Time to Re-Evaluate: Why “Set It and Forget It” is Not a Medicare Strategy
You’ve done the hard part—you conquered the Initial Enrollment Period (IEP) and made your first big decision between Original Medicare with Supplements and Medicare Advantage. Congratulations!
But the world of Medicare doesn’t stand still. Every year, private insurance companies make changes to their plans—adjusting premiums, deductibles, drug lists, and even which doctors and hospitals are included in their networks. The plan that was perfect for you in January might not fit your needs by October.
That’s why Medicare created the Annual Enrollment Period (AEP). It’s your chance every year to review, compare, and make sure your coverage still works for you. At Gentreo, we encourage you to treat AEP as your annual financial and health check-up—a time to take charge of your coverage like the CEO of your own health and finances.
The AEP Deep Dive: October 15 – December 7
The Annual Enrollment Period runs from October 15 through December 7 each year. Any changes you make during this time take effect on January 1 of the following year.
During AEP, you can make nearly any change you need:
|
If You Currently Have...
|
You Can Change To...
|
Original Medicare Only |
A Medicare Advantage Plan (Part C) or a stand-alone Part D plan. |
|---|---|
|
Medicare Advantage (Part C) |
Another Medicare Advantage Plan, or drop it and return to Original Medicare (Parts A & B). |
|
A Stand-Alone Part D Plan |
A different Part D plan, or a Medicare Advantage Plan that includes drug coverage. |
|
Original Medicare + Part D |
Change your Part D plan to a different one. |
Clarification: You can submit multiple changes during AEP, but only the last valid election made before December 7 will take effect on January 1. This means you can review and adjust as often as you like, but your final choice is what counts.
Important Note: If you switch from a Medicare Advantage plan back to Original Medicare, you’ll need to enroll separately in a stand-alone Part D plan to maintain prescription drug coverage.
The Medicare Advantage Open Enrollment Period (MA OEP)
In addition to AEP, Medicare offers another opportunity for changes: the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1 to March 31 each year.
During this time, anyone already enrolled in a Medicare Advantage plan can:
- Switch to a different Medicare Advantage plan, or
- Drop their Medicare Advantage plan, return to Original Medicare, and add a stand-alone Part D plan.
This is a valuable “second chance” for those who realize early in the year that their chosen Advantage plan isn’t the right fit.
Your Annual Homework: The ANOC
Every year in late September, your current Medicare Advantage or Part D plan will send you an Annual Notice of Change (ANOC). This document outlines all updates for the coming year: new premiums, copays, drug list changes, and any network adjustments.
Action Step: Don’t ignore your ANOC! It’s a legal notice that deserves attention. Use it along with the Medicare Plan Finder at Medicare.gov to compare your current plan with others in your ZIP code. Assuming your plan will stay the same could be a costly mistake.
Life Happens: Understanding Special Enrollment Periods (SEPs)
While the AEP happens on a fixed schedule, life doesn’t always play by the rules. Special Enrollment Periods (SEPs) let you make changes outside of AEP or IEP when certain life events occur.
For most Part C (Medicare Advantage) and Part D (prescription drug) situations, SEPs typically last 62 days after the qualifying event. The 8-month SEP for Part B after loss of employer coverage is different, as explained below.
The Most Important SEP: Loss of Employer Coverage
If you delayed enrolling in Medicare Part B past age 65 because you had employer coverage, this SEP is one of the most important to understand.
- The 8-Month Lifeline: You have eight months from the month after your employment or coverage ends (whichever comes first) to sign up for Part B.
- The COBRA Trap: COBRA coverage does not count as active employment coverage. If you miss the 8-month window while on COBRA, you’ll face a lifetime Part B late enrollment penalty and may have to wait for the next General Enrollment Period to sign up.
Other Common SEPs
- Moving outside your plan’s service area
- Qualifying for or losing Medicaid
- Gaining or losing eligibility for Extra Help (Low-Income Subsidy)
- Losing creditable prescription drug coverage
If any of these apply, contact Medicare or your State Health Insurance Assistance Program (SHIP) promptly. Each SEP has its own rules and deadlines.
Don’t Leave Money on the Table: Financial Assistance Programs
If Medicare’s costs—premiums, copayments, or prescriptions—feel overwhelming, help is available. These programs are not charity; they’re financial protections you’ve earned.
Extra Help (Low-Income Subsidy – LIS)
This federal program helps pay for Part D premiums, deductibles, and copayments.
New for 2024 and beyond: Individuals who qualify for Extra Help can change Part D plans once per month from January through September (instead of once per quarter under the old rule).
Medicare Savings Programs (MSP)
These state-run programs can pay your Part B premiums, deductibles, and coinsurance. In some cases, qualifying for an MSP can also waive your Part B late enrollment penalty.
Eligibility is based on income and assets, but the limits are often higher than people expect. Apply through your state Medicaid office or the Social Security Administration—it’s quick and worth doing.
You Are Empowered: Your Year-Round Medicare Strategy
Medicare isn’t a one-time decision—it’s an ongoing process. Reviewing your plan during AEP, understanding your MA OEP rights, and knowing how SEPs work helps you stay in control of your health and finances.
Keep these three key milestones in mind:
- IEP (Age 65): Your one-time enrollment window to avoid lifelong penalties.
- AEP (Oct 15 – Dec 7): Your annual chance to make sure your plan still meets your needs.
- MA OEP (Jan 1 – Mar 31): Your opportunity to switch or return to Original Medicare early in the year.
- SEPs (As Needed): Your safety net for life’s unexpected changes.
Final Step: Keep Everything Organized
You’ve made important decisions about your health and finances—now make sure you can always access them. With Gentreo, you can securely store your Medicare information, plan documents, and other essential paperwork in one Digital Vault. You can also share specific items with family members or caregivers to ensure everyone is informed when it matters most.
Start organizing your Medicare and life planning documents with Gentreo today and take control of your complete life plan—one smart decision at a time.
Don’t wait until it’s too late; start your estate planning journey with Gentreo today. By doing so, you’ll not only protect your loved ones but also gain the peace of mind that comes with knowing your legacy is secure. Click HERE to join now.
This article is for informational purposes only and should not be considered legal advice. Consult with a qualified attorney or estate planning professional for personalized guidance.
