New Forms: The Office of Management and Budget has approved updated versions of the Important Message from Medicare (IM) and the Detailed Notice of Discharge (DND). The new forms, available at www.cms.gov/bni, are effective now through March 31, 2029. Providers must begin using the new forms by May 15, 2026.

Medicare Open Enrollment is October 15 - December 7

We are the Beneficiary and Family Centered Care Quality Improvement Organization, working to improve the quality of care for Medicare beneficiaries. Our site offers beneficiary and family-centered care information for providers, patients, and families. Welcome!

Home / Medicare Open Enrollment

Information You Can Use During Medicare's Open Enrollment Period

This is an important time for people who have Medicare because it gives you the chance to review and make changes to your current Medicare coverage.

This page includes the following articles to help you make sense of Medicare Open Enrollment:

  1. Medicare Open Enrollment: What You Need to Know
  2. What’s the difference between Original Medicare and Medicare Advantage?
  3. How the State Health Insurance Assistance Program (SHIP) can help you during Medicare Open Enrollment
  4. Medicare Savings Program

 

Medicare Open Enrollment: What You Need to Know

Every year, Medicare gives you a chance to take another look at your health coverage. This special time is called Medicare Open Enrollment, and it runs from October 15 to December 7.

During Open Enrollment, you can:

  • Switch from Original Medicare to a Medicare Advantage plan (or the other way around).
  • Switch from one Medicare Advantage plan to another (with or without drug coverage).
  • Join, drop, or switch a Part D prescription drug plan.

Open Enrollment does not change your basic Medicare Part A and Part B. Those parts stay the same. What you’re choosing during this period are your options around them, such as Medicare Advantage plans or drug plans (Medicare Part D).

Why Open Enrollment Matters

Even if you like your current plan, it is still important to check your options. Plans can change every year. Costs may go up, your doctor might leave the plan’s network, or your medications may no longer be covered in the same way. A quick review can save you money and stress in the year ahead.

Questions to Ask Yourself

  • Am I paying more than I expected for my prescriptions?
  • Are my doctors and preferred hospitals still in my plan’s network?
  • Has my health changed since last year?
  • Do I need different coverage?
  • Would another plan give me the same or better benefits at a lower cost?

When Do Changes Take Effect?

Any changes you make during Medicare Open Enrollment will begin on January 1 of the next year. That means the coverage you choose this fall will be the plan you use starting January 1.

What's the Difference Between Original Medicare and Medicare Advantage?

When you turn 65, you get the option to enroll in Medicare, which helps pay for your healthcare. You will have two main choices: Original Medicare or Medicare Advantage. Each has its own pros and cons. Therefore, taking time to fully research and know the differences can help you choose the best option for your needs.

What Is Original Medicare?

Original Medicare is the traditional Medicare program run by the government. It’s made up of two parts:

  • Part A: This covers hospital stays, nursing home care, and some home health care.
  • Part B: This covers doctor visits, outpatient services, and preventive care like vaccines.

With Original Medicare, you can go to any doctor or hospital in the U.S. that accepts Medicare. This gives you a lot of flexibility. However, you still have to pay some costs out of your own pocket. These can include co-pays, deductibles, and co-insurance (your share of the costs). There’s no yearly limit on how much you might have to pay, so it can add up.

To help with these extra costs, many people buy Medigap (Medicare Supplement Insurance) to cover what Original Medicare doesn’t pay. Original Medicare doesn’t cover prescription drugs, so you’d also need to sign up for a separate Part D plan to get drug coverage.

What Is Medicare Advantage?

Medicare Advantage (also called Medicare Part C) is a different way to get Medicare benefits. Instead of getting coverage directly from the government, you get it from private insurance companies that work with Medicare. Medicare Advantage plans must cover everything that Original Medicare covers, but they often include extra benefits too.

Many Medicare Advantage plans come with:

  • Prescription drug coverage (so you don’t need to sign up for a separate Part D plan).
  • Out-of-pocket limit: This limits how much you have to pay in a year for your medical expenses.

The biggest difference is that Medicare Advantage plans usually have networks of doctors and hospitals. This means you might need to see doctors or go to hospitals that are part of the plan’s network, or you’ll pay more. Some plans also require referrals to see specialists.

When choosing between them, think about your healthcare needs, budget, and preferences for flexibility. If you’re still unsure, it might help to talk to a SHIP counselor or use Medicare’s Plan Finder to compare your options.

Read the SHIP article, How the State Health Insurance Assistance Program (SHIP) Can Help You During Medicare Open Enrollment, on this page for more information about how SHIPs can help you during Medicare open enrollment.

How the State Health Insurance Assistance Program (SHIP) Can Help You During Medicare Open Enrollment

Medicare Open Enrollment is an important time for people who have Medicare. It’s the time when you can make changes to your health or drug plans, and those decisions can affect your healthcare for the next year. But with so many choices, it can get confusing. That’s where the State Health Insurance Assistance Program (SHIP) comes in.

SHIP offers free help to guide you through the process so you can make the best decision.

What Is SHIP?

The State Health Insurance Assistance Program (SHIP) is a free service that provides one-on-one help with Medicare questions and enrollment. Each state has its own SHIP with trained counselors who are familiar with the plans and options available in your area.

SHIP counselors are unbiased, which means they don’t work for insurance companies and won’t try to sell you anything. Instead, their goal is to give you accurate, easy-to-understand information to enable you to make informed choices about your Medicare coverage.

How Can SHIP Help During Open Enrollment?

SHIP counselors can help in many ways during Medicare Open Enrollment:

  • Understanding Your Options. SHIP counselors can explain the different parts of Medicare, such as Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug plans). They’ll help you understand how each plan works so you can decide what’s best for you.
  • Checking Prescription Drug Coverage. If you take prescription medications, it’s important to find a Part D plan that covers those medications at a good price. SHIP counselors can review your current medications and see which plans will cover them next year. This can save you money on drug costs.
  • Helping You to Save Money. If you have a limited income, you might qualify for programs that can lower your Medicare costs. Programs include Extra Help for prescription drugs. SHIP counselors can check to see if you qualify and help you apply for these programs.

More Information:

  • Visit www.shiphelp.org for your local SHIP’s phone number. Some SHIPs also offer virtual counseling.
  • The SHIP website also has a blog with information about Medicare’s Open Enrollment period, common enrollment notices, and cost-saving programs. If you enjoy getting your information from videos, take a look at their YouTube channel.