Medicare Open Enrollment Starts Oct. 15
Category: Medicare
Sept. 25, 2024 — The annual Medicare Open Enrollment period starts Oct. 15. This is when people on Medicare can review and change their plans without penalty.
When’s the Medicare Open Enrollment Period?
Every year, Medicare’s open enrollment period is October 15 – December 7.
What’s the Medicare Open Enrollment Period?
Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 to December 7 is when people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.
How do people know if they need to change plans?
People in a Medicare health or prescription drug plan should always review the materials their plans send them, like the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC). If their plans are changing, they should make sure their plans will still meet their needs for the following year. If they’re satisfied that their current plans will meet their needs for next year and it’s still being offered, they don’t need to do anything.
What changes are coming to Medicare for 2025
Thanks to actions signed into law by the Biden administration there are a host of important changes coming to Medicare in 2025.
Lowering your prescription drug costs
In 2025, your yearly out-of-pocket drug costs will be capped at $2,000. If you have Medicare drug
coverage (Part D) and your drug costs are high enough to reach this cap, you
don’t have to pay a copayment or coinsurance for Part D drugs for the rest of the
calendar year. Starting in 2025, you’ll also have the option of spreading your drug
costs across monthly payments throughout the year.
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Managing your mental health and wellbeing
Medicare covers expanded mental health care, like intensive outpatient program
services in certain locations and services from marriage and family therapists and
mental health counselors. During your yearly “Wellness” visit your health
care provider can also use a health risk assessment to better understand your social
needs and refer you for appropriate services and support
.
More resources for caregivers
Medicare covers additional caregiver support, like training that helps your caregiver
better care for you and relief when they’re caring for family members in
hospice care. Also, some people living with dementia and their caregivers
may be able to get more support though a new pilot program.
Changes to telehealth coverage
You can get telehealth services at any location in the U.S., including your home,
through December 31, 2024. After this period, you must be in an office or medical
facility located in a rural area for most telehealth services. However, you can still get
certain telehealth services (like for mental and behavioral health) in your home no
matter where you live.
Differences between Medicare and Medicare Advantage Plans
One big decision you could make during the open enrollment period is to change from Medicare plus supplemental (traditional Medicare) to a Medicare Advantage plan (or vice versa). This is a big decision, with advantages and disadvantages to each. Factors like where you live, available doctors in your area, what drugs you take, the state of your health, and your budget will help you choose the type of plan that is right for you. In general traditional Medicare with supplement insurance is more expensive than Medicare Advantage plans, but provides more bullet proof coverage and control. Advantage plans are less expensive (many have zero premiums!) and provide extensive coverage for vision, dental, drugs, and wellness at no charge. For our detailed description of the differences between traditional Medicare and Medicare Advantage plans, check out this helpful article on the Best Medicare Program for you.
Where can people find Medicare plan information or compare plans?
1-800-MEDICARE or Medicare.gov.
This Manual from Medicare is very helpful describing the program along with what is new for 2025.
Comments? Do you take advantage of the Open Enrollment Period to see if you have the best plan for you (many people don’t)? Do you change your program from year to year? Let us know in the Comments section below.
Comments on "Medicare Open Enrollment Starts Oct. 15"
Mike says:
Key points from KFF, an independent source of healthcare policy, says most people do not review their coverage. My unscientific polling agrees with KFF, most people I know couldn't tell me if they have Medicare with a supplement or an Advantage plan.
Everything below is quoted from the KFF study:
Overall, nearly 7 in 10 (69%) Medicare beneficiaries did not compare their own source of Medicare coverage with other Medicare options offered in their area during the 2021 open enrollment period, while 31% did so. A larger share of beneficiaries in traditional Medicare than in Medicare Advantage did not compare their own source of coverage with other plans (73% vs 65%).
Among Medicare Advantage enrollees, more than 4 in 10 (43%) did not review their current plan’s coverage to check for potential changes in their plan’s premiums or other out-of-pocket costs, while the remainder (57%) did so. A similar share (44%) did not review their current plan for potential changes in the kinds of treatments, drugs, and services that would be covered in the following year.
Most enrollees in Medicare Advantage prescription drug plans (82%) and stand-alone prescription drug plan (PDPs) (69%) did not compare their plan’s drug coverage with drug coverage offered by other plans in their area.
Medicare’s official information resources are used by half or fewer of Medicare beneficiaries, with just a quarter (26%) reporting calling the toll-free number, 4 in 10 (42%) reporting visiting the Medicare website, and slightly more than half (54%) reporting reading some or parts of the Medicare & You handbook.
