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Mid-October to early December is a season of change for the more than 66 million Americans covered by Medicare, the government-funded health insurance for people 65 and older. This eight-week stretch in late fall is Medicare’s open enrollment period when participants can enroll or make changes to their coverage to take effect in the next year.
Reviewing coverage is especially important this year as major changes are coming to Medicare in 2025, specifically the prescription drug coverage known as Medicare Part D.
Let’s take a closer look at coverage options for Medicare participants and how to use the open enrollment period to ensure you’re getting the most out of your health plan.
Medicare open enrollment runs from Oct. 15 to Dec. 7, allowing Medicare beneficiaries to make changes to their current coverage that will go into effect on Jan. 1 of the following year.
During the open enrollment period, people should closely review any materials they receive about eligibility or plan coverage changes. These notices are usually titled “Evidence of Coverage” (EOC) or “Annual Notice of Change” (ANOC).
Those with original Medicare can sign up for a Medicare Part D plan, switch from one Part D plan to another, or choose a Medicare Advantage plan available in their service area.
If you’re currently on Medicare Advantage, you can use the Medicare open enrollment period to switch to a regular Medicare plan and choose a Part D prescription drug plan or choose a new Medicare Advantage plan from a different insurance company.
If you find Medicare and its myriad plan options confusing, you’re not alone. There are several distinctions, advantages, and drawbacks between original or “traditional” Medicare and Medicare Advantage.
Traditional Medicare, also sometimes called original Medicare, covers doctor’s office visits and hospital stays, known as Part A and Part B, respectively. Most doctors — including surgeons and specialists — in the U.S. accept Medicare patients. Unlike Medicaid, there is no income limit for eligibility to receive Medicare benefits. Still, Medicare is not free. You’ll pay fees similar to a private insurance plan for things like premiums, deductibles, and co-pays. Traditional Medicare plans are usually coupled with a separate prescription coverage plan called Part D.
Medicare Advantage is offered through private insurance companies and usually bundles several parts of Medicare. Medicare Advantage plans have become hugely popular because they provide savings in the form of very low premiums and yearly out-of-pocket caps. Some Medicare Advantage plans also offer dental or vision coverage, and fold in Part D drug coverage. But MA plans may limit which providers you can see and require you to get approval for some procedures.
Medicare Advantage has a different open enrollment period from traditional Medicare. The Medicare Advantage open enrollment period starts on Jan. 1 and closes March 31 each year, enabling only those enrolled in a Medicare Advantage plan to adjust their coverage.
Starting in 2025, whether you receive healthcare through original Medicare or opt into a Medicare Advantage Plan, out-of-pocket costs for prescriptions covered by Medicare’s prescription drug plan will be capped at $2,000.
This is great news for older adults in the U.S., especially those with chronic conditions. But lower drug costs could prompt private insurers to make other changes to insurance plans, so carefully reviewing plan options and costs during the open enrollment period is crucial this year.
Dig deeper: Read about other changes coming to Medicare in 2025
One of the most confusing parts about Medicare can be the different components that make up this health insurance coverage. Here’s a quick glance at what each part of Medicare provides.
Part A: Inpatient, hospice, and home healthcare
Medicare Part A provides coverage for inpatient care, typically at hospitals or nursing facilities. This part of Medicare can also cover hospice and in some cases, at-home care.
Part B: Medically necessary and preventative services
Medicare Part B covers doctor visits for both medically necessary and preventative services. It also includes things like ambulance service, medical equipment, and some mental health or substance abuse coverage.
Part C is the alternative to traditional Medicare known as Medicare Advantage, which bundles Part A, B, and usually Part D coverage into one health plan.
Part D covers the cost of prescription drugs at pharmacies and clinics, including shots and vaccines. Medicare Part D is usually offered as a separate plan unless you have Medicare Advantage.
As you might expect, Medicare won’t foot the bill for everything. With the exception of individual Medicare Advantage plans that offer extra benefits, the following services and care are not included in standard Medicare coverage.
Although Medicare specifically prohibits coverage for “routine” physical exams, it does cover an annual “wellness” visit, which can include updating prescriptions, healthcare screenings, and cognitive assessments.
Medigap policies, sometimes called Medicare Supplement Health Insurance, are private health insurance policies you can purchase to cover or fill in the gaps for some of the out-of-pocket costs of original Medicare, including deductibles, coinsurance and in some cases medical costs when traveling outside the US.
This insurance may not be available to some with preexisting conditions and is not subject to Medicare’s open enrollment period.
There are some situations in which eligible Medicare recipients may qualify for a special enrollment period. Those who move cross country, lose an employer or union-sponsored coverage, or live in nursing homes or care facilities may be eligible to make changes to their Medicare coverage at other times of the year.
Those newly eligible to enroll in Medicare have an initial enrollment period that extends three months before to three months after their 65th birthday.