Why is the Medicare Open Enrollment Period Important?


Greg DuretteBy Greg Durette, Florida Health Connector

Now that the Medicare Annual Election Period (AEP) is over (ended on December 7th), you will have a chance to try out your new Medicare Advantage or Supplement plan. If you suddenly discover the plan you selected during the AEP is not right for you, all is not lost. You will get one more bite at the apple to make changes to your plan.

As with many situations, to get a good outcome, you must ask the right questions. In this case, the question(s) you would have to ask first are:

Did you sign up for a new Advantage Plan or a stand-alone Part D prescription drug plan during the last Annual Enrollment Period (AEP)?

Do you have an existing Advantage Plan or a stand-alone Part D prescription drug plan that renewed with a January 1st effective date?

If the answer to either of these questions is yes, then the Medicare Open Enrollment Period (OEP) is very important to you.

The OEP runs annually from January 1st to March 31st.

During this time, Advantage plan holders are given the option to make certain changes to the plan they selected in the AEP.

These allowed changes are:
• Cancel your stand-alone Part D prescription drug plan.
• Drop your Medicare Advantage Plan and return to Original Medicare.
• Enroll in a stand-alone Medicare Part D prescription drug plan.
• Elect to change from one Medicare Advantage Plan to another.

Let’s take a look at each option.

First, why would someone elect to cancel their stand-alone Part D prescription plan? The only reason one could have would be that it was being replaced by other qualifying coverage. If you cancel without replacing, penalties will accrue and be waiting for you when you do put this coverage back in place.

Second, there are a few rare circumstances when it makes sense for someone to cancel the Advantage plan and return to Original Medicare known as Part A and Part B. Usually this would have something to do with provider networks which are insufficient for the beneficiary. This rare circumstance would require you to also enroll in a stand-alone Part D prescription drug plan (to avoid accruing the future penalties).

Again, enrolling in a stand-alone Part D prescription drug plan is a requirement (if you do not have qualifying coverage elsewhere and want to avoid these penalties). If you neglected to get that done during the AEP, now is the time to take care of this.

Lastly, some folks have a change of heart once they see the detailed materials of the Advantage plan they enrolled in during the AEP.

Perhaps you find your HMO plan does not have the providers you will need going forward, but a PPO plan does.

Perhaps the terms of coverage are better in a plan different from your current plan.
Maybe another plan costs less (or even $0!).

You do not need any reason to switch plans provided you do so before the OEP expires on March 31st. Just remember, you only get one chance to make this change. Once you do, you will have to keep that plan until the next AEP, which begins on October 15th of every year.

The best options for your specific situation should be thoroughly discussed with your insurance agent/broker to make sure you get all your questions answered and know all the facts about the choices that are available to you.

Greg Durette is your local agent for Florida Blue and brings his nearly 38 years of insurance experience to help folks navigate the complexities of Medicare. He can be reached at 850-842-2400.