Medicare Open Enrollment 2022

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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:
|
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:
|
5-star special enrollment period |
December 8 - November 30 |
|
Enrollment periods for those with Extra Help |
January - March April - June July - September |
|
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) |
|
Part B (medical coverage) |
|
Part C (Medicare Advantage) |
There is no late enrollment penalty for Part C |
Part D (prescription drug coverage) |
|
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)
Below is a breakdown of each plan type.
Plan Type |
Description |
---|---|
HMO (Health Maintenance Organization) |
|
HMO-POS (Health Maintenance Organization Point of Service) |
|
MSA (Medicare Medical Savings Account) |
|
PPO (Preferred Provider Organization) |
|
PFFS (Private Fee-for-Service) |
|
SNP (Special Needs Plan) |
|
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:
- Premiums
- Deductibles
- Copays
- Coinsurance
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.
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
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