Key Takeaways

  • The Medicare Open Enrollment Period (Oct. 15 - Dec. 7) is a time when your loved ones can join or switch private Medicare health or drug plans.

  • Beware of aggressive marketing tactics that try to sell your loved one a specific plan; Medicare has strict rules about what brokers can and cannot do.

  • Plans that advertise having $0 premiums usually shift those costs to other parts of the plan's coverage.

You may be seeing lots of mail coming to your loved ones starting in early fall. Medicare’s annual Open Enrollment Period runs October 15 through December 7, and is a time when people can join, switch, or disenroll from Medicare health (Medicare Advantage) and/or prescription drug (Part D) plans.

Here we answer some common questions caregivers may have about what happens during the annual Open Enrollment period, and how to help your loved one navigate their coverage.

My parents have been on Medicare for five years. Do they have to do anything during Open Enrollment? 

There is no requirement to do anything during Medicare Open Enrollment. However, because health and drug plans can change from year to year, you may want to see whether their current coverage still meets their needs. 

For example, Medicare Part D drug plans often change which medications are on their formulary (approved drug list) and how much those drugs cost. It’s worthwhile to see whether switching plans can save your parents money.

Learn what questions to ask.

Someone came to my dad’s door and tried to get him to sign up for a Medicare Advantage plan from a specific company. Is that legal?

The Medicare Open Enrollment Period is often ripe for fraudulent behavior by people representing, or claiming to represent, plans. Medicare sets very strict rules for what brokers/agents are allowed to do and not do when marketing health and drug plans. 

A Medicare broker or agent cannot:

  • Come to your home uninvited to sell or endorse anything.
  • Offer you cash (or gifts worth more than $15) to join their plan.
  • Sell you a non-Medicare product, like life insurance, during a sales pitch for a Medicare plan.
  • Pressure you to enroll in a specific plan.
  • Ask for payment. There is no broker’s fee and the plan will bill your dad once he is enrolled.
  • Ask for names and numbers of friends/family to sell plans to them.

If you think this person came to your father’s door without prior communication or an appointment, you can report this behavior to Medicare at 1-800-MEDICARE (1-800-633-4227).

What’s the deal with $0 premium Medicare Advantage plans? Are they really free?

Many Medicare Advantage plans have a premium of $0. But that doesn’t mean your health care is free. Unless you/your loved one qualifies for a Medicare Savings Program, you’ll still be responsible for paying the monthly Part B premium.

In addition, there are other costs associated with plans, such as an annual deductible (amount you pay before the plan’s coverage kicks in), copayments for services, and co-insurance (a percentage of costs). When comparing plans, it’s important to look at the overall estimate of how much you will pay out of pocket during the year. 

Can my mom switch her Medigap plan during the Medicare Open Enrollment Period? 

Medigap is supplemental insurance that helps offset the costs of Medicare Parts A and B. Like Medicare Advantage and Part D plans, Medigap policies are sold by private insurance companies.

Switching Medigap plans is more difficult than switching a Medicare health or drug plan. Medigap policies are intended to provide wraparound cost coverage for the rest of your life. Depending on your state’s insurance rules, companies can refuse to sell you a new policy if you’re outside of your initial Medigap enrollment period (the six-month window when you first enroll in Part B). 

Your mother can use the Medicare Open Enrollment Period to leave Medigap and select a Medicare Advantage plan, but know that if she is not happy with this decision, she may have limited opportunities to reenroll in Medigap. 

Discover other scenarios during which you can switch Medigap plans.

My husband always has “buyer’s regret”. What if he chooses a Medicare Advantage plan and doesn’t like it? Does he have to wait an entire year to get a new plan? 

Fortunately for your husband, there is a way out that doesn’t require waiting a full year.

The Medicare Advantage Open Enrollment Period runs from January 1 through March 31. During this time, someone who is enrolled in a Medicare health plan as of the first day of the year can switch plans, or leave Medicare Advantage and return to Original Medicare with a Part D drug plan. In both instances, the new plan coverage will begin the first day of the month after your new plan gets your request to enroll. The Medicare Advantage Open Enrollment Period does not provide an opportunity to switch Medicare Part D drug plans. 

How true are those Medicare advertisements claiming to provide coverage for dental, vision, and hearing benefits?  

Anything that sounds too good to be true probably is. Keep in mind that the ads are designed to prompt people with Medicare to call a phone number, enter an email address, or perform some other action to learn more about an advertised plan. Beneficiaries need to recognize that placing a call, providing an email address, or returning a postcard routinely opens the door to more direct marketing and possibly high-pressure sales tactics. You can independently learn more about plans in your area by visiting medicare.gov or refer to the Compare Health and Drug Plans in your area portion of the Medicare and You handbook which you receive each fall.