What Can I Do in the Medicare Advantage Open Enrollment Period?

Older couple walking, talking about changing their Medicare Advantage plan during the Open Enrollment Period

The Medicare Advantage Open Enrollment Period (OEP) is a not well-known window of opportunity for individuals enrolled in a Medicare Advantage plan. Running from January 1 to March 31 each year, this period allows beneficiaries to make adjustments to their current coverage. Whether you’re looking to switch plans or return to Original Medicare, the OEP can be an important time to ensure your health insurance aligns with your healthcare needs.

Understanding what changes are allowed during this time—and how to evaluate your options—can make a significant difference in the quality and affordability of your healthcare. With so many choices available, it’s easy to feel overwhelmed. However, by taking the time to review your plan and compare alternatives, you can find a plan that offers the best balance of coverage, costs, and benefits.

What Is the Medicare Advantage Open Enrollment Period?

The Medicare Advantage Open Enrollment Period (OEP) is a specific time each year, from January 1 to March 31, during which individuals enrolled in a Medicare Advantage plan can make changes to their coverage. This period is distinct from the Annual Enrollment Period (AEP), which takes place in the fall from October 15 to December 7. Unlike AEP, where beneficiaries can initially enroll in a Medicare Advantage plan or make broader changes to their Medicare coverage, the OEP is only available to individuals already enrolled in a Medicare Advantage plan.

During the OEP, you have the flexibility to:

  • Switch to another Medicare Advantage plan (with or without prescription drug coverage).
  • Drop your Medicare Advantage plan and return to Original Medicare, with the option to add a standalone Part D prescription drug plan.

However, it’s important to note what you cannot do during OEP. For instance, you cannot switch from Original Medicare to a Medicare Advantage plan, nor can you enroll in a Part D prescription drug plan if you aren’t already enrolled in one. Additionally, if you’re enrolled in Original Medicare, this period does not apply to you.

Why Consider Making Changes During OEP?

The Medicare Advantage Open Enrollment Period (OEP) offers a valuable opportunity to adjust your healthcare coverage to better meet your needs. There are several reasons why you might want to make a change during this time, particularly if your current plan is no longer working for you.

1. Changes in Your Current Plan

Many Medicare Advantage plans adjust their benefits, provider networks, and costs from year to year. If you’ve reviewed the Annual Notice of Change (ANOC) sent out last fall and noticed changes in your plan, such as increased premiums, higher copayments, or reduced coverage for certain services, now is the time to act. For example, if your preferred doctors or specialists are no longer in-network, you might need to switch to a plan that includes them.

2. Increased Out-of-Pocket Costs

Unexpected or rising out-of-pocket expenses can place a financial burden on many older adults. Whether it’s higher deductibles, copays, or out-of-network charges, these costs can add up quickly. If you’ve found that your plan isn’t providing the financial protection you expected, OEP allows you to look for a plan with better cost-sharing or lower overall expenses.

3. Dissatisfaction with Plan Coverage

Your healthcare needs can change over time. For example, you may have developed a new health condition that requires specialized care or more frequent doctor visits. If your current plan doesn’t provide sufficient coverage for the services you need or doesn’t cover your prescription drugs adequately, it may be time to switch.

How to Evaluate Your Medicare Advantage Plan Options

If you’re considering making changes during the Medicare Advantage Open Enrollment Period (OEP), evaluating your options thoroughly is very important. With numerous plans available, understanding what to look for and comparing the details will help you choose a plan that best fits your healthcare and financial needs.

First, review your existing plan. Ask yourself if your doctors, specialists and preferred hospitals are in-network. If they aren’t, are you OK with switching? Or do you need to choose another plan? Are your prescriptions covered at an affordable cost? Are you happy with the benefits the plan offers?

Second, use Medicare’s Plan Finder tool or consult with a licensed insurance agent to compare available plans in your area. Look closely at premiums, out-of-pocket costs, coverage details, and prescription drug coverage.

Third, check out the extra benefits. Medicare Advantage plans often include additional benefits not covered by Original Medicare, such as dental, vision, hearing, and wellness programs. Compare these benefits across plans and determine which ones add the most value to you. For example, if dental care is a priority, look for a plan that offers comprehensive dental coverage rather than just routine cleanings.

Woman getting a vision exam as part of her Medicare Advantage plan's extra benefits

Your current and future health needs should guide your decision. If you anticipate needing more frequent medical care, consider plans with lower out-of-pocket costs or expanded benefits for chronic conditions. Additionally, look into whether the plan offers support services like transportation to medical appointments, telehealth options, or fitness programs.

Lastly, while it’s important to address your immediate needs, also consider how your health and financial situation may evolve. Selecting a plan with flexibility and comprehensive coverage can provide peace of mind down the road.

Common Questions About the Medicare Advantage Open Enrollment Period

Navigating the Medicare Advantage Open Enrollment Period (OEP) can be confusing, and you may have questions about what you can and can’t do. Here are answers to some of the most common questions about this important time of year.

1. Can I make multiple changes during OEP?

No. Beneficiaries are only allowed to make one change during the OEP. Once you switch to a new Medicare Advantage plan or return to Original Medicare, that choice is locked in for the rest of the year unless you qualify for a Special Enrollment Period (SEP). This is why it’s essential to carefully evaluate your options before making a decision.

2. What happens if I switch back to Original Medicare?

If you choose to leave your Medicare Advantage plan and return to Original Medicare, you have the option to add a standalone Part D prescription drug plan to maintain coverage for your medications. Additionally, you might consider enrolling in a Medicare Supplement (Medigap) plan to help cover out-of-pocket costs like deductibles and coinsurance. However, depending on your state’s rules, you may be subject to medical underwriting when applying for Medigap, which could affect your ability to enroll.

3. Does OEP allow me to enroll in Medicare Advantage for the first time?

No. The OEP is only for individuals already enrolled in a Medicare Advantage plan. If you’re enrolled in Original Medicare and want to join a Medicare Advantage plan, you’ll need to wait for the Annual Enrollment Period (AEP) in the fall, unless you qualify for a Special Enrollment Period.

4. Will changing plans affect my Part D prescription coverage?

If you switch from one Medicare Advantage plan to another, your Part D prescription drug coverage will automatically transfer if the new plan includes drug benefits. However, if you switch to a Medicare Advantage plan that doesn’t offer drug coverage, or if you return to Original Medicare, you’ll need to enroll in a standalone Part D plan to maintain prescription drug coverage.

5. Can I change plans after OEP ends?

Once OEP ends on March 31, you typically cannot make additional changes to your Medicare Advantage plan until the next Annual Enrollment Period, which begins on October 15. However, there are exceptions if you qualify for a Special Enrollment Period due to circumstances like moving, losing other coverage, or becoming eligible for Medicaid.

Take Control of Your Medicare Coverage Today

The Medicare Advantage Open Enrollment Period is your chance to make sure your healthcare coverage aligns with your needs. Whether you’re seeking better benefits, lower costs, or a plan that includes your preferred doctors, now is the time to act. Waiting too long could leave you locked into a plan that no longer fits your lifestyle or health requirements.

At Carolina Senior Benefits, we understand that navigating your options can feel overwhelming. Our licensed agents are here to provide personalized guidance and ensure you’re making the best decision for your unique situation. Don’t let this opportunity pass you by—contact us today to explore your Medicare Advantage options and find the plan that works best for you.