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Medicare Open Enrollment 2022

Open enrollment for Medicare begins October 15th and goes through December 7th every year with coverage beginning January 1st. Medicare Advantage (Part C) plans have a separate enrollment date wherein those enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage Plan or switch to Original Medicare (Part A and Part B). This enrollment period is January 1st through March 31st every year with coverage starting the first day of the month after you apply to join a plan. During these enrollment periods, you can join, switch or drop a Medicare plan. If your current plan doesn’t offer the coverage you need, consider changing to a different plan that suits your needs. If your current coverage is exactly what you need, you will be automatically re-enrolled as long as you continue to pay your premiums. To find out more about Medicare open enrollment and your options, keep reading to find out the types of plans available, late enrollment penalties, what gaps can exist in coverage, and other enrollment options.

Types of Enrollment Periods

Enrollment Type

Timeframe

Description

Initial enrollment

Any time of year assuming you meet eligibility requirements

When you first become eligible for Medicare. Eligibility includes:

  • Being 65 years old
    or
  • Having a disability
    or
  • Having Endstage Renal Disease
  • Have submitted for social security benefits
  • Have collected social security benefits for at least four months before turning 65

General open enrollment

October 15 - December 7

You can join, switch, or drop a Medicare plan

Medicare Advantage open enrollment

January 1 - March 31

You can switch to a different Medicare Advantage Plan or switch to Original Medicare once during this time if you are already enrolled in a Medicare Advantage plan

Special circumstances enrollment period

Any time a listed circumstance occurs

Special circumstances include:

  • You change where you live
  • You lose your current coverage
  • You have a chance to get other coverage such as through an employer, Tricare, or VA
  • Your plan changes its contract with Medicare

5-star special enrollment period

December 8 - November 30

  • Switch from your current Medicare plan to a Medicare plan with a “5-star” quality rating
  • This can only be done once during the special enrollment date

Enrollment periods for those with Extra Help

January - March

April - June

July - September

Medicare Open Enrollment begins October 15th and goes through December 7th, with coverage beginning January 1st.

Are There Penalties for Late Enrollment

You can receive a late penalty for most Medicare plans. Below is a breakdown of what these penalties are and how they affect your costs according to Medicare.gov.

Part

Penalty

Part A (hospital coverage)

  • Your monthly premium may go up 10% if you don't buy Part A when you're first eligible
  • You'll have to pay the higher premium for twice the number of years you could have had Part A but didn't sign up

Part B (medical coverage)

  • The premium for Part B may go up 10% for every 12-month period you could have had Part B
  • You may have to wait until the General Enrollment Period of January 1 to March 31 in order to enroll in Part B
  • Coverage starts July 1 of that year

Part C (Medicare Advantage)

There is no late enrollment penalty for Part C

Part D (prescription drug coverage)

  • Penalty depends on how long you went without Part D.
  • The penalty is calculated by multiplying 1% of $33.37, the "national base beneficiary premium" in 2022, times the number of uncovered months you went without Part D
  • The total is then rounded to the nearest $.10 and added to your monthly Part D premium
  • The Part D penalty might change every year due to changes in the national base beneficiary premium

What Can You Do During Medicare Open Enrollment?

You are able to join, switch, or drop a Medicare plan during open enrollment. Medicare plans include Part A (hospital coverage), Part B (medical coverage), Medicare Advantage (Part C), prescription drug coverage (Part D), and Medicare Supplement (Medigap).

Are There New Medicare Plans Available for 2023?

The cost and availability of a plan will likely change every year. Review your options and compare rates to make sure you’re getting the best health insurance coverage for the right price. Your Annual Notice of Changes (ANOC) will tell you how your current plan is changing.

Does My Current Coverage Match My Medical Needs?

For some, Original Medicare, which consists of Part A (hospital coverage) and Part B (medical coverage), is enough to cover their health needs. For others, they may require more robust coverage. This could mean you need prescription drug coverage which you can receive with Part D of Medicare. In order to qualify for Part D, you must also be enrolled in the Original Medicare Program (Part A and Part B). The average basic premium for Part D in 2022 is $33 per month. You will need to pay the Part D premium as well as the premiums of Part A and B if there are any.

Should I Change My Medicare Plan Style?

This is based on your needs and life situation. Medicare Advantage has several plan types for customers to choose from. They include:

  • Health Maintenance Organization (HMO) Plans
  • Health Maintenance Organization Point of Service (HMO-POS) Plans
  • Medicare Medical Savings Account (MSA) Plan
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)
Medicare Advantage (Part C) Open Enrollment is January 1st through March 31st.

Below is a breakdown of each plan type.

