Can You Keep the Same Medicare Plan During Open Enrollment?

While a 2022 KFF survey found nearly 7 in 10 beneficiaries don't compare plans during open enrollment, doing so is critical. The answer to 'Can you keep the same Medicare plan during open enrollment?' is yes, but it's vital to understand the implications of inaction.

Quick Summary

Yes, you can keep your Medicare plan. If you do nothing during Open Enrollment, your current plan will likely renew automatically, but your benefits, costs, and provider network can change significantly.

Key Points

• Automatic Renewal: If you do nothing during Open Enrollment (Oct 15 - Dec 7), your Medicare Advantage or Part D plan will likely renew automatically, but not without changes.

• Annual Notice of Change (ANOC): You must review your ANOC, sent by your plan in September, to understand changes in costs, drug coverage, and provider networks for the next year.

• Costs Can Change: Premiums, deductibles, and copayments can increase even if you keep the same plan.

• Coverage Can Change: Your plan’s formulary (covered drug list) and network of doctors and hospitals can change annually.

• Proactive Review is Key: Comparing plans each year on Medicare.gov is the best way to ensure your coverage still meets your health and financial needs.

Understanding Medicare Open Enrollment

Each year, Medicare's Fall Open Enrollment Period runs from October 15 to December 7. This is the designated time for beneficiaries to review their health and prescription drug coverage and make changes for the upcoming year. Any adjustments made during this period take effect on January 1 of the following year. If you're satisfied with your current Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plan, you generally don't have to do anything; your plan will most likely renew automatically for the next year. However, choosing to do nothing can lead to unexpected and costly surprises.

Why You Must Review Your Plan Annually

Even if you like your current plan, it's a mistake to assume it will remain the same. Insurance companies can, and often do, make significant changes to their plans from one year to the next. These changes are officially communicated to you in a document called the Annual Notice of Change (ANOC), which you should receive from your plan by the end of September each year. Ignoring this document means you might miss critical updates.

Here are the top reasons to actively review your coverage:

• Changes in Costs: Your plan's premium (the monthly fee), deductible (the amount you pay before coverage starts), copayments, and coinsurance can all increase. Your maximum out-of-pocket cost could also change, exposing you to higher potential expenses.
• Changes in Drug Coverage (Formulary): The list of prescription drugs your plan covers, known as the formulary, can change. A medication you currently take might be removed from the formulary, moved to a more expensive tier, or have new restrictions like prior authorization or step therapy.
• Changes in Provider Networks: For Medicare Advantage plans, your network of doctors, specialists, and hospitals can change. A trusted physician you've seen for years might no longer be in-network, meaning visits could cost significantly more or not be covered at all.
• Changes in Your Health: Your own health needs may have evolved over the past year. You might have a new diagnosis, require different medications, or need to see new specialists. Your current plan may no longer be the most cost-effective or suitable choice for your new health circumstances.

The Crucial Role of the Annual Notice of Change (ANOC)

The ANOC is your single most important tool for evaluating your current plan. This document explicitly outlines all the changes coming to your plan for the next calendar year. It provides a side-by-side comparison of your current benefits and costs with the new ones taking effect in January. When you receive your ANOC, you should immediately review it and pay close attention to:

1. Premium and Deductible Changes: Check how your monthly premium and annual deductible will be adjusted.
2. Copayment/Coinsurance Updates: See if the costs for doctor visits, hospital stays, and specialist appointments have changed.
3. Drug Formulary Modifications: Verify that all your current medications are still covered and check their cost-sharing tier. The ANOC will direct you to the full formulary for complete details.
4. Provider Network Status: The ANOC will state if there are changes to the provider network. You will need to check the plan's provider directory to confirm your specific doctors, hospitals, and pharmacies are still included.

If your plan is being discontinued entirely, you will receive a non-renewal notice instead of an ANOC. This notice will explain that you must choose a new plan during Open Enrollment to avoid a potential gap in coverage or being defaulted to Original Medicare.

How to Compare Your Medicare Plan Options

Once you've reviewed your ANOC, you can determine if your current plan still meets your needs. If you find unfavorable changes or believe a better option might exist, it's time to compare plans. The official Medicare Plan Finder tool is the most comprehensive resource available.

