US Medicare enrollment and Medigap guidelines

Medicare enrollment involves several components: Part A (hospital), Part B (medical), Part C (Medicare Advantage), and Part D (prescription drugs). The Medicare Annual Enrollment Period (AEP) for Medicare Advantage and Part D plans runs from October 15 to December 7, with changes taking effect on January 1.

To prepare for the AEP, beneficiaries are encouraged to create accounts at Medicare.gov to access Medicare Summary Notices, medication history, and the ‘Medicare & You’ handbook. During the AEP, seniors should review their Annual Notice of Change (ANOC) to identify updates to costs or service areas. Key evaluation steps include verifying that medications remain on the plan’s formulary, confirming preferred doctors and pharmacies are in-network, and comparing total annual costs, such as deductibles and copays, rather than just monthly premiums. Beneficiaries should also prepare for upcoming shifts, including rising Part B premiums and a redesigned Part D structure for 2027.

Regarding Medigap, a one-time, six-month Open Enrollment Period begins the first month an individual turns 65 and enrolls in Medicare Part B. During this window, federal law guarantees access to policies at the best available rate without medical underwriting. While individuals can switch Medigap carriers at any time, doing so outside this window or without a ‘Guaranteed Issue Right’ may require medical underwriting. Switching carriers while maintaining the same plan letter only changes the insurer and premium, whereas changing plan letters alters the coverage and cost-sharing structure. Additionally, the Medicare Advantage Open Enrollment Period allows those already in a Medicare Advantage plan to switch once between January 1 and March 31.