What changes can I make during Medicare’s annual enrollment period?


This is my first Medicare annual enrollment period, and I don't know anything about this process. How do I find out which options are best for me? I have some health problems, and I'm concerned about making a change. Which Medicare health plan and prescription drug plan do I choose? Will I have to answer health questions to qualify? Currently, I am being bombarded by marketing material, and I would really appreciate your help! Thanks.

— Frank from San Antonio

Hello Frank,

During the Medicare annual enrollment period Oct. 15-Dec. 7, the Toni Says Medicare team is asked this question at least 20 times a day. (I discuss it at length in Chapter 6 of my book, "Medicare Survival Guide Advanced" edition.)

Which Medicare option is right for you depends on your health and financial situation. You may be someone who has a history of serious health issues requiring expensive brand name prescription drugs or who goes to the doctor once a year for a physical and takes inexpensive generics. Take your time and research your options.

Here are steps the Toni Says team uses when helping clients during Medicare's annual enrollment period:

1. Decide if you want original Medicare (Parts A and B) or a Medicare Advantage (Part C) plan.

— Ask your doctor's office which plan is recommended. Most doctors accept original Medicare but not all accept Medicare Advantage plans. If you have a doctor who is in a Medicare Advantage plan's provider directory, make sure you call to verify the office is still accepting that specific Medicare Advantage plan in the upcoming calendar year.

— The main difference between original Medicare and Medicare Advantage plans is that original Medicare works only with Medicare, and the Medicare supplement pays the deductibles or co-insurances (or you pay, if no supplemental policy is selected). Medicare Advantage plans are also called Part C. They are administered by private insurance companies that are approved by Medicare and are primarily health maintenance organization and preferred provider organization plans.

— When choosing a Medicare Advantage plan, you must use that specific insurance company's card, not your Medicare card.

2. Decide if you need to enroll in or change your current Medicare Part D plan during Medicare's annual enrollment period.

— If you want Medicare prescription drug coverage to go along with original Medicare, then you must enroll in a standalone Medicare Part D plan, which has a monthly premium.

— If you choose a Medicare Advantage plan, make sure the plan has Medicare Part D prescription drug coverage included to keep from receiving a Medicare Part D penalty for not enrolling in a Medicare prescription drug plan.

— Verify that all your prescriptions, both brand name and generic, are covered.

3. Remember, you have from Oct. 15-Dec. 7 to change your Medicare Advantage plan or stand-alone Medicare Part D plan to begin Jan. 1.

— If you miss the Dec. 7 deadline, you will have to wait until next year's annual enrollment period.

— Medicare's annual enrollment period is only for enrolling or changing your Medicare Advantage prescription drug or Medicare Part D plans. You can change your Medicare supplement, long-term care or dental plans any time of year.

— Verify that your brand name and/or generic prescriptions are also in the specific Medicare Advantage prescription drug or Medicare Part D formulary.

Take your time during Medicare's annual enrollment period to explore your Medicare options.

Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email [email protected] or call 832-519-8664. Toni's books are available at tonisays.com with a bundle discount for Toni Says readers.