Medicare Annual Enrollment Period explained
The Medicare Annual Enrollment Period – AEP for short – is a set time each year during which Medicare beneficiaries can make new coverage choices. AEP runs from October 15th - December 7th, with new coverage effective on January 1st.
The actions you can take during AEP depend on your current coverage:
I. If you currently have Original Medicare (Parts A & B), you can:
• Join a Medicare Advantage plan (Part C) with or without built-in drug coverage. You may be charged a late enrollment penalty if you do not currently have other creditable drug coverage.
• Join a stand-alone Medicare prescription drug plan (Part D). A penalty may apply here as well if you do not currently have other creditable drug coverage.
• Make no changes and your current coverage will renew as is (unless there is a Plan Termination, which does not occur frequently).
II. If you currently have Original Medicare (Part A and/or Part B) and a stand-alone Medicare prescription drug plan (Part D), you can:
• Join a Medicare Advantage plan (Part C) with or without built-in drug coverage.
• Switch from your current Medicare prescription drug plan to another Medicare prescription drug plan.
• Drop Medicare prescription drug coverage completely. You may be charged a penalty if you decide to re-enroll in drug coverage later.
• Make no changes and your current coverage will renew as is.
III. If you currently have a Medicare Advantage plan (Part C) with built-in drug coverage, you can:
• Switch from your current Medicare Advantage plan to another Medicare Advantage plan with or without built-in drug coverage.
• Drop your Medicare Advantage plan and go back to Original Medicare.
• Join a stand-alone Medicare prescription drug plan if you go back to Original Medicare or if you switch to a Medicare Advantage plan that does not include drug coverage.
• Drop Medicare prescription drug coverage completely. You may be charged a penalty if you decide to re-enroll in drug coverage later.
• Make no changes and your current coverage will renew as is.
IV. If you currently have a Medicare Advantage plan (Part C) and a stand-alone Medicare prescription drug plan (Part D), you can:
• Switch from your current Medicare Advantage plan to another Medicare Advantage plan with or without built-in drug coverage.
• Switch from your current Medicare prescription drug plan to another Medicare prescription drug plan.
• Drop your Medicare Advantage plan and go back to Original Medicare.
• Drop Medicare prescription drug coverage completely. You may be charged a penalty if you decide to re-enroll in drug coverage later.
• Make no changes and your current coverage will renew as is.
Inflation Reduction Act Impacts - Part D Cost-Sharing Updates and New SEP
Effective January 1, 2023, the Inflation Reduction Act (IRA) will be in effect for all Medicare beneficiaries. The IRA was introduced in October this year and provides cost-share reductions to assist Medicare beneficiaries with their Part D drug expenses. The following updates will be reflected for Plan Year 2023:
- Covered insulins will be capped at $35 per fill for a 30-day supply.
- Part D vaccines (flu, shingles, pneumonia, COVID-19 etc.) will be $0.
Cost-Share Reduction Information on the Medicare Plan Finder
Prior to October 1, 2022, the Medicare Plan Finder reflected insulin and vaccine benefits as they were submitted in the 2023 bids made by Plan Sponsors. Since the formulary submissions to CMS prior to the IRA being instated did not reflect the requirements highlighted above, some Part D coverage may not be accurately reflected on the Medicare Plan Finder. CMS is in the process of making updates to include new insulin and vaccine drug footnotes and other help features to explain the benefit changes resulting from the IRA.
New Special Enrollment Period (SEP)
Due to the inaccuracies in the Medicare Plan Finder, CMS is granting a Special Enrollment Period (SEP) for Exceptional Circumstances to allow members to add, drop, or change their Part D coverage if they find a better option after the 2022 Annual Enrollment Period (AEP) through the end of 2023. This SEP will be available for all beneficiaries who use a covered insulin product and begins on December 8, 2022 and ends on December 31, 2023. Beneficiaries may use this SEP one time during this period. To utilize this SEP, beneficiaries must call 1-800-MEDICARE so a customer service representative can process the enrollment change.
Until next time,
Andrew Herman
