What You Need to Know
Medicare Open Enrollment is held annually from October 15 – December 7.
The Open Enrollment period is when you can sign up or change your Medicare coverage. This includes Original Medicare (Part A and Part B), Medicare Advantage (Part C) and prescription drug coverage (Part D).
Medicare Part A is hospital insurance. Part B is medical insurance. You are not required to enroll in Part B or may delay enrollment if you have current insurance coverage, like through an employer.
Costs range between Original Medicare and Medicare Advantage based on income and/or location.
You can change your Medicare coverage outside of Open Enrollment but could face a penalty for doing so.
Individuals with disabilities under the age of 65 can also qualify for Medicare coverage.
This guide will help determine which Medicare program is best for you. We cover the ins and outs of Original Medicare (federal program) and Medicare Advantage (private insurance companies), plus Medicare Part D (private insurance companies).
When Is Medicare Open Enrollment?
Medicare Open Enrollment lasts from October 15 to December 7 every year. It’s also known as the Annual Election Period.
Enrolling during this time period guarantees your acceptance and avoids any penalties for enrolling after the Open Enrollment period has expired.
A separate Open Enrollment for Medicare Advantage is held annually between January 1 – March 31.
What Can You Do During Medicare Open Enrollment?
You can do several things during Medicare Open Enrollment:
- Enroll for the first time
- Change your existing coverage
- Switch plans, either to a Medicare Advantage or back to Original Medicare
- Sign up, switch or opt of Medicare Part D.
Where should you start?
Think about what type of plan you want:
- Do you want to enroll in Original Medicare which is federally run?
- Do you want to buy a Medicare Advantage plan, which is from a private insurance company?
- Do you need prescription drug coverage?
Next, think about features important to you:
- Do you want to see nearly any doctor or hospital you would like (Original Medicare) or are you okay staying in a specific network if the cost is less (Medicare Advantage)?
- Do you want to buy plans individually (Original Medicare, Medigap, Part D) or is it easier to buy one plan that includes everything (Medicare Advantage)?
- Do you want to travel overseas frequently (Original Medicare with a Medigap plan) or do you prefer to stay close to home (Medicare Advantage)?
During Open Enrollment, you can switch from Original Medicare to Medicare Advantage or vice versa. You can also change Medicare Advantage plans if multiple insurance companies offer plans in your area.
Medicare Advantage has become increasingly popular in the U.S., with nearly 39% enrolled as of 2020. The Congressional Budget Office expects that number to increase to over 50% by 2030.1
An “advantage” of Medicare Advantage is that it’s a one-stop-policy for coverage. Many times, it includes extra benefits like dental, vision and hearing. These benefits are not available on Original Medicare. Drug coverage is a separate application.
Most Medicare Advantage plans have prescription drug coverage built right in, eliminating the need for a separate program. If you’re enrolled in Medicare Part A and Part B with Part D included, you can switch to a Medicare Advantage plan during the annual open enrollment with no consequences. Or you can switch back to Original Medicare and sign up for Part D drug coverage.
How Do You Sign Up for Medicare?
You can sign up for Medicare coverage or change your plan up to twice a year, depending on what you select. Here are additional things to know about enrolling:
- You will automatically get Part A coverage at age 65 once you sign up for Social Security. But you will need to sign up for Part B since you have to pay a premium.
- If you’re near 65 and already receive Social Security benefits, you’ll automatically be enrolled in Medicare Part A and Part B.
- If you are within three months of turning 65, you can sign up for Medicare through the Social Security Administration. You can also start or delay your retirement benefits at the same time.
How Much Does Medicare Cost?
Contrary to popular belief, Medicare Part A and Part B are not free and cover 80% of costs, leaving you with 20% of the remaining expenses.
In most cases, Medicare Part A is free from any premium cost. If you don’t qualify for free premium, the cost is up to $499 per month in 2022, depending on how long you or your spouse worked and paid Medicare taxes.
If you are required to purchase Part A, you’re also required to purchase Part B on a monthly basis. It’s a good idea to speak with the Social Security Administration about your options.
The Part A deductible is $1,556 as of 2022. You are responsible for daily coinsurance payments if you are hospitalized for more than 60 days. After 90 days in the hospital, the coinsurance cost increases once again.
In 2022, Medicare Part B is $170.10 for most individuals. (It depends on income.) The Part B deductible is $233. After your deductible is met, you have to pay 20% coinsurance for medical care.
About 65% of Medicare Advantage beneficiaries with prescription drug coverage pay $0 other than the Part B premium. For those that do pay a premium, the average monthly cost is $60. Premium pricing varies by location and plan selected.
For Medicare Advantage Part A and Part B, the maximum out of pocket limit in 2021 is $7,550 for in-network services and $11,300 for a combination of in-network and out-of-network services.2
Part D premium pricing is based on ZIP code so costs vary by region and state.
For example, in Collin County, Texas, northeast of Dallas, Part D monthly premium ranges from $7.30 to $154.70 depending on the plan you select and drugs covered.3
The standard deductible is $480 in 2022. The out of pocket maximum limit for 2022 is $7,050.4
An income-related monthly adjustment amount (IRMAA) applies if you earn more than $91,000 per year. If your income is higher, you pay higher premiums for Part B and Part D.5
|If your adjusted gross income in 2019 is:||You pay Part B premium||You pay Part D premium|
|More than $91,000 but less than $114,000||$238.10||$12.40 plus plan premium|
|More than $114,000 but less than $142,000||$340.20||$32.10 plus plan premium|
|More than $142,000 but less than $170,000||$442.30||$51.70 plus plan premium|
|More than $170,000 but less than $500,000||$544.30||$71.30 plus plan premium|
|More than $500,000||$578.30||$77.90 plus plan premium|
When Are Other Enrollment Periods?
You can apply for Medicare beginning three months before your 65th birthday.
If you apply during this timeframe, your coverage starts the first day of the month you turn 65 years of age unless your birthday is on the 1st of the month. If your birthday is on the 1st of the month, you become eligible on the 1st of the prior month.
You have up to 90 days after your birthday month to enroll as well. Once this window of time passes, you could face penalties for trying to enroll outside of your birthday enrollment and the annual open enrollment period.
Here are some other dates to keep in mind:
- Each year the Annual Enrollment Period is October 15 – December 7.
- Medicare Advantage Open Enrollment is January 1 – March 31.
- Special Enrollment Periods can occur outside of these other dates if you move or lose your health insurance coverage.
You can apply for Medicare either online or through a licensed insurance agent. Many website entities have licensed brokers who are able to talk you through the options they have online.
Medicare.gov also has a Medicare Plan Finder to shop and compare options in your state.
Another option is State Health Insurance Assistance Programs (SHIP). The service offers free help in your local area to help you navigate your options.
Let’s recap your options. Starting three months before your 65th birthday, you can:
- Apply for Medicare Part A and Part B through Social Security. You can also determine your retirement benefits at the same time.
- Decide if you want to supplement your Original Medicare coverage with a Medigap plan.
- Determine if you want to enroll in Part D prescription drug coverage.
- Look at Medicare Advantage plans and coverage options.
Then, during Open Enrollment, you can:
- Make changes to your existing Medicare coverage by dropping or adding coverage.
- Switch from an Original Medicare plan to Medicare Advantage.
- Switch from Medicare Advantage to Original Medicare.
- Change Medicare Advantage plans for better network options or price points.
The most important thing is to shop around every year during Open Enrollment to see if you can reduce your costs. Once you decide how you want your Medicare plan structured and administered, you’re on your way to making a decision on health insurance for the next year.