Medicare Open Enrollment, and the Two Rules Outside It
Medicare’s Open Enrollment runs October 15 through December 7, and changes made in it take effect January 1 of next year. The plan has to have your request by December 7. It is one of Medicare’s enrollment windows. Two of the things a change in this window touches follow rules of their own, on clocks the window does not control.
Open Enrollment is the time to change how you get Medicare: your Medicare Advantage Plan, your drug plan, or the choice between the two systems. Two of those moves run into rules that live outside the window: whether a Medigap policy you gave up can be bought back, and what follows 63 days or more without creditable drug coverage.
The Letter That Arrives in September
What you can do in the window depends on the coverage you have now. You can join, drop, or switch to another Medicare Advantage Plan with or without drug coverage, or add or drop drug coverage. If you’re in Original Medicare, you can join, drop, or switch to another Medicare drug plan. And you can move between the two systems in either direction — Original Medicare to a Medicare Advantage Plan, or a Medicare Advantage Plan back to Original Medicare.
Before any of that, if you’re in a Medicare plan, your plan sends you a Plan Annual Notice of Change each fall, and September is the month it is expected. The plan is the sender. If it doesn’t arrive, the plan is also who to ask.
The notice includes any changes in coverage, costs, and more that will be effective in January. Medicare.gov’s guidance is to review those changes to decide whether the plan will continue to meet your needs in the next year.
Those changes belong to that plan. The window is where you answer them — by staying with the plan and its new terms, or by leaving it.
Leaving a Medicare Advantage Plan, and What Stays Behind
Switching from a Medicare Advantage Plan back to Original Medicare is one of the moves the window allows, and two other things may travel with it. You may need to join a separate drug plan. You may want to add Medicare Supplement Insurance, known as Medigap — and there are limits on when you can add it.
Those limits run on a different clock than the one ending December 7. Your Medigap Open Enrollment Period comes when you’re 65 or older and first get Part A and Part B: you have 6 months after your Part B coverage starts to buy a policy, and during that stretch you can buy any Medigap policy sold in your state, even if you have health problems. If you’re under 65, you might not be able to buy a Medigap policy, or you may have to pay more, even in those first 6 months. After it ends, insurance companies don’t have to sell you a Medigap policy, unless you have Medigap protections called guaranteed issue rights.
There is a route back. If you drop a Medigap policy to join a Medicare Advantage Plan for the first time, you’ll have a single 12-month period — your trial right period — to get your Medigap policy back if the same insurance company still sells it once you return to Original Medicare. That is several conditions, not one: dropping Medigap to join Medicare Advantage for the first time, returning to Original Medicare within the 12 months, and the same company still selling the policy. If it isn’t available, Medicare.gov says you can buy certain Medigap policies depending on state law and whether you’re new to Medicare on or after January 1, 2020. A second route covers someone who joined a Medicare Advantage Plan when first eligible for Medicare Part A at 65: Medicare.gov says that person can buy certain Medigap policies sold in their state if they switch to Original Medicare within the first year of joining the plan.
Inside a Medicare Advantage Plan, Medicare’s side-by-side comparison of the two systems puts it this way: “You can’t buy Medigap to cover your out-of-pocket costs.” The Medigap page carries the one exception: you can’t buy Medigap while you’re in a Medicare Advantage Plan unless you’re switching back to Original Medicare. Under Original Medicare, buying Medigap to help with out-of-pocket costs like the 20% coinsurance is a choice you can make. Same person, two different columns.
The Second Window: January 1 Through March 31
December 7 is not the last date on the calendar, but the next window is open to fewer people. The Medicare Advantage Open Enrollment Period runs January 1 through March 31, and it applies only if you’re already in a Medicare Advantage Plan.
Inside it, you can switch to another Medicare Advantage Plan with or without drug coverage, or drop your Medicare Advantage Plan and return to Original Medicare. Take that second path and you’ll also be able to join a separate Medicare drug plan. Coverage starts the first of the month after the plan gets your request, rather than on a fixed January 1 date.
A separate three-month clock exists as well. Someone who joined a Medicare Advantage Plan during their Initial Enrollment Period can change to another Medicare Advantage Plan, with or without drug coverage, or go back to Original Medicare within the first 3 months they have Medicare Part A and Part B.
Drug Coverage and the 63-Day Line
Dropping Medicare drug coverage has 3 opportunities, depending on your circumstances: during the Open Enrollment Period between October 15 and December 7, with the change going into effect January 1 of the following year; during the Medicare Advantage Open Enrollment Period if you’re in a Medicare Advantage Plan with drug coverage; and when you meet certain other circumstances.
Switching is quieter than dropping. Your old drug coverage will end when your new drug coverage begins, and Medicare’s page says you should get a letter from your new plan telling you when your coverage begins, so you don’t need to cancel your old plan.
Dropping it is where the line appears. You can rejoin a plan with Medicare drug coverage in the future, but if you go 63 days or more in a row without other creditable prescription drug coverage, you’ll have to wait for an enrollment period to sign up, and you may have to pay a late enrollment penalty.
The penalty is an extra 1% for each month — that’s 12% a year — and it is added for as long as you have Medicare drug coverage, even if you switch plans. It is not a one-time fee that a later enrollment clears. Medicare.gov adds that, generally, you won’t have to pay a Part D penalty if you have creditable drug coverage or qualify for Extra Help. See also: help with drug costs.
Each Move, and the Rule That Sits Outside It
Here is the same material, arranged by the decision in front of you.
Each Open Enrollment move, and the separate rule that applies to it — assembled from Medicare.gov’s Open Enrollment, Medigap, drug coverage, and comparison pages.
| If you have and want | Which window | The rule outside the window |
|---|---|---|
| Original Medicare to a Medicare Advantage Plan | Open Enrollment, effective January 1 | Medigap: in a Medicare Advantage Plan you can’t buy Medigap to cover your out-of-pocket costs |
| A Medicare Advantage Plan to Original Medicare | Open Enrollment, or the Medicare Advantage Open Enrollment Period, January 1–March 31 | A Medigap policy you gave up: after the Medigap Open Enrollment Period, companies don’t have to sell you one unless you have guaranteed issue rights; a 12-month trial right applies only to a first move from Medigap into Medicare Advantage, and only if the same insurance company still sells the policy; if not, certain policies may be available depending on state law and whether you’re new to Medicare on or after January 1, 2020 |
| Switching drug coverage | Open Enrollment, the Medicare Advantage Open Enrollment Period if you’re in a Medicare Advantage Plan with drug coverage, or certain other circumstances | Nothing in between: your old drug coverage ends when your new drug coverage begins |
| Dropping drug coverage | The same three opportunities | If you then go 63 days or more in a row without other creditable drug coverage: you’ll have to wait for an enrollment period, and you may have to pay a penalty of 1% per month |
| Staying in your Medicare plan | No window needed | The changes announced in that plan’s September Annual Notice of Change take effect in January |
| Keeping a Medigap policy you already have | No window needed | All standardized Medigap policies are automatically renewed every year, even if you have health problems; Medicare.gov lists three grounds on which the insurer can drop you — you stop paying your premiums, you weren’t truthful on the application, or the company goes bankrupt or goes out of business |
The window is wide. Two rules sit outside it: the Medigap purchase rules, and the 63-day line for drug coverage. The plan’s notice comes first, in September.
This article is general information, not professional advice. For decisions about your money or health, consult a qualified professional.