What to know about Medicare open enrollment 2023

What is the Medicare Annual Enrollment Period (AEP)?

Medicare Annual Enrollment is a period that runs through October 15 and December 7 each year. This is the time for eligible beneficiaries to make a change to their Medicare health plan and prescription drug coverage. These changes will go into effect on January 1 of the following year and will carry forward throughout that year.

Medicare beneficiaries don’t have to do anything during open enrollment if their current plan is being offered again and they’re satisfied with their coverage. Instead, coverage will automatically carry over into the next year.

That said, it’s still a good idea to see what other options are now available. Health insurance companies expand their Medicare Advantage options each year, so you may find a better plan for you this year.

When is Medicare Annual Enrollment?

For most people on Medicare, the term "open enrollment" refers to the period between October 15 and December 7, also known as AEP or Annual Enrollment Period, and is when those enrolled in Medicare can change their coverage for the following year.

However, other enrollment periods apply to some people. For example, if you have never signed up for Medicare before, you have an initial Medicare enrollment period that starts three months before the month you turn 65 and ends three months after the month you turn 65. You may also be eligible for enrolling in Medicare before you turn 65 if you have a qualifying condition such as end-stage renal disease or ALS. 

People with Medicare Advantage can also change plans during the more limited Medicare Advantage open enrollment from January 1 to March 31. People can only switch Medicare Advantage plans or move from Medicare Advantage to Original Medicare during that time and only one change is allowed. 

Parts of Medicare

Let’s quickly review the types of Medicare:

• Part A -- Inpatient hospital care
• Part B -- Physician services, outpatient care, lab work, X-rays and preventive services, among others
• Part C (Medicare Advantage) -- Medicare plans offered by private insurers; coverage includes inpatient, physician and often prescription drug coverage and supplemental benefits, such as vision and dental
• Part D (prescription drugs) -- Prescription drug coverage for people with Parts A and/or B who have opted-in for this coverage

Parts A and B are often called Original Medicare. If you have Original Medicare, you can pair it with Part D for prescription drug benefits. Since most Medicare Advantage plans include prescription drug coverage, those with a Medicare Advantage plan usually cannot purchase a standalone Part D plan. There are exceptions to this, however, if a Medicare Advantage plan without prescription drug coverage is selected. 

The federal government offers Original Medicare. Private insurers provide Medicare Advantage plans.

How to change Medicare plans

If you’re enrolled in a Medicare Advantage plan and want to switch to a new plan, you can simply search for a plan and change to it during an open enrollment period.

On the other hand, if you’re enrolled in a Medicare Advantage plan and want to switch to Original Medicare, you can contact your current plan and let it know your desire to make the change, or call 1-800-MEDICARE.

If you have Original Medicare and want to switch to a Medicare Advantage plan, you can also do so at open enrollment. Just remember that Medicare Advantage plans typically have a prescription drug component. That means if you signed up for Medicare Part D to cover your medications, you may no longer need that coverage. So, call your plan to disenroll from it.

Medicare changes for 2023

Each year, Medicare and Medicare Advantage plans make changes to plans and offerings. Here’s what changed in 2023:

Original Medicare changes

Part B premiums for 2023 fell to $164.90 for individuals earning $97,000 or less and those filing jointly and earning $194,000 or less. Also, Part B premiums are higher for people with incomes above $97,000 for individuals and above $194,000 for married joint filers. Part B deductible in 2023 is $226.

Original Medicare often has higher premiums than Medicare Advantage plans. 

People with Original Medicare also can enroll in a Part D prescription drug benefit plan.

Medicare Advantage changes

Some 28 million people are enrolled in Medicare Advantage plans in 2022, according to healthcare consultancy The Chartis Group.

Those eligible for Special Needs Plans will have more choice, with the number of Medicare Advantage dual-eligible special needs plans rising to 1,156 in 2022, up from 975 in 2021.

There will be a greater percentage of plans offering special supplemental benefits for chronically ill people. Overall, the number of plans providing such benefits has risen from to 272 plans in 2022, up from 122 in 2017.

Several top health insurers are also expanding into hundreds of new counties nationwide in 2023. 

How to qualify for a Medicare special enrollment period

There are times in life when you may qualify for a special enrollment period for both Medicare Advantage and Medicare Part D. A special enrollment period allows you to make changes to your Medicare coverage outside of open enrollment.

You may qualify for such a period if you:

• Change where you live. Perhaps the new plan isn't available in your new community or you move back to the U.S. after living abroad.
• Lose your current coverage. Maybe you lose eligibility for Medicaid coverage or are no longer covered by an employer.
• Have a chance to get other coverage. Perhaps you now can enroll in drug coverage that is just as good as what Medicare offers, such as TRICARE or VA coverage.
• Have a plan that changes its contract with Medicare. The government may sanction your plan for some transgression on the part of the plan or Medicare might not renew a contract with a plan.

There are other situations where you might qualify for a special enrollment period, which are detailed on the official Medicare website.

How to enroll in Medicare

If you receive Social Security benefits for at least four months before turning 65, you’re automatically enrolled in Medicare Part A when you become eligible for coverage at 65.

In addition, you’re enrolled in Medicare Part B, but it’s your decision as to whether or not to keep this part of your Medicare coverage. You can decide to delay signing up for Part B (and face potentially premium penalties when you later get Part B) or you can also choose a Medicare Advantage plan.

