Medicare open enrollment is from Oct. 15 to Dec. 7 and is when Medicare beneficiaries can make changes to their coverage.
If you’re a senior, one of the most important events in your annual calendar rolls around each October, when Medicare open enrollment begins.
This is the period when you can make changes to your health care coverage that best suit your needs. While it’s common for seniors to assume they’re fine to keep the same coverage each year, this can be a costly mistake.
- You can change Medicare Advantage plans, switch between Original Medicare and Medicare, and change Part D plans and Medicare supplement plans during the open enrollment period.
- When choosing a Medicare plan, you should review costs, coverage, provider network, quality of care, and plan design to find the right plan for you.
- CMS estimates the average monthly Medicare Advantage premiums will decrease to $19 in 2022.
- Deductibles and premiums vary by Medicare Advantage and Part D plans, so it’s vital to dig into the information and compare each plan’s costs.
Read on to learn all you need to know about Medicare open enrollment.
What is Medicare open enrollment?
Open enrollment allows you to review your plan and other options to see which Medicare plan works for you — and make changes to your Medicare coverage.
The Medicare open enrollment period runs from Oct. 15 to Dec. 7 each year. Changes made during open enrollment begin on Jan. 1 of the following year. There’s also a second, more limited open enrollment that starts in January.
Although seniors can switch plans annually, a 2019 Kaiser Family Foundation study found that only 8% of Medicare Advantage plan members and 10% of Medicare Part D plan members voluntarily switch plans for the coming year. That can be a mistake.
Medicare Advantage and Part D plans can change each year and you may find a new plan that works better for your specific situation.
Fortunately, shopping for a new Medicare plan is relatively easy.
“Shopping online for your health plan coverage can save time,” says Lisa Wright, principal consultant for community programs at BlueCross BlueShield of Tennessee.
Wright recommends preparing a list of:
- Services you use the most
- Doctors and hospitals that are important to you
- Your prescriptions
“Visit a few websites to see which health plans meet your individual needs best,” Wright says. ”It is not uncommon for spouses to have different plans that accommodate their different needs.”
Now, let’s walk through what’s new this year for Medicare, Medicare open enrollment options, and what you need to know.
When is the Medicare open enrollment period?
There are two open enrollment periods for Medicare. The Medicare open enrollment period runs from Oct. 15 to Dec. 7. During the Medicare enrollment period, you can:
- Do nothing and keep your current Medicare medical and drug coverage.
- Change from Original Medicare to a Medicare Advantage plan.
- Switch to Original Medicare from a Medicare Advantage plan.
- Switch from one Medicare Advantage plan to another.
- Swap Part D prescription drug plans, sign up for a drug plan if you don’t have one now, or drop drug coverage.
There is a second, more limited Medicare Advantage open enrollment period from Jan. 1 to March 31. During that time, you can only:
- Switch Medicare Advantage plans.
- Move from a Medicare Advantage plan to Original Medicare.
Medicare’s open enrollment also called the general enrollment period, is different from the Affordable Care Act marketplaces, which are also called the exchanges. In the past, the open enrollment period for those plans usually started on Nov. 1 and stretched to at least Dec. 15. Now, the period is being extended through Jan. 15 in most states.
Some seniors mistakenly think they can enroll in a Medicare plan through the ACA health insurance marketplace. However, you can’t buy a Medicare Advantage plan on the exchanges. Instead, you have to get it through the Centers for Medicare and Medicaid Services.
Choosing a Medicare plan
When selecting a Medicare plan, you can pick between Original Medicare with Part D or Medicare Advantage.
Don’t base your opinion solely on a plan’s premiums, Wright says. Instead, weigh other potential costs that might take a bite out of your wallet.
“This may include copayments or coinsurance for the services you use most, as well as the projected cost of your prescription drugs,” she says, noting that such costs vary from plan to plan.
When to think about when comparing Medicare plans
Here’s what to review when choosing a plan:
- Costs — Look at both premium and out-of-pocket costs.
- Coverage — Both Original Medicare and Medicare Advantage offer comprehensive benefits, but you may find a Medicare Advantage plan with additional benefits.
- Prescription drugs — See what prescription drugs each plan covers and the costs.
- Doctor and hospital choice — Not all doctors and facilities accept every Medicare plan. Check to make sure your providers, hospitals, and facilities take the plan before choosing it.
- Quality of care — Medicare ranks each Medicare Advantage plan on quality of care. If you’re comparing Medicare Advantage plans, you want to see their star ratings.
