Is it just me, or does it seem like there are always commercials telling us we’re in another Medicare enrollment period. “Hurry. There’s not much time, so enroll today!”
The fact is, there are two regular enrollment periods every year. The Medicare Annual Enrollment Period (AEP) happens every year from October 15-December 7. It’s the time when you can make a lot of changes to your Medicare plan:
- Switch from Original Medicare to a Medicare Advantage plan, or vice versa
- Join a Medicare Part D prescription drug plan
- Change Medicare Part D prescription drug plans
- Disenroll from a Medicare Part D prescription drug plan
Then, there’s the General Enrollment Period (GEP). It happens every year from January 1-March 31. It’s for people who elected Medicare Advantage to deliver their healthcare. During the General Enrollment Period (GEP) you can:
- Switch to another Medicare Advantage plan with or without prescription drug coverage, or
- Drop the Advantage plan and return to Part A and Part B automatically with the option to enroll in a stand-alone Part D prescription drug plan. You can also apply for a Medigap policy (Medicare supplement insurance). However, you may be subject to medical underwriting.
You can make the changes online through your medicare.gov account, by contacting the plan you want to switch to, or by getting help from an independent Medicare agent who will help you through the process.
Why would you want to switch plans? The biggest reason is to get a plan that better meets your needs. For example, I have a client who switched Medicare Advantage plans during the Annual Enrollment Period (Oct 15-Dec 7) last year because her current plan would no longer be accepted by some of her healthcare providers. January of 2025, she discovered that some of her providers did not accept the new insurance, even though they were listed as in-network. Fortunately, she found a plan accepted by all her providers and she made the switch during the General Enrollment Period (Jan 1-March 31).
How do you handle that situation?
- Check the plan’s online directory but realize that it may not be completely accurate. (There have been issues in the past with the accuracy of the plans’ directories.)
- Call the plan and your healthcare provider to confirm network status.
- If you want more flexibility, consider a preferred provider organization (PPO) plan. However, know that out-of-network physicians have no obligation to see you.
- Also remember that networks can change at any time during the year.
- Other reasons to change—
Drug deductible
Plans can charge any amount up to the standard deductible, which is $590 this year. According to KFF, only 20% of Medicare Advantage plans charged a deductible last year. This year, 60% of members will face one.
Check the Medicare Plan Finder for the plan’s deductible and how that affects your medications. Some drugs are not subject to it and, if they are, the Plan Finder will indicate when you should reach the deductible.
Annual out-of-pocket spending limit
The maximum limits for 2025, established by the Centers for Medicare and Medicaid Services, are $9,350 for in-network care and $14,000 for in- and out-of-network combined. Just as with the drug deductible, plans can set any limit up to the maximum. So,
- Check your plan’s 2025 information for the limit
- Then guesstimate how much you will pay for your medical care. If your costs will be high, a plan with a lower maximum might work better
Cost sharing for medications
Many Advantage plans charge a copayment for Tier 3, 4 & 5 non-preferred brand drugs. For example: A nonsteroidal treatment for dry eye had a $100 copayment in 2024. This year, there will be 50% coinsurance, increasing the monthly cost to $275.
Identify how your plan treats your medications. If your plan now has a coinsurance, perhaps a different plan might not.
Supplemental benefits
Since 2019, Medicare Advantage plans have been able to offer supplemental benefits for services not covered by Medicare. The primary purpose of these benefits is to maintain health by including a wide range of services: dental, vision, hearing, transportation, fitness, over-the-counter supplies, meals and more.
Many plans felt a financial pinch in 2024. That’s why some plans are offering fewer benefits. For example, one plan with a $2,000 dental benefit in 2024 covered 100% of the cost of dentures. In 2025 it only covers 50%. Other common changes this year include:
- Reducing the amount of the dental benefit
- Cutting the amount of the over-the-counter benefit
- Reducing the amount allowed for eye glasses and contacts
- Eliminating some benefits altogether
- Removing some healthcare providers from the in-network choices
As with other categories, review what other plans have to offer. But remember, your most important concern should be how your plan treats your medical issues.
Other things to check
- The monthly premium: The 2025 average monthly premium for Advantage plans is $17. But premiums can range from zero up towards $200.
- The drug plan formulary: It’s possible that a drug you have taken for a long time is no longer included in the plan’s formulary for 2025
- Coverage rules for medical services and medications: You can’t escape prior authorization for medical care but see if prior authorization for your drugs is now required.
- Pharmacy networks: You may find a significant difference in cost between preferred and standard pharmacies.
A Second Chance
If you have a Part D drug plan you get only one chance a year to review drug coverage and make a change. That’s the October 15-December 7 Annual Enrollment Period. It’s important that you do your homework so you aren’t locked in to a plan that’s made changes that are not good for you.
But if you have a Medicare Advantage plan, you get a second chance and it’s going on right now through March 31. Dig out the Annual Notice of Changes your plan sent last fall and make sure the plan you have is truly the plan that’s right for you. Otherwise, it could be a long and expensive year until you can change your plan again.
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