Open Enrollment is Oct 15 – Dec 7: Review Your Medicare Options for 2025

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 2025. 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 2025. 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 2025 and compare other options to determine which 2025 plans have the coverage you need. Also note that:
- Medicare Part D changes that started in 2023 and 2024 due to the Inflation Reduction Act of 2022 (IRA) will continue in 2025. These include:
  - Limiting insulin copayments to $35/month per prescription for covered insulin products in Medicare Part D plans and insulin received through durable medical equipment through Medicare Part B (such as insulin pumps) with no deductible.
  - Eliminating cost-sharing for adult vaccines covered under Part D (e.g. shingles), even if the deductible hasn’t been met.
  - Requiring drug companies to pay rebates if prices rise faster than inflation.
  - Eliminating any coinsurance or co-payments during the catastrophic phase of the prescription drug benefit.
  - Limiting Part D plan premium increases to 6% over what it was the previous year. This protection continues through 2029. The law also provides for a mechanism to stabilize plan premiums in 2030 and subsequent years.
  - Expanding the full Low-Income Subsidy (LIS) also known as Part D Extra Help to those with incomes up to 150% of the federal poverty level. This provides expanded financial help with prescription drug cost-sharing and premiums.
- Medicare Part D changes starting in 2025 due to IRA include:
  - Having a Medicare Part D $2,000 out-of-pocket cap. Beginning January 1, 2025, you won’t pay more than $2,000 over the calendar year in out-of-pocket costs for your prescription medications, regardless of whether you have a Part D prescription drug plan or a Medicare Advantage plan with drug coverage. All prescriptions covered by your health/prescription drug plan are included in this $2,000 cap, including all deductibles, copayments and coinsurance for covered drugs.
  - Offering a voluntary Medicare Prescription Payment Plan. This voluntary payment plan allows you to spread out your drug costs over the calendar year, but does not reduce them. You can opt in to the program through both Original Medicare with a Part D drug plan and Medicare Advantage Part D drug plans.
- See the Center for Medicare and Medicaid Services’ summary timeline for changes due to IRA over the next several years.
- Medicare Advantage plans continue to offer supplemental benefits in 2025 – 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.
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 2025 plans as of October 1, 2024. 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 2025. 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. Also, Medicare is now offering Medicare & You in Spanish, Chinese, Korean and Vietnamese.

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?

Note: This section will be updated with 2025 info soon… In 2024, you may be able to stay in your current plan. Three of the four 2023 benchmark plans are staying. These are: Cigna Secure Rx, Clear Spring Health Value Rx and WellCare Classic. One plan, SilverScript Choice (run through Aetna) will not continue in 2024. Benchmark plans are plans whose premiums are at or below the weighted average of premiums in California ($40.98 for 2024).

If you are already in one of these three continuing plans, you can stay in your plan and not pay a premium or deductible. If you are in SilverScript Choice, 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 $4.50 for generic drugs or $11.20 for brand name drugs.) You may also join a non-benchmark plan but you may have to pay a premium. Note: Clear Spring Health is sanctioned and will terminate as of December 31, 2024. If you are already enrolled in this plan, you can stay enrolled for 2024 if you’d like. Clear Spring Health, however, is prohibited from accepting any new enrollees for 2024.

For 2024, California’s 3 benchmark plans are:

Clear Spring Health Value Rx – SANCTIONED – no new enrollees accepted
Cigna Secure Rx
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:

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.