2016 Medicare Annual Election Period Checklist
This article was updated on: 02/23/2016
The Annual Election Period (AEP) is an annual open enrollment period for Medicare Advantage and Medicare prescription drug coverage that takes place from October 15 to December 7 every year. During AEP, you may:
- Switch from Original Medicare to a Medicare Advantage plan.
- Switch from a Medicare Advantage plan back to Original Medicare.
- Switch from a Medicare Advantage plan to different Medicare Advantage plan.
- Switch from a Medicare Advantage plan that doesn’t include drug coverage to one that does, and vice versa.
- Join a Medicare prescription drug plan.
- Switch from one Medicare prescription drug plan to another one.
- Drop your Medicare prescription drug coverage.
There are different election periods for different parts of Medicare. See Medicare Enrollment Periods for more information.
Unless you qualify for a Special Election Period (SEP), you cannot make changes to your Medicare Advantage or Medicare prescription drug coverage outside of the Medicare AEP. However, if you are in a Medicare Advantage plan, you may disenroll during the Medicare Advantage Disenrollment Period and be returned to Original Medicare. This disenrollment period runs from January 1 to February 14. If you disenroll from a Medicare Advantage plan that included drug coverage, you will also have a Special Election Period to enroll in a stand-alone Medicare Part D prescription drug plan, which occurs at the same time as the Medicare Advantage Disenrollment Period, starting January 1 and ending February 14.
To help you take advantage of this important opportunity to make changes to your Medicare coverage, here is a yearly AEP checklist:
Checklist for the Annual Election Period
1. Confirm your eligibility to enroll.
If you’re thinking of joining a Medicare Advantage plan, verifying your eligibility should be the first item on your checklist for the Annual Election Period. To join a Medicare Advantage plan, you must have Medicare Part A and Part B and live in the service area of the Medicare Advantage plan you’d like to join. If you have end-stage renal disease (ESRD), you usually cannot join a Medicare Advantage plan, but there are a few exceptions.
Similarly, if you’d like to join a Medicare Part D prescription drug plan, you must have Medicare Part A and/or Part B and live in the service area of the prescription drug plan you are considering.
2. Decide if your current coverage still meets your needs and review any coverage changes.
You should carefully review your current Medicare coverage before AEP to see if it’s still meeting your health needs. Now is the time to take stock of what health services you typically use and whether you’re getting covered for them at a cost you’re comfortable with. Think of it as an annual check-up for your Medicare coverage.
If you’re currently enrolled in Original Medicare, Part A and Part B, you might consider joining a private Medicare plan to receive coverage not included in Original Medicare, such as vision or dental benefits. Medicare Advantage plans vary in the specific benefits they offer, but all are required to offer at least the same amount of coverage as Original Medicare. Prescription drug coverage is not included in Original Medicare and must always be obtained separately, either through a stand-alone Part D prescription drug plan or a Medicare Advantage plan that includes drug coverage.
If you’re already enrolled in Medicare Advantage or a Medicare prescription drug plan, you should carefully review your plan’s Evidence of Coverage and Annual Notice of Change documents, which are mailed out every fall before AEP. These documents provide detailed information on your plan’s coverage for the upcoming year, as well as any changes in benefits or costs. If a health service you rely on or a medication you take is no longer covered, your plan will notify you in these documents.
If you don’t have Medicare prescription drug coverage, but have other prescription drug coverage, verify that your drug coverage is still considered “creditable”—that is, coverage that’s expected to pay at least as much, on average, as standard Medicare prescription drug coverage. If not, you may want to sign up for Medicare prescription drug coverage during AEP. If you go for 63 or more consecutive days without creditable drug coverage, you may be subject to a Medicare Part D late enrollment penalty if you sign up later.
3. Be aware of how joining a Medicare plan may affect your other insurance.
If you have other coverage, such as retiree or veterans’ benefits, check if that insurance covers services that Medicare does not. Talk with your benefits administrator to see how your insurance works with Medicare. Some kinds of coverage may require you to have Medicare to maintain eligibility, while in other cases, enrollment into a Medicare Advantage or Medicare prescription drug plan may cause you to irreversibly lose your other coverage. Always make sure you understand the rules and how Medicare enrollment may affect your other insurance before joining a Medicare plan.
4. Find the best price for your coverage.
No checklist for the Annual Election Period would be complete without a thorough review of your present and projected health costs. Even if you are currently happy with your plan’s coverage, it may still be a good idea to shop around to compare prices, as Medicare plans can vary widely in what they pay for services and prescription medications. You may be able to find a better or more affordable option. Keep in mind that most Medicare Advantage plans charge a separate premium for coverage, in addition to the Medicare Part B premium you must keep paying. However, total cost-sharing expenses for Medicare Advantage plans are generally lower than Original Medicare.
Keep the following in mind when shopping during this AEP:
- Provider networks — If there are certain doctors you’d like to keep, make sure they are in the preferred network of any Medicare Advantage plan you join, or you could end up paying more to use an out-of-network provider.
- Prescription medications — Make sure any plan you’re considering covers all of the drugs you take. Medicare-covered drugs are often separated into different tiers, with higher or lower copayments/coinsurance depending on the tier they fall under. Keep in mind that the same drug may have different costs from plan to plan.
- Total cost-sharing expenses — When comparing plan costs, don’t just look at premiums, but at cost-sharing expenses as a whole. A plan with a lower premium may end up costing more overall if it’s offset by expensive copayments and deductibles or a high out-of-pocket maximum.
- Ratings — All Medicare prescription drug plans and Medicare Advantage plans are rated on a scale of 1 to 5 stars for quality and customer satisfaction, with a 5-star rating indicating excellence.
Medicare doesn’t have to be complicated, and, hopefully, this checklist gives you a good sense of steps you might need to take during the Annual Election Period. Of course, I am happy to answer any other questions you might have.
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