9 Things You Need to Know Before Locking in Your Medicare Coverage

The holiday season is ahead of us, and the season of summer is well behind us, but we’re smack dab in the middle of another exciting season: Medicare open enrollment season!

From Oct. 15 to Dec. 7, those eligible for Medicare are permitted to switch from one Medicare plan to another. Here are some things you should know before you take any action during Medicare open enrollment.

Medicare basics

You can enroll in Medicare as you approach age 65. When you do so, your choices are opting for either “original” Medicare, which features Part A (hospital coverage) and Part B (physician/medical insurance), or a Medicare Advantage plan, sometimes referred to as Part C.

Those who sign up for original Medicare typically add Part D prescription drug coverage and sometimes a “Medigap” supplemental coverage plan, too.

Choosing between original Medicare and Medicare Advantage plans

Original Medicare and Medicare Advantage plans each offer different upsides and downsides. For example:

• Original Medicare offers access to nearly every doctor in the U.S., and you’ll often be charged only 20% of various costs, with Medicare forking over the other 80%. That may sound great, but paying only 20% can still be disastrous if you’re facing a huge bill. (Medigap plans exist to help cover some or all of such costs for you — for a price.)
• A Medicare Advantage plan caps your out-of-pocket costs and is likely to offer dental, vision, and hearing coverage, too. But while enjoying these low costs, you’ll be restricted to using providers and facilities within the plan’s network. That can be fine, as some plans feature top-notch providers and facilities — though they may not offer the specific ones you want. Some Medicare Advantage plans have also been criticized for denying certain care for members.

So choose carefully, and whichever kind of Medicare you choose, be sure to enroll on time — or you can face an extremely stiff penalty.

Switching between plans — during the open enrollment period

Whichever Medicare plan you pick, you’re not stuck with it for the rest of your life. Here are nine things to know:

1. You’re allowed to switch plans annually during the Medicare open enrollment, which runs from Oct. 15 through Dec. 7. (There are also some additional special enrollment periods for certain people in certain situations, such as those who move to a new region.)
2. Different plans might serve you better at different points in your life, depending on which features you need and would use.
3. Plans change over time, in terms of what they cover and what they charge. For example, original Medicare won’t be covering most telehealth visits beginning in 2025. So it’s important to keep up with what your current plan does and, when shopping, what other candidate plans offer.
4. Your options include switching from original Medicare to a Medicare Advantage plan, switching from a Medicare Advantage plan to original Medicare, switching from one Medicare Advantage plan to another, and/or switching Part D prescription plans.
5. Remember that if you’re married, you and your spouse might be best served by different plans, depending on your needs.
6. While you can make all kinds of changes during the open enrollment period, you won’t be able to switch your Medigap supplemental plan.
7. If you’re switching from a Medicare Advantage plan to original Medicare, you may not be permitted to sign up for a Medigap supplemental plan — or you might be charged a lot more for it than you would have been had you signed up for it initially.
8. It’s smart to consider all the choices available to you, even if you like your current plan — because you might end up pleasantly surprised by some other plan.
9. You can research your options using Medicare’s own plan finder. Know, too, that Medicare awards star ratings to Medicare Advantage and Part D plans, so definitely favor ones with higher star ratings — especially five-star plans.

So do some research and thinking during the annual Medicare enrollment period, to see if any changes would serve you better and/or save you money.