Open Enrollment, also known as the Annual Election Period (AEP), is period each year in which you may change your Medicare health plan and/or Part D coverage, and/or return to Original Medicare. The AEP is earlier this year: October 15 – December 7, 2011. Any plan changes you make during the AEP are effective January 1, 2012.
Each year, Medicare health plans and Part D prescription drug plans can change their premiums, deductibles, cost-sharing and some benefits, or discontinue their coverage altogether. You need to be aware of how your plan may change, and prepare accordingly.
- Review your plan’s changes for 2012. If you’re in a Medicare Advantage and/or Part D plan, your plan should have mailed you an Annual Notice of Change by now, explaining its changes for 2012. For example, the Annual Notice of Change would inform you what your copayment will be, if your plan’s provider network will change, and/or a list of drugs that will be covered. Even if you like your current plan, review your plan’s changes for 2012 and study your options, to determine if the 2012 plans has the coverage you need.
- Look for other options. If your health plan or drug plan is terminating its coverage, you should have received a notice by now informing you of your rights and options for other coverage. See When Medicare Advantage Plans Terminate Coverage.
- Be on the alert. Medicare health plans and prescription drug plans started marketing their 2012 plans as of October 1, 2011. Agents and brokers selling these plan must follow strict guidelines when marketing to you — report any suspected marketing fraud or abuse to the Senior Medicare Patrol at 1-855-613-7080.
What can I do during Open Enrollment?
You can make changes involving your Medicare Advantage or Part D plan. Medicare Advantage plans must include hospital and medical benefits. Some Medicare Advantage plans also cover prescriptions drugs. Stand-alone Part D plans cover only prescription drugs. Thus you can get prescription drug coverage through a Medicare Advantage plan or a stand-alone Part D plan.
During the AEP, you can enroll in a Medicare Advantage or a stand-alone Part D plan if you do not have one. If you do have one of these plans, you can change to a different stand-alone Part D plan or Medicare Advantage plan. If you’re in a Medicare Advantage plan, you can return to Original Medicare and join a stand-alone Part D plan to continue prescription drug coverage.
What are my coverage options?
- Your local Health Insurance Counseling & Advocacy Program (HICAP) has county-specific information on the Medicare advantage and Part D plans available in your area, as well as info on Medicare supplement plans known as Medigap.
- Use the Plan Finder and Formulary Finder on medicare.gov to find Medicare Advantage and Part D plans in your area and to see what Part D plans cover the drugs you use.
- Read the official U.S. government Medicare handbook: Medicare & You 2012 (PDF).
I receive the Part D low-income subsidy (Extra Help) and currently don’t pay any premium or deductible. Can I stay in my same plan or do I need to switch plans to continue with no premium or deductible?
This depends on what plan you are in. In 2012, the Advantage Star and Bravo Rx (no premium and no deductible for people with Extra Help) will no longer be offered. Advantage Star is terminating, and Bravo Rx is charging a higher premium and will no longer be a benchmark plan. Benchmark plans are plans whose premiums are at or below the average premium in California ($30.86 for 2012). If you are in Advantage Star or Bravo Rx, you will need to choose a new Part D plan that has a premium amount at or below the California benchmark amount. If you do not choose another plan by December 31, Medicare will reassign you to a plan with $0 premium and deductible for people with Extra Help.
For 2012, California has 6 benchmark plans:
- Health Net Orange Option 1
- Humana Walmart-Preferred Rx
- Wellcare Classic
- CVS Caremark Value
- Aetna CVS/Pharmacy Prescription Drug Plan
- EnvisionRxPlus Silver
If you continue to be eligible for Part D Extra Help, by joining a benchmark plan you will continue to pay $0 premium and deductible for 2012. You are still responsible for your copays which will be up to $1.10 or $3.30 for generic drugs or up to $2.60 or $6.50 for brand name drugs depending on your income and assets.
What if I miss the AEP and still want to make a change? Are there other times during the year I can change my health plan and/or Part D coverage?
The AEP is the main time most Medicare beneficiaries can change plans. However, some Medicare beneficiaries may change plans at other times:
Medicare Advantage Disenrollment Period (MADP)
If you’re in a Medicare Advantage plan with or without Part D coverage, you can disenroll from your plan and return to Original Medicare anytime between January 1 – February 14. You are also given a Special Election Period (SEP) to enroll in a Part D plan during this time. But you may not enroll in a Medicare Advantage plan at this time.
Your MA plan disenrollment becomes effective the first of the month following the month of disenrollment. For example, if you disenroll from your MA plan in January, your change becomes effective February 1. If you diseroll in February, your change becomes effective March 1.
We also encourage you to enroll in a Part D plan as close to the time of your MA plan disenrollment as possible in order to avoid any gap in drug coverage. For example, if you disenroll from your MA plan on January 28 and enroll in a Part D plan on February 1, you would return to Original Medicare on February 1, but wouldn’t have drug coverage until March 1.
Plan Non-Renewal Special Election Period
If your MA or Part D plan is not renewing next year, you should have received a notice from your plan by October 2 telling you of this change and your rights and options for other health coverage.
One of your rights is that you have a Special Election Period (SEP) to join a new plan. The dates are from December 8 through the end of February of the following year. Your new coverage will become effective the first of the following month.
Ongoing Special Election Period Right for Certain People with Low-Incomes
People who receive the Part D Extra Help (which includes people in a Medicare Savings Program) can change their Medicare Advantage and/or Part D coverage on a monthly basis.
Other Special Election Periods (SEPs)
There are certain events/situations that trigger your rights to other SEPs where you can enroll in, switch, or disenroll from a Part D or Medicare Advantage plan. Some of these events include if you move out of your plan’s service area; your plan violates its contract with Medicare (including marketing misconduct); or you move in or out of a nursing facility. See our list of events triggering an SEP for more information.
Can I switch plans more than once during the AEP?
Yes, you can. Your final choice will be the last one received by December 7. Your new coverage becomes effective on January 1.