- Plan design — Medicare Advantage insurers offer multiple plans, such as preferred provider organization (PPO) and health maintenance organization (HMO) plans. PPOs have fewer restrictions but cost more than HMOs, which usually have smaller networks and don’t pay for any out-of-network care.
Deb Gordon, author of “The Health Care Consumer’s Manifesto,” says people looking for a health plan should figure out their “must-haves.” That includes making sure your doctor accepts the health plan.
Then, analyze your preferences and how much risk you’re willing to take. For instance, you may want a high-deductible plan if you prefer to pay the lowest premiums with the understanding that you’ll spend more out-of-pocket when you need health care services.
“It’s impossible to predict your health needs or utilization,” Gordon says. “But you can assess the likelihood that you’ll need a lot of health care services or very little.”
If you know you’ll need a lot of care – such as if you have surgery on the horizon or require ongoing treatment for the chronic disease — you may quickly run through your deductible.
“Once you do, insurance will pick up most of the costs after that, so paying more in premium for a lower-deductible may save you money,” Gordon says.
Medicare Plan Finder can help you choose
Medicare Plan Finder is one way to compare Original Medicare and Medicare Advantage plans offered in your area. Plan Finder provides a plan’s rating and estimates for premiums, deductibles, health, and drug costs. By answering questions, the tool also narrows choices for you.
It’s a good idea to review your coverage annually and see if your plan meets your health care needs.
You should receive an “Annual Notice of Change” from your plans before the fall open enrollment period begins. Review the information to understand Medicare coverage and costs for next year.
Questions to ask when comparing Medicare plans
Among the questions to ask are:
- Does the prescription drug plan cover your medications? What are the coverage rules for drugs?
- Are your doctors and hospital in the health plan’s network? Do you need to get referrals to see specialists?
- How much will you pay in premiums and out-of-pocket health care costs, such as deductibles, copayments, and coinsurance?
- What is the plan’s quality rating?
- Will you have coverage when you’re out of state or the country?
- Do you have access to other coverage, such as group health through a current or former employer? How will Medicare work with that insurance?
What’s most important when comparing plans? Insure.com recently surveyed 505 people with Medicare about that question in 2020. Here’s what those with Original Medicare and Medicare Advantage chose as most important:
- Breadth of services, including supplemental benefits — 23%
- Low deductibles and out-of-pocket costs — 22%
- Low premiums — 16%
- No referral requirement — 11%
- Provider network — 8%
Medicare Advantage plan
- Breadth of services, including supplemental benefits — 28%
- Low deductibles and out-of-pocket costs — 26%
- Provider network — 16%
- Low premiums — 10%
- No referral requirement — 8%
The results are similar, but you’ll see slight differences, such as Original Medicare beneficiaries are more interested in lower premiums than Medicare Advantage beneficiaries. Meanwhile, Medicare Advantage members want a breadth of services and lower out-of-pocket costs.
How to apply for Medicare
Those enrolled in Social Security are automatically enrolled in Medicare Part A when they become eligible for Medicare coverage at age 65, as long as they receive Social Security benefits for at least four months before turning 65. You also will be enrolled in Medicare Part B and can decide whether or not to keep it.
There are several ways to enroll in Medicare during the initial enrollment period. They include:
- Online. Going to the Social Security website is the “easiest and fastest way to sign up,” the federal government says.
- By Phone. You can enroll by calling Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.
- At your local Social Security office.
If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772 to enroll in Medicare.
The Centers for Medicare and Medicaid Services mails a welcome package and Medicare card about two weeks after you sign up.
Even if you’re automatically enrolled in Medicare, you need to make important decisions about what type of coverage you want. So, the earlier you start, the more time you will have to research and make crucial decisions.
In fact, one of the biggest mistakes people make when signing up for Medicare is to wait too long to start the process, Wright says.
“You can enroll in Original Medicare as early as three months before you turn 65,” Wright says. ”It’s your first step to accessing all of your Medicare options, and most people don’t do it early enough.”
If you don’t enroll in Part B during your initial enrollment period, you may be subject to a late enrollment penalty once you finally sign up.
How much does Medicare cost?
Medicare costs vary by type of plan. Here’s a rundown on averages?