In focus groups conducted by KFF, Medicare beneficiaries highlighted many of these factors, including out-of-pocket costs, access to specific doctors, and coverage of prescription drugs, as important in choosing their Medicare coverage. Yet, Medicare beneficiaries also expressed difficulty understanding and comparing the various plan options and being overwhelmed by a barrage of television ads – mostly for Medicare Advantage plans.
Editor's comment: Thanks Mike. Always appreciate your valuable insights and information.
Mike says:
Medicare announce this about Advantage plans pricing yesterday:
“The average monthly plan premium for all MA plans, which includes MA plans that provide prescription drug coverage and MA Special Needs Plans (SNPs), is projected to decrease from $18.23 in 2024 to $17.00 in 2025. Benefit options will remain stable, including MA supplemental benefit offerings such as hearing, dental, and vision. The amount of rebate dollars, which can be used for supplemental benefits, will remain stable, with a slight increase, from 2024 to 2025. Enrollment in MA is projected to be 35.7 million in 2025, an increase from 2024, with MA enrollment representing approximately 51% of all people enrolled in Medicare.”
Roberta says:
Don't forget to contact your local Area Agency on Aging to talk to a volunteer SHIP Medicare Counselor. These volunteers are highly trained, do know about all the plans (Advantage and Supplements and Drug plans) in your area and they DO NOT SELL ANYTHING.
Carol says:
I am a retired rehab hospital CEO and nurse. All I can say is BEWARE of Medicare Advantage plans. They throw in lots of freebies but then refuse expensive care when tragedy strikes. I have seen innumerable patients refused hospital-level, intensive rehabilitation following strokes, brain injuries, multiple trauma from car crashes, etc. Instead they were sent to nursing homes. MA plans pay for dental, eyeglasses, gym memberships, etc. by refusing access to the expensive care when and if you need it. Buyer beware.
Carol says:
Here is the link to an October 2024 Senate report that substantiates what I said above:
https://www.hsgac.senate.gov/wp-content/uploads/2024.10.17-PSI-Majority-Staff-Report-on-Medicare-Advantage.pdf
RichPB says:
Good advice, Carol. While visiting in a neighboring state, I was hospitalized with a heart attack and was scheduled for a triple bypass (widow -maker artery 100% blocked, two others 99 and 75% blocked), but our MA company at first refused to cover because I was out of state and demanded we return home first. The cardiologist said if they put me in an ambulance with two EMTs that he would give me a 50% chance of survival. Thanks to his efforts they finally agreed, but the stress on me and my wife was extreme at a rather bad time. Buyer beware. There er reasons MAs are in business and it's not in your best interests.
Beebs says:
Carol
Thanks for the info. I have HDG and was deciding if I should switch to an advantage plan. Now I decided to stay with the plan I have.
RichPB says:
One last comment on this. If you are thinking Medicare Advantage, be sure to check in you specific state whether you can switch back or to regular Medicare before you commit. When we took MA, we understood that we could not go back to regular Medicare without medical review. After the "refusal" we wanted to change back and only the fact that my former employer stopped providing in-house coverage for retirees allowed me a one time option to "start over" was I able to return to standard Medicare. Otherwise, my heart condition would have prevented me from changing. So check your situation just in case.
Mike says:
A comprehensive look at all things Medicare from KFF, a nonprofit health policy research, polling and news organization. https://www.kff.org/health-policy-101-medicare/?entry=table-of-contents-what-is-medicare
Mike says:
You can get a supplement without underwriting in any state during the first year you have an Advantage plan if you decide to change back to Medicare and a supplement. That is Federal law, it is called a trial right switch. A guide for other options: https://www.senior65.com/medicare/article/medicare-insurance-switching-ultimate-guide#mss
Admin says:
Just out from the NY Times, Medicare or Medicare Advantage: A Guide for 2025. a very helpful article explaining what is up with the latest in Medicare/Medicare Advantage Plans. That includes considerations you need take into account, like whether your plan has been discontinued or modified. Only 20% of recipients shop their plans each year.
Mike says:
Additional information related to Carol's comments on October 17 & 18
https://www.finance.senate.gov/imo/media/doc/102924_wyden_neal_pallone_letter_to_cms_about_ma.pdf?wpisrc=nl_health202
https://healthcareuncovered.substack.com/p/leaders-of-three-key-health-committees?publication_id=255152&post_id=150958253&isFreemail=true&r=6x3jh&triedRedirect=true
Mike says:
More information related to Carol’s comments of October 17 & 18.
https://www.finance.senate.gov/imo/media/doc/102924_wyden_neal_pallone_letter_to_cms_about_ma.pdf?wpisrc=nl_health202