Open Enrollment, also known as the Annual Election Period (AEP), is the period each year during which you may change your Medicare Advantage plan and/or Part D coverage, and/or return to Original Medicare. The AEP is October 15 – December 7. Any plan changes you make during the AEP are effective January 1.
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 2021. If you’re in a Medicare Advantage and/or Part D plan, your plan should have mailed you an Annual Notice of Change by September 30, explaining its changes for 2021. For example, the Annual Notice of Change would include information such as your premium and copayment, if your plan’s provider network will change, and/or a list of drugs (called a formulary) that will be covered. Even if you like your current plan, review your plan’s changes for 2021 and compare other options to determine which 2021 plans have the coverage you need.
- Additional Notes on Part D and MA plan changes in 2021:
- Enhanced coverage of insulins for some Part D drug plans in 2021 – Some, but not all, Part D plans will participate in the new “Part D Senior Savings Model”. Participating plans will offer enhanced coverage of insulins on their formulary with a maximum out-of-pocket cost of $35 per thirty-day supply per insulin prescription. If you receive Part D Extra Help (aka the Low-Income Subsidy program), you will not be eligible for this limited copay because the Extra Help already limits copays for all prescription drugs. Read CMS’ Q&A about the Part D Senior Savings Model for more information.
- Medicare Advantage plans continue to offer supplemental benefits in 2021 – With what started in 2020, MA plans can continue to offer new health and non-health related supplemental benefits in their plans. These benefits can be a bit misleading as they are not necessarily offered to all enrollees; they have specific eligibility criteria and limitations; and they could overlap with Medi-Cal benefits for dually eligible beneficiaries. Make sure to closely review plan member Handbook, as MA plans are required to clearly spell out the eligibility requirements for any supplemental benefits. See our past article for more info: Tips to Navigate Medicare Advantage Plans’ New Supplemental Benefits.
- Additional Notes on Part D and MA plan changes in 2021:
- Look for other options. If your health plan or drug plan is terminating its coverage, you should receive a notice by October 2 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 can start marketing their 2021 plans as of October 1, 2020. Agents and brokers selling these plan must follow strict guidelines when marketing to you. Review our new novella that shares what Medicare health plans and their agents CANNOT do in their plan marketing and provides savvy tips on how to protect yourself from enrollment fraud. It’s available in English and Spanish. Report any suspected marketing or enrollment 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.
During the AEP, if you are now in a Medicare Advantage or a stand-alone Part D plan, you can change to a different Medicare Advantage plan or stand-alone Part D plan. If you’re now in a Medicare Advantage plan, you can return to Original Medicare and join a stand-alone Part D plan for prescription drug coverage. If you have Original Medicare currently, you can enroll in a Medicare Advantage plan. If you are not in a Medicare Part D, you can join one.
What are my coverage options?
You can learn more about your coverage options by:
- Contacting your local Health Insurance Counseling & Advocacy Program (HICAP), also called State Health Insurance Assistance Program (SHIP). Your local 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.
- Using the Plan 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.
- Reading the official U.S. government Medicare handbook: Medicare & You 2021. The section in the back lists Medicare Advantage and Part D plans available in your area. Hard copies were mailed to beneficiaries between September 16-30, and it is also available online. (See the “Go Paperless” option on Medicare.gov for more info.)
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?
In 2021, you can most likely stay in your current plan. Seven of the eight 2020 benchmark plans are staying. These are: Cigna HealthSpring Rx Secure, Clear Spring Health Value Rx, Elixir Rx Secure (same plan but formerly called Envision Rx Plus), Humana Basic Rx, SilverScript Choice (now run through Aetna), UHC- AARP Medicare Rx Saver Plus and WellCare Classic. One plan, Journey Rx Standard will not continue in 2021. Benchmark plans are plans whose premiums are at or below the weighted average of premiums in California ($31.45 for 2021).
If you are already in one of these 7 continuing plans, you can stay in your plan and not pay a premium or deductible. If you are in the Journey Rx Standard plan, you will need to enroll into a different benchmark plan before December 7. (Reminder: When in a benchmark plan, you are still responsible for your copays which will be up to $3.70 for generic drugs or $9.20 for brand name drugs.) You may also join a non-benchmark plan but you may have to pay a premium.
For 2021, California’s 7 benchmark plans are:
- Cigna HealthSpring Rx Secure
- Clear Spring Health Value Rx
- Elixir Rx Secure
- Humana Basic Rx
- SilverScript Choice
- AARP Medicare Rx Saver Plus (UHC)
- WellCare Classic
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:
New Special Election Period Due to COVID-19 Public Health Emergency & California Wildfires
If you are unable to make your needed Medicare coverage changes due to the COVID-19 pandemic and/or due to wildfires, the Centers for Medicare and Medicaid Services (CMS) is granting a Special Election Period (SEP). This SEP starts at the start of the incident and ends 4 months later. The coverage change will be effective the first of the following month. You should NOT be asked to provide proof that you were unable to make a change during the Medicare AEP due to COVID-19 or wildfires. It should just be granted to you. See CMS’ memo and CMS’ Current Emergencies webpage for more information.
Medicare Advantage Open Enrollment Period (January 1 – March 31)
If you’re in a Medicare Advantage plan with or without Part D coverage, you can switch to another Medicare Advantage plan with or without Part D coverage, OR disenroll from your plan and return to Original Medicare anytime between January 1 – March 31. If you disenroll and return to Original Medicare, you are also given a Special Election Period (SEP) to enroll in a Part D plan during this time.
Your MA plan switch or disenrollment becomes effective the first day of the following month. For example, if you switch or disenroll from your MA plan in January, your change becomes effective February 1. If you switch or diseroll in February, your change becomes effective March 1.
If you’re returning to Original Medicare, we 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 SEP is from December 8 to February 29 the following year. Your new coverage will become effective the first day 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 with full Medi-Cal or in a Medicare Savings Program) can change their Medicare Advantage and/or Part D coverage on a quarterly basis for the first 3 quarters of the year. Their coverage will be effective the first of the following month. For the 4th quarter, they can change during the Annual Election Period (Oct 15 – Dec 7) with coverage effective January 1. Note that beneficiaries who have been identified as “at risk” for opioid abuse, may be further restricted from changing plans.
5-Star Medicare Advantage or Part D Plan Special Election Period
If you live in an area with a Medicare Advantage and/or Part D plan(s) that has an overall plan performance rating of 5 stars, and you’re otherwise eligible to enroll in the plan, you have a Special Election Period (SEP) to join that plan. Medicare releases plan performance ratings each fall and the ratings apply for the following calendar year. Your SEP is from December 8 through November 30. Your new coverage will become effective the first day of the following month. You can use this SEP to enroll in a 5-star plan only once during the SEP.
Other Special Election Periods (SEPs)
There are certain events/situations that allow a SEP to enroll in, switch, or disenroll from a Part D or Medicare Advantage plan. Some of these events include relocation – if you move out of your plan’s service area; contract violation – if your plan violates its contract with Medicare (including marketing misconduct); change in care setting – if you move into 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?
You may, but the choice that will be effective will be the last one received by a plan by December 7. Your new coverage becomes effective on January 1.