- Part A – Nearly all Medicare beneficiaries don’t pay a monthly premium for Part A. However, if you’re not eligible for premium-free coverage, you pay between $259 to 471 monthly for Part A, depending on how long you paid Medicare taxes while you were working. The deductible is $1,484 for each benefit period. A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility (SNF). The benefit period ends when you have not received any inpatient hospital or SNF for 60 days in a row.
- Part B – The standard Part B premium is $148.50. People who make more than $87,000 for individuals or $174,000 for joint filers pay more for premiums. The annual deductible for 2021 is $203. Once you meet that deductible, you usually pay 20% of your Part B healthcare costs.
- Part C – The average monthly Medicare Advantage premium is $19 for 2022. Deductibles vary by plan, so you want to make sure you understand the out-of-pocket costs when comparing plans. Many Medicare Advantage plans offer zero premiums but make sure to read the fine print to see about those plans’ out-of-pocket costs when you need care. The out-of-pocket maximum for Medicare Advantage plans is $7,550.
- Part D (drug plan) – Most Medicare drug plans charge a monthly premium that varies by plan. The average monthly basic Part D premium for 2022 is $33. Deductibles vary, but no Medicare drug plan may have a deductible of more than $445.
What types of Medicare Advantage plans are available?
Medicare Advantage coverage offers an alternative way to get Medicare coverage. These plans — sold by private insurers — must follow Medicare rules, and they are available in a variety of flavors. They include:
- Health Maintenance Organization (HMO) plans, which typically limit care to services from providers in the plan’s network.
- Preferred Provider Organization (PPO) plans, in which you can see providers outside the network but typically pay less when using providers that don’t belong to the plan’s network.
- Private Fee-for-Service (PFFS) plans, in which the plan may or may not cover services from specific out-of-network providers.
- Special Needs Plans (SNPs), which limit membership to those with specific diseases or characteristics.
There are also a handful of additional types of Medicare Advantage plans, including HMO Point of Service (Hmopos) plans and a Medicare Medical Savings Account (MSA) plan.
What’s new in Medicare in 2022?
The federal government has made a handful of changes to Medicare for 2022.
Original Medicare premium increases
People with Original Medicare can expect to see Part B premiums and deductibles increase. How much more you’ll pay hasn’t been decided yet, though.
Premiums for 2021 were $148.50 for individuals earning $88,000 or less and those filing jointly and earning $176,000 or less.
Also, Part B premiums are higher for people with incomes above $88,000 for individuals and above $176,000 for married joint filers. In 2021, individuals with income over $88,000 paid the following premiums:
- Above $88,000 up to $111,000: $207.90
- Above $111,000 up to $138,000: $297
- Above $138,000 up to $165,000: $386.10
- Above $165,000 and less than $500,000: $475.20
- $500,000 or above: $504.90
In 2021, those who filed joint tax returns with income over $176,000 paid the following premiums:
- Above $176,000 up to $222,000: $207.90
- Above $222,000 up to $276,000: $297
- Above $276,000 up to $330,000: $386.10
- Above $330,000 and less than $750,000: $475.20
- $750,000 and above: $504.90
Medicare Advantage changes in 2022
Private insurers offer Medicare Advantage plans. The program has grown in membership and companies offering plans over the years.
The Centers for Medicare and Medicaid Services (CMS) says about 29.5 million Medicare members will likely enroll in a Medicare Advantage plan in 2022. That is up from 26.9 million in 2021.
People in Medicare Advantage will have lower premiums in 2022. CMS estimates that the average monthly Medicare Advantage premium will decrease to $19 in 2022. Premiums have fallen from $21.22 in 2021, $23.63 in 2020, and $26.87 in 2019.
CMS estimates a higher number of Medicare Advantage dual-eligible special needs plans will cover both Medicare and Medicaid services for people who are dually eligible — 295 plans in 2022, compared to 256 in 2021.
The percentage of plans offering special supplemental benefits for chronically ill people also jumps from 19% to 25% in 2022.
CMS also announced that more than 1,000 Medicare Advantage plans will participate in the CMS Innovation Center’s Medicare Advantage Value-Based Insurance Design (VBID) Model in 2022. This model “tests the effect of offering a projected 3.7 million people customized benefits that are designed to better manage their disease(s) and meet a wide range of social needs, from food insecurity to social isolation,” according to CMS.
In addition, 115 Medicare Advantage plans in portions of 22 states and U.S. territories will offer the VBID Model’s Hospice Benefit Component. It offers enrollees more access to palliative and integrated hospice care.
