Clinical Report: Medicare Open Enrollment: Coverage Choices

Overview

Medicare’s annual open enrollment period runs from October 15 through December 7, allowing beneficiaries to change how they receive Medicare coverage, with changes effective January 1. Beneficiaries can switch between traditional Medicare and Medicare Advantage, change Medicare Advantage plans, and enroll in or change Part D drug coverage; the source reports that 65% did not compare alternative coverage choices during a recent enrollment period.

Background

Medicare covers more than 70 million people, including adults aged 65 years or older and younger adults with long-term disabilities. Beneficiaries may receive Part A and Part B benefits through traditional Medicare or a private Medicare Advantage plan. Traditional Medicare beneficiaries may obtain outpatient prescription drug coverage through a separate Part D plan and may consider Medigap, while Medicare Advantage plans cover Part A and Part B services and generally include Part D coverage. Annual plan changes can affect provider access and costs, and beneficiaries’ medical needs may change over time.

Data Highlights

Key Findings

• During annual open enrollment, beneficiaries may switch from traditional Medicare to Medicare Advantage or vice versa, change Medicare Advantage plans, and enroll in or change Part D plans.
• Traditional Medicare beneficiaries with Parts A and B may move to Medicare Advantage; the selected plan may include Part D coverage but is not required to do so.
• Beneficiaries moving from Medicare Advantage to traditional Medicare may enroll in a separate Part D plan for outpatient prescription drug coverage and may consider Medigap if available.
• People who enroll late in Part D may face a penalty if they lacked comparable or other creditable prescription drug coverage before enrollment.
• Medicare Advantage and Part D plans generally change from year to year, with potential effects on provider access and costs.
• In the reported recent enrollment period, 65% of beneficiaries did not review and compare available coverage choices; the proportions were 71% for traditional Medicare and 60% for Medicare Advantage.

Clinical Implications

The source encourages beneficiaries to reassess their current Medicare coverage and examine other plans or coverage arrangements available where they reside. Medical needs may change over time, and Medicare Advantage and Part D plans generally change each year, potentially affecting provider access and costs.

Conclusion

Annual open enrollment provides an opportunity to change Medicare coverage, but plan options and benefits may change each year. The source reports that many beneficiaries did not compare alternatives, despite potential differences in coverage, provider access, and costs.

Related Resources & Content

1. Source article, Medicare Open Enrollment: Answers to Common Questions About Coverage Choices, year not provided
2. The ASCO Post, Extended Open Enrollment, Special Enrollment Periods Finalized for Some Insurance Exchanges, Increasing Access to Cancer Care, 2021
3. Centers for Medicare & Medicaid Services, Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027, year not provided
4. ASCO Publications — Medicare's Seasons
5. retinal physician — Coding Q&A: Part C Medicare vs Traditional Medicare
6. ASCO Publications — Medicare's Seasons
7. Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027 | CMS
8. Final CY 2026 Part D Redesign Program Instructions | CMS
9. Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027 | CMS
10. Final CY 2026 Part D Redesign Program Instructions | CMS