Medicare provides health care coverage to millions of seniors and those with disabilities, but it can be a difficult system to navigate. It has several programs and plans to choose from, which you can change as your healthcare and coverage needs change. Most of these changes can be made during the open enrollment period that occurs every year. It’s important for seniors to understand this enrollment period and what changes are available.
Understanding Medicare
Medicare is a federal program that you have likely been paying into through payroll taxes throughout your life. When you turn 65, you automatically qualify for Medicare, but you may also qualify if you meet certain disability criteria, regardless of your age. There are no income or asset limits to be eligible for Medicare.
Who Qualifies for Medicare?
To qualify for Medicare, you must be 65 or older and a U.S. citizen or legal resident that has lived in the United States for five years or longer. You can also qualify if you’re younger than 65 and have been receiving Social Security Disability income for at least 24 months. If you have end-stage renal disease (ESRD) or ALS (Lou Gehrig’s disease), you can qualify regardless of your age.
When Is the Medicare Open Enrollment Period?
The Medicare open enrollment period occurs each year from October 15th through December 7th. During this period you can choose or change your Medicare plan. Changes made become effective on January 1st of the following year.
Medicare Parts Explained
Medicare has four parts that are important to understand so that you can choose the parts that are right for you.
- Medicare Part A covers hospital stays, skilled nursing facility care, some home health services, and hospice. It usually has no premium payment required.
- Medicare Part B covers doctor visits, preventive care, outpatient services, and medical equipment such as wheelchairs. Part B does have a required premium.
- Medicare Part C, also known as Medicare Advantage, combines Parts B and C and comes with extra benefits, but also comes with a premium.
- Medicare Part D covers prescription medications and has a premium.
What Can You Do During the Open Enrollment Period?
If you are already enrolled in Medicare, you can make the following types of changes.
- Changing from Original Medicare to a Medicare Advantage Plan, or vice versa
- Change from one Medicare Advantage Plan to another
- Add Medicare Part D, opt out of Part D, or change your Part D plan
- Change to a different private insurance provider
Medicare Advantage Plan Open Enrollment Period
If you are already enrolled in a Medicare Advantage Plan, you have another opportunity to change your plan during the Medicare Advantage Plan Open Enrollment Period from January 1st to March 31st. During this period you can:
- Change from one Medicare Advantage Plan to another
- Leave a Medicare Advantage Plan to go back to Original Medicare with or without Part D
Considerations When Choosing a Medicare Plan
The Open Enrollment Period is your opportunity to shop for the Medicare plan that meets your needs. You should consider:
- Out of pocket costs that you’ll have with the plan including premiums, copays, and deductibles
- Prescription drug coverage eligibility requirements, and medication costs and coverage
- Your upcoming health care needs, such as preventive care or treatment of a chronic condition
- Whether your current healthcare providers are in the insurance provider’s network
- Additional benefits included in some Medicare Advantage Plans
What If I Miss the Open Enrollment Period?
Most of the time, if you don’t do anything during the open enrollment period, your current plan will automatically renew. However, sometimes you may have another opportunity to make changes under certain circumstances including:
- Special Enrollment Periods may be available if you lose other insurance coverage or move, changing your coverage options.
- 5-Start Special Enrollment Periods may apply if a 5 star Medicare plan is available in your area and you want to choose it instead of your current plan. Certain limitations may apply.
What if I’m Just Turning 65 in 2026?
While you will become eligible for Medicare when you turn 65, your Initial Enrollment Period starts the month 3 months before your 65th birthday month and ends 3 months after your birthday month. You should sign up as early as possible to prevent a gap in your insurance coverage.
If you miss your initial enrollment period, you can sign up during the general enrollment period, which runs from January 1st to March 31st. You may be subject to certain penalties that will be added to your premiums.
What Is the Medicare Supplement Program?
A Medicare Supplement plan (also called Medigap) is private insurance that works alongside Medicare to help pay for out-of-pocket costs like copayments, coinsurance, and deductibles that Original Medicare doesn’t cover. They don’t replace Medicare and typically don’t include prescription drugs, dental, or vision benefits. You can enroll during your 6 month Medigap Open Enrollment Period, which begins the month you’re both age 65 or older and enrolled in Medicare Part B.
If you miss this enrollment period, you can still apply, but your application will be subject to medical underwriting, which can increase your premiums based on your health or cause you to be denied.
In Closing
The Medicare system can be complex, but it can provide you with peace of mind during your senior years. Health Service Alliance proudly accepts Medicare plans and can guide you if you need medical services and are not sure about your coverage. We are dedicated to providing compassionate, personalized, and accessible care regardless of your ability to pay. Reach out today to learn more.
