What Is the Medicare Annual Election Period?

The Medicare Annual Election Period runs from October 15 through December 7 every year. During that window you can switch between Original Medicare and a Medicare Advantage plan, change from one Advantage plan to another, or join, change or drop a Part D prescription drug plan. Changes you make take effect January 1.

If you are on Medicare, this is the one stretch of the year when most of your options are open. The rest of the year, they largely are not. That is why the mail starts piling up in October.

What is the Medicare Annual Election Period?

The Medicare Annual Election Period (AEP) is an important time of year for anyone enrolled in Medicare. AEP runs each year from October 15 through December 7 and gives Medicare beneficiaries an opportunity to review their current coverage and make changes for the upcoming year.

During the Annual Election Period, you may be able to:

• Switch from Original Medicare to a Medicare Advantage plan
• Change from one Medicare Advantage plan to another
• Return from Medicare Advantage to Original Medicare
• Join, change, or drop a Medicare Part D prescription drug plan

Anything you change during AEP starts on January 1. Nothing happens to your coverage before then, so there is no advantage in rushing a decision in the first week.

You can also change your mind as often as you like until December 7. If you enroll in one plan in late October and find a better fit in November, the last change you submit before the deadline is the one that counts.

What AEP is not for

AEP is not when you first sign up for Medicare. It is not when you enroll in Part A or Part B, and it is not the window for buying or switching a Medicare Supplement plan. Those run on their own schedules, which is where most of the confusion comes from.

The Medicare windows, and which one applies to you

There are four separate enrollment windows in Medicare, and people routinely act in the wrong one. Medicare publishes the rules for joining or switching a plan in full, but here is the short version of which is which.

Your Initial Enrollment Period

This one is personal to you. It opens three months before the month you turn 65 and closes three months after it, seven months in total, and it is when you first sign up for Medicare.

If you are turning 65 soon, AEP is not your deadline. Your own window is, and signing up in the first three months of it is what keeps your coverage from starting late.

The Annual Election Period, October 15 to December 7

This is the one everyone means when they say “open enrollment.” It applies to everyone already on Medicare, it is the same seven weeks for all, and it is about changing coverage you already have rather than signing up for the first time.

Medicare Advantage Open Enrollment, January 1 to March 31

This is the window most people have never heard of, and it is the reason missing December 7 is not always the disaster it feels like.

If you are enrolled in a Medicare Advantage plan on January 1, you get one opportunity between January 1 and March 31 to switch to a different Advantage plan, or to drop your Advantage plan and return to Original Medicare with a standalone Part D plan. One change, and the new coverage starts the first day of the following month.

It only applies if you are already in an Advantage plan. If you are on Original Medicare, this window does nothing for you.

Your Medigap open enrollment

Medicare Supplement plans have their own one-time window: six months starting the month you turn 65 and are enrolled in Part B. During those six months a carrier has to accept you regardless of your health history.

After that window closes you can still apply for a supplement at any time of year, but the carrier can ask health questions and can turn you down. That is medical underwriting, and it is the single most consequential piece of timing in all of Medicare.

Why should you review your Medicare coverage each year?

Even if you’re happy with your current Medicare plan, it’s a good idea to review your coverage annually. Medicare Advantage and Part D plans can change their premiums, copays, deductibles, provider networks, prescription drug coverage, and other benefits from one year to the next.

Your own needs can change, too. You may be taking different medications, seeing new doctors, or simply looking for coverage that better fits your budget and healthcare needs.

The plan that fit you perfectly two years ago may have quietly moved. It is rarely one dramatic change. It is usually a drug that shifted to a higher tier, or a specialist who left the network.

Read the letter that came in September

Every Medicare Advantage and Part D plan is required to send you an Annual Notice of Change before AEP opens. It arrives around late September and it lists exactly what is changing in your plan for the coming year: premiums, deductibles, copays, the drug formulary, and the provider network.

Most people set it aside. It is the single most useful piece of paper you will get all year, and reading it takes ten minutes.

If you cannot find yours, your plan can send another copy and the same information is on their website. We can also pull it up with you.

What to actually check

Four things, with your Annual Notice of Change next to you. Work through them in this order, because the first one is where most of the surprises live.

Your prescriptions

Is every medication you take still on the plan’s formulary, and is it still in the same tier?

A formulary is the list of drugs a plan covers, sorted into tiers. Tier 1 is usually generics with the lowest copay, and the tiers above it cost progressively more. A plan can move a drug to a higher tier, add a requirement such as prior authorization, or drop it from the formulary entirely for the coming year.

Check each medication by name and dosage, not by category. Two drugs that treat the same thing can sit in different tiers.

Your doctors

If you are on a Medicare Advantage plan, confirm that the providers you want to keep are still in the network for next year. Networks are set annually and they do change, sometimes because the plan dropped a provider and sometimes because the provider chose to leave.