Here’s a step-by-step guide to comparing plans:

1. Gather Your Information: Have your Medicare card, a list of all your prescription medications (including dosages), and the names of your preferred doctors and pharmacies ready.
2. Use the Medicare Plan Finder: On the Medicare.gov website, enter your zip code and medication list. The tool will show you available Part D and Medicare Advantage plans in your area.
3. Filter and Compare: You can filter plans based on insurance carrier, pharmacy preference, and star ratings. The tool provides an estimated total annual cost for each plan, including premiums and out-of-pocket drug costs.

Comparison of Key Plan Features

Feature	Original Medicare (with Part D)	Medicare Advantage (Part C)
Provider Choice	Can see any doctor or hospital in the U.S. that accepts Medicare. No referrals needed for specialists.	Usually required to use a network of doctors and hospitals. May need referrals for specialists.
Costs	Pay a deductible for Part A and Part B, plus 20% coinsurance for most Part B services. No annual out-of-pocket max.	Costs vary by plan. Includes deductibles, copayments, and an annual out-of-pocket maximum.
Prescription Drugs	Requires purchasing a separate Part D plan.	Most plans bundle prescription drug coverage (MA-PD).
Extra Benefits	Does not cover dental, vision, or hearing. Requires a separate Medigap policy to cover cost-sharing.	Often includes extra benefits like routine dental, vision, hearing, and fitness memberships.

What Happens If You Do Nothing?

If you have a Medicare Advantage or Part D plan and you take no action during the Open Enrollment Period, your plan will automatically renew for the next year, assuming it's still offered. You will be subject to all the changes outlined in the ANOC. While this automatic renewal ensures you maintain coverage, it's a passive decision that could lock you into a plan that is more expensive or less suitable for your needs for an entire year. If you only have Original Medicare (Parts A and B), open enrollment doesn't directly affect you unless you wish to join a Part D or Medicare Advantage plan.

Conclusion: Take Control of Your Coverage

While you can keep the same Medicare plan during open enrollment, the real question is should you? The answer for nearly every beneficiary is to be proactive. By taking the time to review your ANOC, assess your health needs, and compare your options using the Medicare Plan Finder, you empower yourself to make an informed decision. This annual review is the key to ensuring your healthcare coverage remains affordable, effective, and aligned with your personal health journey.

Frequently Asked Questions

What happens if I do nothing during Medicare Open Enrollment?

If you are in a Medicare Advantage or Part D plan and do nothing, your current plan will automatically renew for the next year, as long as it's still offered. However, you will be subject to any new costs, coverage, and network changes detailed in the Annual Notice of Change (ANOC).

When is the Medicare Open Enrollment Period?

The Medicare Fall Open Enrollment Period runs from October 15 to December 7 each year. Any changes you make to your coverage will become effective on January 1 of the following year.

What is the Annual Notice of Change (ANOC)?

The ANOC is a document your Medicare Advantage or Part D plan must send you each fall. It outlines all the changes in costs, benefits, drug coverage (formulary), and provider networks that will take effect the following January.

Can my doctor leave my Medicare Advantage plan's network?

Yes. Provider networks for Medicare Advantage plans can change from year to year. It is crucial to check your plan's provider directory each Open Enrollment period to ensure your doctors, specialists, and hospitals are still in-network.

Will my prescription drugs still be covered next year?

Not necessarily. A plan's list of covered drugs (formulary) can change each year. A drug may be removed, or its cost-sharing tier could change, making it more expensive. Review the formulary in your ANOC documents.

How can I compare different Medicare plans?

The official Medicare Plan Finder tool at Medicare.gov is the best resource. You can enter your specific prescriptions and preferred pharmacies to compare the total estimated annual costs of different plans available in your area.

What's the difference between the Fall Open Enrollment and the Medicare Advantage Open Enrollment Period?

The Fall Open Enrollment (Oct 15 - Dec 7) is for all beneficiaries to make changes. The Medicare Advantage Open Enrollment Period (Jan 1 - Mar 31) is only for those already enrolled in a Medicare Advantage plan. During this time, they can switch to another MA plan or return to Original Medicare.