after the Medicare AEP
But that’s not all. It must be good to know that you can also make changes after the Medicare AEP which brings you another opportunity to decide on a plan change. The Medicare Annual Enrollment Period (OEP) starts on January 1 and runs through March 31 annually. What exactly can you do during the Medicare OEP?
- Change to another Medicare plan during the Medicare Advantage Open Enrollment Period that better suits your needs, on the off-chance that you already have a Medicare plan.
- Drop your Medicare Advantage plan and return to Original Medicare, Part A, and Part B.
- switching from Original Medicare and joining a Medicare Advantage plan with or without Part D drug coverage;
- Sign up for a Medicare Part D prescription drug plan if you return to Original Medicare.
Similarly, to those of you who currently have a plan, be sure to review your Annual Notification of Change (ANOC), a booklet that you should have received by late September or early October from your plan provider. You will be able to see if the plan you currently have will be available in your service area next year and review any changes to see if the Medicare plan still meets your health insurance needs.
For others new to Medicare or just looking for coverage options, there are various ways to learn about this coverage. Numerous insurance companies offer seminars, appointments with licensed sales agents, and guidance centers; or, they can simply access plan information on their plan’s website. Others who want to compare various plan options can talk to a health insurance broker or access the websites that are dealing with Medicare enrollment information.
The most notable among them is the government site medicare.gov where you can view all the Medicare Advantage choices, prescription drug plans, and enrollment options and receive up-to-date information about the changes I discussed earlier. You can even use the Medicare Plan Finder tools to see which insurance company covers your prescriptions or to make a side-by-side comparison of various plan options in your zip code.
Special Election Period (SEP)
Now that we have gotten past the OEP, you must know that there are still various reasons you may be able to change your Medicare coverage beyond the other enrollment periods. You may be eligible for what is referred to as a special election period (SEP) which is for certain special circumstances. For instance, Medicare allows changes outside the standard enrollment periods in specific situations that are often out of the Medicare beneficiary’s control, such as Medicare ending its contract with the beneficiary’s plan. Other examples of these situations include, but are not limited to, the following:
- You have changed your address and moved out of your plan’s service area.
- You have lost coverage, such as that with your employer or union.
- You receive both Medicare and Medicaid benefits.
- You qualify for Extra Help.
- You live in or are moving to or from an institution such as a long-term care hospital or skilled nursing facility.
- Your plan has changed its contract with Medicare.
- You have enrolled in a State Pharmaceutical Assistance Program (SPAP) or lost SPAP eligibility.
- You dropped a Medigap policy for the first time to join a Medicare Advantage Plan.
- You have joined a plan or chosen not to join a plan due to a federal employee error.
- You weren’t adequately informed that your private drug coverage wasn’t as credible as Medicare drug coverage.
- You have a severe or disabling condition. There’s a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with my condition. I’m enrolled in an SNP and no longer have a condition that qualifies as a special need which the plan serves.
So there you have it! These are some of the health insurance coverage options available to you, beginning with the AEP and beyond. If you, or your loved one, are a Medicare member, there is much that is going on which may affect your healthcare insurance choices, especially during this COVID-19 pandemic. Go ahead and let me know about your insurance coverage journey. I hope you find this post helpful and, most importantly, have a successful AEP!
