Maximizing Your Medicare Benefits: An Overview of the Annual Enrollment Period

October represents a crucial time for Medicare beneficiaries seeking to optimize their healthcare and drug coverage, providing a valuable opportunity for recipients to learn how to maximize Medicare benefits. 

Each year, from October 15th to December 7th, those eligible to participate in Medicare’s Annual Enrollment Period (AEP) can opt to make changes to their healthcare and prescription drug coverage for the upcoming year.Given rising drug costs, fluctuations in access to providers, and potential changes to personal health, many reasons exist to reassess the effectiveness of existing plan selections. The sheer volume of choices, especially among Medicare Advantage plans, can be reason enough to take stock. For example, the average beneficiary now has access to 42 Medicare Advantage plans, slightly fewer than in previous years but still offering a broad array of potential selections, making evaluation of these choices crucial for those on Medicare.

Who can participate in AEP?

Anyone enrolled in Original (or “Government”) Medicare can choose to make changes during the AEP. Additionally, anyone receiving their benefits through a Medicare Advantage Plan or enrolled in a Medicare Part D Prescription Drug coverage plan can participate in the Annual Enrollment Period, the ideal time to make changes in the interest of maximizing your Medicare coverage. Those who missed the chance to enroll in a Medicare plan during their Initial Enrollment Period must wait for the General Enrollment Period (GEP) to enroll in coverage. The GEP lasts from January 1st through March 31st each year.

Beneficiaries who have purchased a Medicare Supplemental (or “Medigap”) plan do not qualify to participate in the AEP. It may be possible, however, to switch from a Medicare Advantage plan to Original Medicare and add a Medicare Supplement plan. In addition to potentially requiring medical underwriting, this step may be costly if it does not coincide with the beneficiary’s Medigap Open Enrollment Period.

Available changes during the Annual Enrollment Period

Medicare beneficiaries can choose to make a variety of changes during the Annual Enrollment Period, all of which will take effect on January 1st of the following calendar year. These changes include, but are not limited to:

• Switching Medicare Advantage plans (with or without a Part D plan);
• Adding, dropping, or changing Medicare Part D Prescription Drug coverage; or
• Moving to/from Original Medicare to a Medicare Advantage plan.

Additional cost savings for drug plans in 2025

With the enactment of the new prescription drug law under the Inflation Reduction Act (IRA), some helpful cost savings measures go into effect starting in 2025. These may be worth factoring into any changes being considered during the AEP for Medicare plan optimization.

• Starting January 1, 2025, Medicare Part D enrollees will have their annual out-of-pocket costs capped at $2,000, providing significant relief for those with high prescription drug expenses.
• Beneficiaries will have the option to spread out their out-of-pocket drug costs over the plan year through monthly payments, easing the financial burden of high upfront costs.
• Coinsurance payments for certain Medicare Part B drugs may be reduced if the drug prices have increased faster than the rate of inflation, with adjustments potentially changing quarterly.
• The Part D Low-Income Subsidy (LIS) program will continue to assist those earning less than 150% of the federal poverty level by covering more drug costs.
• There will be no out-of-pocket costs or deductible impact for those with Medicare Part D when receiving vaccines recommended by the Advisory Committee on Immunization Practices (ACIP).
• For those using an insulin pump covered under Part B’s durable medical equipment benefit or those obtaining insulin through a Medicare Advantage Plan, a month’s supply of Part B-covered insulin cannot exceed $35 as of 2025.

Speak with an experienced Licensed Insurance Agent and make an informed decision

With so many options to consider and opportunities to save on costs, taking time for an evaluation during the AEP can be helpful to ensure your unique financial and medical needs are being met. For Medicare assistance, contact an agent at Advocator Advantage.

Guidance extends through every step of the enrollment process, with our Social Security Disability Advocates providing all of the necessary details for you to maximize your Medicare coverage.

Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.