This matters most for specialists and for the hospital you would use. Primary care tends to be stable; a cardiologist two counties over may not be.

On Original Medicare with a supplement, this check does not apply. You can see any provider that accepts Medicare.

Your total cost, not just the premium

A lower monthly premium can cost you more over a year. Look at the deductible, the copays for the visits you actually make, and the out-of-pocket maximum.

That maximum is worth understanding. Medicare Advantage plans have an annual cap on what you pay out of pocket for covered medical services. Original Medicare on its own does not, which is a large part of why people add a supplement to it.

The extras, and what they are worth to you

Many Advantage plans include dental, vision, hearing or a fitness benefit. These are real, but read the limits. A dental benefit with a low annual maximum covers cleanings comfortably and a crown barely at all.

Judge the extras by what you will actually use, not by how many of them are listed.

What this looks like in practice

Here is the kind of thing we see every autumn.

Someone on a Medicare Advantage plan opens their Annual Notice of Change and the premium is unchanged. Good news, so the letter goes back in the envelope.

What the letter also said, further down, is that one of their maintenance medications moved from tier 2 to tier 3. The premium stayed flat; the copay on that prescription went from modest to meaningful, every month, for the whole year. Nobody calls to tell you about it, and you find out at the pharmacy counter in January.

That is a fixable problem in October and a twelve-month problem in January. Sometimes the fix is a different plan. Sometimes it is a conversation with the prescriber about a therapeutic alternative on a lower tier. Sometimes the plan is still the best one available and you simply decide to live with it, knowingly instead of by surprise.

The point is not that your plan has gone bad. It is that the one document telling you what changed is the one most people do not read.

What happens if you miss the December 7 deadline

In most cases your current coverage simply rolls into the new year and you keep it until the next AEP. That is not a penalty, it is just the default.

There are two routes out before next October.

Medicare Advantage Open Enrollment

If you are in an Advantage plan on January 1, the January 1 to March 31 window described above gives you one more change. For a lot of people who miss December 7, this is the answer.

Special Enrollment Periods

Certain life events open a window of their own, outside the normal calendar. The common ones:

• You move out of your plan’s service area, or move to an address with different plan options
• You lose employer or union coverage
• Your plan leaves the area or ends its contract with Medicare
• You move into, live in, or move out of a nursing home or similar institution
• You qualify for Medicaid or for Extra Help with prescription costs
• A five-star plan becomes available where you live

Each has its own rules and its own clock, usually counted from the month the event happened. If something on that list applies to you, call before you assume the door is closed.

The penalties, and what they actually cost

Two late enrollment penalties are worth knowing about, because both are permanent rather than one-time.

The Part B penalty applies if you did not sign up for Part B when you were first eligible and did not have qualifying coverage through an employer. It adds a percentage to your Part B premium for each full year you could have had it and did not, and it stays on your premium for as long as you have Medicare.

The Part D penalty works the same way for prescription coverage. If you go 63 days or more without Part D or other creditable drug coverage after your Initial Enrollment Period, a permanent amount is added to your Part D premium, calculated per month you went without.

This is why skipping Part D because you take no medications today is a more expensive decision than it looks.

Can you change a Medicare Supplement during AEP?

Medicare Supplement plans are not part of the Annual Election Period at all.

You can apply to change from one supplement plan to another at any time of year. Outside your initial six-month window at 65, a new carrier can ask health questions and can decline your application, so timing matters for a different reason than a date on the calendar.

If you are on a supplement and happy with it, AEP may not require anything from you beyond a look at your standalone Part D plan, which does follow the October 15 to December 7 schedule.

Do you have to change plans during AEP?

No. If you’re satisfied with your current coverage and it continues to meet your needs, you may decide to keep it. However, reviewing your options can help you understand any changes to your existing plan and determine whether another available option may be a better fit.

Doing nothing is a real choice, and often the right one. It is only a bad choice when it is made by default, because the Annual Notice of Change went into a drawer unopened.

Need help reviewing your Medicare options?

Medicare can be confusing, and you don’t have to sort through all of the options alone. An insurance professional can help you review your current coverage, compare available plans, and understand the differences so you can make an informed decision.

Bring your current plan, a list of your medications with dosages, and the doctors you want to keep. With those three things on paper we can compare both side by side and show you what each one would mean for your situation, and you decide from there.

It costs nothing and there is no obligation. We consider ourselves educators first and foremost, and that starts with making sure you understand the plan you already have before anyone talks about changing it.

If you have questions about the Medicare Annual Election Period or would like help reviewing your Medicare coverage, contact us today. We’d be happy to help. Call (812) 556-0629 to set up an appointment, or talk it through with us first.

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