Medicare Open Enrollment: Check Your Doctors and Drugs First

What are the three basics: Original Medicare, Medicare Advantage and Medigap?

Original Medicare is the federal program you get when you first qualify, made up of Part A (hospital coverage) and Part B (medical coverage). Medicare Advantage replaces how you get Original Medicare. Medigap supplements Original Medicare.

That's the whole picture at a high level. Everything else is detail, and the detail is where the differences between plans live.

When is Medicare open enrollment in California?

The Annual Enrollment Period runs October 15 to December 7. If you join or change a plan in that window, coverage starts January 1, and the plan has to get your request by December 7.

This is the main window each year for people with Medicare to review their coverage. It is separate from the Initial Enrollment Period, the window when you first become eligible for Medicare, which is usually around your 65th birthday but isn't only for 65-year-olds. You can read the official rules on Medicare.gov.

What if I'm already in a Medicare Advantage plan and don't like it after January 1?

There is a second window, but only if you're already in a Medicare Advantage plan. From January 1 to March 31, you get one change during those 3 months. You can switch to another Medicare Advantage plan once, or return to Original Medicare and join a drug plan.

This window does not let you move from Original Medicare into Medicare Advantage. Your new coverage starts the first of the month after the plan gets your request. Official dates are on the Medicare key dates sheet.

Can I join a plan for a chronic condition?

Chronic condition plans: You can join a Chronic Care Special Needs Plan that serves your condition, if one is available in your area. Once you enroll, this special enrollment period ends.

A Special Enrollment Period lets you join a Chronic Care Special Needs Plan that serves a severe or disabling chronic condition. You need Medicare Parts A and B, and a plan has to be available where you live. Details are on Medicare.gov.

How do I check that my doctors and prescriptions are covered?

Check every year, and check four things: your doctors, your hospitals, your pharmacy and your drug list. Use the plan's provider directory and drug list, use the Medicare Plan Finder on Medicare.gov, or call the plan.

Plans can change from one year to the next. Even if you like your plan, look again. Then compare costs, extras and the out-of-pocket maximum. Many plans bundle extras such as dental or vision, and what's covered varies by plan. A plan can still be the wrong plan if your doctor isn't in it.

What is the Annual Notice of Change?

If you're in a Medicare Advantage or Part D plan, your plan should have sent your Annual Notice of Change by September 30. It tells you what's changing next year. If you can't find it, call your plan, then use it to check your doctors and prescriptions before December 7.

What is the 2027 Part D out-of-pocket threshold?

For 2027, the Part D out-of-pocket threshold is $2,400, according to the CMS 2027 announcement. How that applies to you depends on your plan and your prescriptions, so ask about it when you compare.

What is the Part B giveback?

Some plans reduce the Part B premium you pay, and amounts vary by plan. Treat it as one piece of the comparison.

What should I know about Medigap in California before I leave Medicare Advantage?

[NELSON TO CONFIRM: wording and accuracy of this paragraph.] If you leave Medicare Advantage for Original Medicare, you may be asked health questions for a Medigap policy, unless you have a guaranteed-issue or trial right. Medigap has its own timing and rules, separate from the October 15 to December 7 enrollment period.

Where can I get help with Medicare?

You have several places to turn:

• Medicare.gov
• 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week
• California HICAP at 1-800-434-0222, the state's Medicare counseling program

If you want to talk it through, call me at 888-954-8999. Are there any questions I can answer for you?

Whether you choose to work with NP Benefit Services or someone else, we hope this post helps you either reach out to us or take these questions to the person you already work with.

NP Benefit Services [NELSON TO CONFIRM: business name as filed with CDI, with or without "Insurance"] | Nelson Pillow, California License: 0C10932 · Norco, California · For California residents

[NELSON TO CONFIRM: version and counts. Use Version A or Version B, not both.]

Version A (if he does not represent all Medicare Advantage organizations): "We do not offer every plan available in your area. Currently we represent [number] organizations which offer [number] products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."

Version B (if he does): "Currently we represent [number] organizations which offer [number] products in your area. You can always contact Medicare.gov or 1-800-MEDICARE for help with plan choices."

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