Medicare Annual Enrollment Period

Medicare Annual Enrollment in San Diego County: October 15 to December 7

Every autumn, Medicare gives you a window to change your coverage for the following year. It runs from October 15 through December 7, and whatever you choose takes effect on January 1. Miss it, and for most people the next opportunity is a full year away.

This is the most important date on the Medicare calendar, and it is also the one most people skip. If you do nothing, your current plan rolls over — but it rolls over with whatever changes the insurer made to it, not the plan you signed up for.

What you can change during Annual Enrollment

• Join, switch or drop a Medicare Advantage plan
• Switch from Medicare Advantage back to Original Medicare, or the other way around
• Join, switch or drop a standalone Part D prescription drug plan
• Add or remove drug coverage from a Medicare Advantage plan

Your plan has to receive the request by December 7. Not postmarked by — received by. We do not leave clients to find that out the hard way.

Why it matters even if you like your plan

Plans are approved one year at a time. Between one January and the next, an insurer can change any of the following without your input:

• The provider network. Your doctor, your specialist or your preferred hospital can be dropped.
• The drug formulary. A medication can move to a higher tier, require prior authorization, or come off the list entirely.
• The premium, deductible and copays.
• The extras. Dental, vision, hearing, transportation and over-the-counter allowances are adjusted every year.

Every plan sends an Annual Notice of Change in late September explaining exactly what is different. It arrives looking like junk mail and most people bin it. If you still have yours, bring it in — it is the fastest way for us to tell you whether you should move.

The five things we check for every client

1. Your doctors. Every physician and specialist you want to keep, verified against next year’s network — not this year’s.
2. Your prescriptions. Each drug, at the tier and the actual dollar cost you would pay next year.
3. Your pharmacy. Preferred pharmacies change, and the same drug can cost meaningfully more at a non-preferred one.
4. Your total exposure. Not just the monthly premium, but the out-of-pocket maximum — what a bad year would actually cost you.
5. The extras you use. An unused dental allowance is not a benefit. One you rely on is.

Where the numbers stand right now

For reference, these are the current published figures. Figures for the coming plan year are released by Medicare in the autumn, and we go through them with clients as soon as they are out.

• Standard Part B premium: $202.90 a month, with a $283 annual deductible
• Part A inpatient hospital deductible: $1,736 per benefit period
• Part D out-of-pocket cap: $2,100 — once your drug spending reaches it, you pay nothing more for covered drugs that year
• Maximum allowable Part D deductible: $615
• Income-related adjustments (IRMAA) begin above $109,000 for individual filers and $218,000 for joint filers

A California rule worth knowing: the birthday rule

If you have a Medicare Supplement (Medigap) policy, California gives you something most states do not. For a 60-day window each year tied to your birthday, you can move to a different Medigap policy with the same or lesser benefits — with any carrier — without medical underwriting. No health questions, no waiting periods.

This is separate from Annual Enrollment and it is the single most overlooked opportunity in California Medicare. If your Medigap premium has crept up over the years, it is often possible to move to identical coverage at a lower price. Call us in the weeks before your birthday and we will check what is available and confirm your exact window.

If you miss December 7

There are two backstops, and both are narrower than Annual Enrollment:

• Medicare Advantage Open Enrollment, January 1 to March 31. If you are already in a Medicare Advantage plan you get one change — to a different Advantage plan, or back to Original Medicare with a Part D plan. It does not help anyone on Original Medicare who wants to switch drug plans.
• Special Enrollment Periods. Triggered by specific events: moving out of your plan’s service area, losing employer coverage, qualifying for Medi-Cal or Extra Help, or your plan leaving the area. If you qualify for Medi-Cal, you get more flexibility than most people realize.

Book your review before the rush

The last two weeks before December 7 are the busiest of our year. October and early November are calmer, and you get more of our time. There is no charge for a plan review — independent agents are paid by the carriers, not by you — and there is no obligation to change anything. Plenty of our clients come in, we check the five things above, and the answer is that they should stay exactly where they are. That is a good outcome too.

Bring your Medicare card, your Annual Notice of Change if you still have it, a list of your prescriptions with dosages, and the names of the doctors you want to keep.

Hablamos español

El Período de Inscripción Anual de Medicare va del 15 de octubre al 7 de diciembre, y los cambios entran en vigor el 1 de enero. Es la única oportunidad del año para la mayoría de las personas. Revisamos su plan en español, sin ningún costo: verificamos que sus médicos sigan en la red, que sus medicamentos sigan cubiertos y a qué precio, y le explicamos con claridad si le conviene cambiar o quedarse donde está. Llámenos al (619) 361-3591 antes del 7 de diciembre.

Related pages

Medicare enrollment help · Carriers we represent · The Part D late enrollment penalty · Medi-Cal and Medicaid help

Talk to a licensed agent in Chula Vista

Call (619) 361-3591, email info@zulemamedicare.com, or stop by our office at 31 Third Ave, Chula Vista, CA 91910. We are open Monday through Friday, 9:00am to 5:00pm.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (HICAP in California, 1-800-434-0222) to get information on all of your options.