You also can enroll in Medicare by going to the Social Security website or calling Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. If you prefer, stop by your local Social Security office and sign up that way.

If you or your spouse worked for a railroad, you can enroll in Medicare by calling the Railroad Retirement Board at 1-877-772-5772.

If you have a qualifying condition such as end-stage renal disease or ALS, you may qualify for Medicare before you turn 65. 

Costs of Medicare in 2023

Premiums and out-of-pocket costs are vital when comparing Medicare plans. Here are the average premiums for Parts A-D:

Part A - Medicare Part A is usually free as long as you’ve been employed and paid the Medicare tax for at least 10 years. The 2023 Part A premium for those who aren't eligible for premium-free coverage is either $278 or $506 each month for Part A, depending on how long your or your spouse worked and paid Medicare taxes. Part A’s deductible in 2023 is $1,600 for each benefit period, which is when you’re admitted to a hospital.

Part B - The Part B monthly premium for 2023 is $164.90 for individuals earning $97,000 or less and those filing jointly and earning $194,000 or less. Those with higher incomes pay higher monthly premiums. The deductible has been reduced from $233 to $226 for 2023. Once you meet that deductible, you pay 20% of your Part B health care costs.

Part C (Medicare Advantage) - CMS projects that the average monthly Medicare Advantage premium will be around the 2022 average of $19 for 2023. Insurers have been decreasing the average premium, but you’ll want to compare plan deductibles. Those out-of-pocket costs can lead to hefty out-of-pocket costs.

Part D (drug plan) - Similar to Medicare Advantage, Part D premiums and deductibles vary.

When else can you change Medicare plans?

Open enrollment isn’t the only time you can switch Medicare plans. Other times are when you’re newly eligible or have experienced a life event that triggers a special enrollment period.

When you’re first eligible for Medicare, you have a seven-month span to sign up for coverage. That includes the three months before your qualifying birthday, your birth month  and the three months after that birth month.

However, once you have a plan, according to CMS, you can trigger a special enrollment period if:

You change where you live and

• The new address is not in your plan’s service area
• The plan is still in the service area, but there are new options in the new location 
• You moved back to the U.S. after living outside of the country 
• You just moved into, currently live in, or just moved out of an institution 
• You are released from jail 
• You move to another state

• You are no longer eligible for Medicaid 
• You left coverage from your employer or union (including COBRA coverage) 
• You involuntarily lose coverage that’s as good as Medicare drug coverage (creditable coverage), or your other coverage changed and is no longer credible 
• You had drug coverage through a Medicare Cost Plan and you leave the plan 
• You dropped your coverage in a Program of All-inclusive Care for the Elderly (PACE) plan 

• Medicare takes an official action (sanction) because of a problem with the plan that affects you

• Medicare ends your plan’s contract 
• Your Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan’s contract with Medicare isn’t renewed 

If those life events happen to you, you can contact Medicare about kicking off a special enrollment period. In that case, you’ll be able to make changes to your Medicare coverage or sign up for a new plan.

What should you do during Medicare Annual Enrollment?

Medicare Annual Enrollment, often referred to as AEP or Medicare open enrollment, is a great time to review your plan and figure out what you want from a health plan.

What to think about during Medicare during annual enrollment:

• Have your plan needs changed?
• Do you have a chronic illness that a Medicare Advantage plan targets?
• Are you paying higher premiums than you need?
• Is your plan’s deductible too high?
• Is there a new plan offering that makes more sense for your situation?
• Is there a better Part D drug plan? Does that Part D plan cover your mediations?
• If you find a better plan, does your doctor and hospital accept it?

Visit Medicare.gov to get information about plans in your area or call 1-800-MEDICARE. You can also go to the Medicare Plan Finder to compare plans available for you.

Tips to get ready for Medicare Open Enrollment

As you prepare for open enrollment, consider your health care needs over the past year, and anticipate what your needs might be in 2023.

“Prepare yourself in advance with a list of services you use the most, doctors and hospitals that are important to you and any prescriptions that you take,” says Lisa Wright, principal consultant for community programs at BlueCross BlueShield of Tennessee.

If you’re thinking about enrolling in Medicare Advantage or finding a new plan, you should weigh three major factors before choosing a plan, Wright says.

• Costs. Consider extra charges, such as copayments or coinsurance, and the cost of prescription medications. "It’s important to not only consider the monthly premium but also any other costs you might experience," Wright says.
• A plan's coverage network. Make sure all your health care providers are included in the network. "Don’t forget to check your pharmacy to ensure it’s in the network," Wright says.
• Any other extras. Many Medicare Advantage plans offer additional perks, such as dental, vision and hearing benefits. 

Check out the website of any insurer you are considering and look over the pharmacy network and provider network. Then, compare benefit designs.

Wright notes that BlueCross BlueShield of Tennessee offers education to Medicare recipients via in-person community meetings and enrollment events, as well as virtual meetings and educational sessions. Other carriers offer similar help.

Frequently Asked Questions

Sources:

1. Medicare.gov. “Costs.” Accessed August 2022.
2. Kaiser Family Foundation (KFF). “Medicare Advantage 2022 Spotlight: First Look.” Accessed August 2022.