May 19, 2022


Its all about the Health

Medicare Fall Open Enrollment Period | Critical things to know

4 min read

Medicare’s various election periods can be confusing, but there is no question that the Medicare Fall Open Enrollment Period is one of the most important periods for reviewing your coverage each year and changing that coverage if you wish to do so. Here are the most critical things you need to know about the Medicare Fall Open enrollment period.

Download your Open Enrollment Period Checklist here:

1)The Medicare Fall Open Enrollment is for Changing your Medicare Advantage plan and your Part D drug plan. It has nothing to do with your Medigap plan because Medigap plans do NOT change their benefits from year to year like Advantage plans and drug plans do.

So to minimize how much you have to do in reviewing your coverage in the fall, leave your Medigap plan out of the equation altogether – nothing is happening with that plan during the fall open enrollment.

2)If you are enrolled in a Medicare Advantage plan or a Part D drug plan, your plan will mail you an Annual Notice of Change letter in September. It’s very important that you sit down and review this letter. It will tell you everything that is changing with your plan from this year to next year.

For example, it might tell you that your doctor copay that was $10 this year is going up to $20 next year or it might tell you that the dental benefit your Advantage plan offered this year is going away next year.

It could also inform you that your monthly premium is changing or most importantly, it will tell you if any medications are being dropped from the plan’s formulary for next year.

The reason they send you this in September is that if you don’t’ like any of your plan’s changes for the upcoming year, then you can use the Fall Open Enrollment Period to switch to a different Part D or Medicare Advantage plan that will take effect January 1st.

3)Next, if you are leaving a Medicare Advantage plan and you intend to return to Original Medicare and buy a Medigap policy, make sure that you apply for the Medigap policy first.
Wait to get your approval on that Medigap application, and then and only then will you cancel your Advantage plan and enroll in a standalone Part D plan.

If you get the order on these wrong and cancel your Medicare Advantage plan first, you could then find out afterward that the Medigap company has declined you for coverage. Now you will find yourself with only Original Medicare and nothing else and you never want that.

Don’t leave your Advantage plan until you get the Medigap approved first and this means that you need to apply for the Medigap plan early enough so that you have time for them to do their underwriting well before your deadline to cancel your Medicare Advantage plan on December 7th.

4) The Medicare website has a plan finder tool that we use here at Boomer Benefits to help our own policyholders with researching plan options when thy want to change.

You can use this tool on your own by entering your zip code and your medications and letting Medicare’s options crunch the numbers to find the plans offering you the lowest overall annual out of pocket costs on your medications.

Be aware that Part D companies can restrict certain drugs. They can require a prior authorization from your doctor before they agree to fill the medication. They could also place quantity limits or step therapy limits on the medication.

When we help our clients enroll in Part D here at Boomer Benefits, we look for these things and it may factor into which drug plan we recommend for a client. If two drug plans are similarly priced, and one has a restriction on one of your medications and the other plan has no restrictions on that medication, we’ll advise that you opt for the one that gives you the least hassle.

If you are enrolling in Part D on your own, then you want to check for these restrictions when you are using Medicare’s Plan Finder Tool.

5) If you review your Annual Notice of Change letter in September and you find that you are unhappy with some of the changes, you can then use the period from October 15 – December 7th to select and apply for a new plan. Your new coverage will begin on January 1st.

Be sure not to procrastinate your review of your ANOC letter. You will feel a lot less pressure and stress if you review your plan options early in the enrollment period.

Boomer Benefits provides free claims support for life for all of our Medigap and Medicare Advantage policyholders so that you are never alone in dealing with Medicare.

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