More Medicare Advantage plans in 2022
Medicare Advantage insurance companies say they’re expanding into more areas and offering more benefits in 2022. Here’s a rundown of some of the changes:
UnitedHealthcare, the nation’s largest health insurance company and also most Medicare Advantage members, is expanding Medicare Advantage to another 276 counties in 2022 to 2,629 counties. Another 3.1 million Medicare beneficiaries will have access to UnitedHealthcare plans.
UnitedHealthcare also says more members will be eligible for zero copays for tier 1 drugs. Most plans will have zero copays for tier 1 and 2 drugs through mail order.
Nearly 3 million current members will have plans with no premiums.
Also, UnitedHealthcare plans will have access to HouseCalls that includes one free in-home visit from a clinician a year.
Humana, the second-largest Medicare Advantage insurance company, is adding 34 counties. The payer will now offer plans in 47 states and 2,737 counties and Humana will also have Medicare Part D prescription drug plans in 50 states.
Humana will additionally have zero telehealth copays for primary care visits, urgent care, and outpatient behavioral health.
The insurer’s Part D Senior Savings Model will have 429 Medicare Advantage plans in 2022, up from 268 in 2021, which helps members with diabetes medications.
Anthem will expand into 154 new counties in 22 states with another 1.5 million eligibles.
Anthem Flex Card offers members a $500 stipend to buy dental, vision or hearing services.
Healthy Groceries cards can help members save on food, up to $50 per month.
Also, plans will offer 60 hours of in-home support to help with housekeeping and errands.
Cigna is adding 108 new counties and expanding into Connecticut, Oregon, and Washington.
Overall, Cigna will be in 477 counties in 26 states and the District of Columbia. Zero premium plans will be available in each market.
New programs include the Senior Savings Model, which caps insulin costs at $35 per month.In 2022, CMS will continue its testing of the Part D Senior Savings Model in more than 2,100 plans. This model is intended to increase access and affordability to some insulins. More than 500 new Medicare Advantage and Part D prescription drug plans will join the model this year.
Social Connection Program will help members in some areas to help with daily living activities.
Cigna will additionally consolidate Express Scripts’ Medicare prescription drug plans, so members have three options: Cigna Secure Rx, Cigna Essential Rx, and Cigna Extra Rx. Plans will include zero copays on some drugs through home delivery.
Aetna is expanding into 83 new counties and will be in 1,875 counties, reaching 53.2 million Medicare eligibles.
The payer is expanding zero-premium MA plans. Eighty-four percent of Medicare eligibles will have the option of zero-premium Aetna plans
Aetna is also growing Medicare Eagle plans, which will be available in 41 states and 1,151 counties. Those plans have no premiums, no primary care copays, dental, hearing, zero lab copays, and the SilverSneakers program.
Aetna says it will cover telehealth for primary, urgent, and specialist care, and behavioral health.
Seventy-seven plans in 28 states will have healthy foods benefit cards to help members get food. Eight states will offer 10 hours per month of companionship at no cost.
Medicare Part D changes in 2022
People with Original Medicare can enroll in a Part D prescription drug benefit plan. In 2022, average monthly Part D premiums are expected to be $33. That is up from $31.47 in 2021.
The premium projection was released in July. At the time, CMS said it would give a final figure for the premium in September. But on Sept. 29, CMS issued a press release that simply referred people to its July statement.
Original Medicare vs. Medicare Advantage
Medicare beneficiaries can choose between Original Medicare or Medicare Advantage. Here’s what you need to know about the two programs and their differences:
The federal government runs Original Medicare, including Part A and Part B:
- Part A covers hospital care
- Part B covers doctor visits, outpatient care, lab work, X-rays, and preventive services
You likely won’t pay a premium for Part A coverage if you and your spouse paid at least 40 quarters of Medicare taxes while working. You have to pay a deductible, however, before hospital coverage kicks in.
You pay a monthly premium for Part B, as well as a deductible and coinsurance.
Original Medicare lets you see any doctor or go to any hospital that accepts Medicare.
You can add a prescription drug plan — Part D — to your Parts A and B plans. Part D private insurers sell drug plans, which are approved by Medicare. You pay a monthly premium for a drug plan. Part D plans aren’t available in Medicare Advantage, but many of those plans have their own prescription drug plans.
In addition, you can buy a supplemental plan, called Medigap, to help cover some of your out-of-pocket costs. Private companies sell Medigap plans, which are standardized by letters A through N in most states.