Plan Type

Description

HMO (Health Maintenance Organization)

  • Limits care to doctors who work for/are contracted with HMO
  • Generally won't cover out-of-network care (emergency health situations are an exception)
  • May require you to live or work in its service area
  • Often provide integrated care
  • Focus on prevention and wellness
  • Requires policyholder to name a primary care physician

HMO-POS (Health Maintenance Organization Point of Service)

  • Allows policyholders to see doctors and healthcare providers out of network (higher out-of-pocket costs, higher deductible, higher coinsurance)
  • May require you to live or work in its service area
  • Often provide integrated care
  • Focus on prevention and wellness
  • Requires policyholder to name a primary care physician

MSA (Medicare Medical Savings Account)

  • Combines high deductible Medicare Advantage Plan and a bank account
  • Money is deposited from Medicare into the account
  • Money is used to pay health care costs
  • Only Medicare-covered expenses count toward deductible
  • Amount deposited is typically less than deductible amount

PPO (Preferred Provider Organization)

  • Contracts with medical providers, creating a network of participating providers
  • Healthcare providers that belong to the network are less expensive
  • Those outside of the network are more expensive

PFFS (Private Fee-for-Service)

  • You don’t need to choose a primary care doctor
  • Referrals aren’t required to see a specialist
  • Offers a network of providers who will always provide service
  • Out-of-network providers can refuse to offer treatment

SNP (Special Needs Plan)

  • Membership limited to those with specific diseases or characteristics
  • Some plans offer coverage for any doctor, other health care provider, or hospital
  • All plans have prescription drug coverage
  • Usually required to have a primary care doctor or healthcare coordinator
  • Usually a referral is required to see a specialist (except for annual mammograms and in-network pap tests and pelvic exams
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Are There Gaps in My Prescription Drug Coverage?

There are coverage gaps in most Medicare plans known as “donut holes.” This refers to the  temporary limit on what Part D will cover. Not everyone falls in this coverage gap. This gap occurs when you and your drug plan spend a certain amount on covered drugs. You’re in the coverage gap if you or your plan have spent $4,430. This is the 2022 amount and is subject to change every year. You can also get Extra Help which helps pay for Part D costs which means you won’t enter the coverage gap. Extra Help offers assistance with:

Consider changing your plan if you need more coverage.

To qualify for Extra Help, you will need a yearly income of $20,385 for an individual and $27,465 for married couples. You will also need “resources” that value at $15,510 and $30,950 for married couples. Eligible resources include:

  • Money in a checking or savings account
  • Stocks
  • Bonds

Ineligible resources include according to Medicare.gov include:

  • Your home
  • One car
  • Burial plot
  • Up to $1,500 for burial expenses if you have put that money aside
  • Furniture
  • Other household and personal items

Brand-name prescription drugs

You won’t have to pay more than 25% of the cost for covered brand-name prescription drugs once you reach the coverage gap. This discounted rate applies if you buy your prescriptions through a pharmacy or order them through the mail. Lower costs in the coverage gap may be offered by other plans. The discount applies to the price your plan has set with the pharmacy for that specific drug.

You may get a discount after your plan's coverage has been applied to the drug's price if you have a Medicare drug plan that already includes coverage in the gap. The discount for brand-name drugs will apply to the remaining amount that you owe.

Generic drugs

Medicare pays 75% for generic drugs during the coverage gap. You pay the remaining 25%. Only the amount you pay will count toward getting you out of the coverage gap for generic drugs. If your Medicare drug plan already includes coverage in the gap, you may be able to get a discount after your plan's coverage has been applied to the prescription’s price.

Items that count towards the coverage gap include:

  • Yearly deductible, coinsurance and copayments
  • Discounts on brand-name drugs in the coverage gap
  • What you pay in the coverage gap

Items that don't count towards the coverage gap include:

  • Drug plan premium
  • Pharmacy dispensing fee
  • What you pay for drugs that are not covered

If you think you should get a discount

You can review your next "Explanation of Benefits" (EOB) if you think you've reached the coverage gap and don't receive a discount when you pay for a brand-name prescription. If the discount isn’t on the EOB, contact your drug plan to verify that your prescription records are up-to-date and correct. You can also file an appeal if your drug plan doesn't agree that you're owed a discount.

The average basic premium for Prescription Drugs Part D in 2022 is $33 per month.

Is There an Automatic Re-enrollment Process

Those who elect to maintain their current Medicare coverage without making any changes will not need to go through a re-enrollment process. Instead, coverage will continue as long as you pay any premiums that are due. If, however, there is additional coverage needed, and you elect to alter your plan, you will need to go through the enrollment process in order to receive your new coverage.

Key Takeaways

  1. Medicare begins October 15th and goes through December 7th every year. Coverage starts January 1st.
  2. Medicare Advantage open enrollment begins January 1st through March 31st every year. Coverage starts the first day of the month after you apply to join the plan.
  3. You can join, switch or drop a Medicare plan during these enrollment periods. Consider changing your plan if you need more coverage. Avoid late enrollment penalties by enrolling during the available times.

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