Medigap plans aren’t insurance. Instead, they help you pay for health care costs for people with Original Medicare.
Private companies approved by Medicare sell Medicare Advantage plans. These plans usually operate like health maintenance organizations or preferred provider organizations found in employer-sponsored health insurance.
You must use doctors or hospitals in the plan’s network. If not, you have to pay more or all of the costs, depending on the plan.
“Review the plan to see if it includes the hospital and health care facilities that you use, as well as your primary care provider and any specialists you see,” Wright says.
Most plans cover prescription drugs and offer dental, fitness, vision, and hearing benefits.
Medicare Advantage plans often offer supplemental benefits that go beyond traditional medical care. Those benefits are one way Medicare Advantage differs from Original Medicare. When comparing plans, make sure to understand the specific supplemental benefits in a Medicare Advantage plan. They differ.
You can use the Medicare Plan Finder when comparing Medicare Advantage plans. The tool lets you compare Original Medicare, Medicare Advantage and Part D prescription drug plans. Medicare enrollees can choose between Medicare and Medicare Advantage. They can also see about pairing a Part D plan with original Medicare. Part D isn’t available to people with Medicare Advantage since Part C plans often have prescription drug coverage. With that tool, you can also explore your options for Medigap.
You can’t buy a Medigap plan if you have Medicare Advantage.
Frequently Asked Questions
Has Medicare open enrollment been extended for 2022?
Medicare open enrollment runs from Oct. 7 to Dec. 15 each year. To date, there is no indication that the federal government plans to extend this period during 2021 or 2022.
Can you be denied Medicare supplement insurance?
A Medicare supplement policy – also known as a Medigap policy – helps cover costs that your Original Medicare policy doesn’t cover.
If you buy a Medigap policy during your initial enrollment period, you can’t be denied coverage, even if you have health problems. You also will be charged the same rate for the policy as a healthy person would pay.
However, if you wait until after that point, you may be denied a policy or end up paying more for coverage. After the open enrollment period, Medigap insurance companies can use medical underwriting to decide whether to issue you a policy and how much to charge for it.
CMS says the best time to purchase a supplement policy is during the six-month Medigap open enrollment period when coverage is guaranteed at the most favorable rates.
When can I change my Medicare supplement plan for 2022?
There are many reasons you might consider switching your Medicare supplement plan, also known as a Medigap policy. Perhaps you need more help paying out-of-pocket costs. Conversely, you might be paying for coverage you no longer need. You also might desire a cheaper policy or simply want to change health insurance companies.
According to CMS, switching your Medicare supplement plan typically is only possible if:
- You’re eligible under a specific circumstance or guaranteed issue rights.
- You’re within your six-month initial enrollment period. This period begins the first month you have Medicare Part B coverage and you are 65 or older.
For more details about circumstances when you can and can’t switch policies, visit the CMS website.
Once you switch to a new Medicare supplement plan, you will have 30 days to decide if you want to keep it.
What is the best supplemental insurance for Medicare?
Medigap policies help cover some of the costs that Original Medicare doesn’t cover. Private companies sell these plans, which can reduce costs such as:
Medigap plans don’t cover all additional costs. For example, they typically don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
There are 10 different types of Medigap plans, which are named by letter — such as Plan A, Plan B, etc. Each plan differs in terms of how much of your health care costs you will be responsible to pay.
In addition, not all plans are available in every state. Three states — Massachusetts, Minnesota, and Wisconsin — offer different standardized plans.
Choosing the right Medigap plan depends on your individual needs.
What is the average cost of supplemental insurance for Medicare?
The cost of a Medigap policy varies by company. CMS notes that it is important to learn how an insurance company sets its prices for these policies, as this will determine how much you pay both now and in the future.
Each insurance company decides how it will set the price, or premium, for its Medigap policies. It’s important to ask how an insurance company prices its policies. The way they set the price affects how much you pay now and in the future.
Prices typically are set according to one of the following criteria:
- Community-rated (also known as “no age-rated”): Rates are the same for everyone, regardless of age.
- Issue-age-rated (also known as “entry age-rated”): Rates are based on your age when you purchase a policy.
- Attained-age-rated: Rates are based on your current age and increase as you get older.
Can you change Medicare plans outside of open enrollment?
Yes, you can change Medicare plans outside of the annual election period if you face a qualifying life event that starts a special enrollment period. Qualifying life events include if you lose other health coverage, the death of a spouse, or moving to another area.