Open enrollment has started! Here’s everything you need to know about this year’s enrollment dates, coverage costs, eligibility details and opportunities to change coverage.
Right now – during the annual Medicare open enrollment – Medicare plan enrollees can reevaluate their coverage – whether it’s Original Medicare with supplemental drug coverage, or Medicare Advantage – and make changes if they want to do so.
Louise Norris, October 15, 2021
What’s in this guide?
- When is Medicare open enrollment?
- How to change Medicare plans
- Medicare eligibility
- How to enroll in Medicare
- 2021 and 2022 Medicare coverage costs
- How IRMAA affects your Medicare premiums
Medicare open enrollment for 2021 coverage is now underway. Our 2021 Medicare Open Enrollment Guide will walk you through enrollment dates, tips for choosing a plan, and more.
When is Medicare open enrollment?
Medicare open enrollment – also known as Medicare’s annual election period – runs from October 15 through December 7 each year. (Although Medicare’s open enrollment period ends on December 7 each year, extended enrollment opportunities are available to people in areas where FEMA declares an emergency or major disaster that hampers your ability to complete your signup during the normal window.)
Time to sign up for Medicare? During this annual window, Medicare plan enrollees can reevaluate their coverage – whether it’s Original Medicare with supplemental drug coverage, or Medicare Advantage – and make changes or purchase new policies if they want to do so.
During the Medicare open enrollment period, you can:
- Switch from Original Medicare to Medicare Advantage (as long as you’re enrolled in both Medicare Part A and Part B, and you live in the Medicare Advantage plan’s service area).
- Switch from Medicare Advantage to Original Medicare (plus a Medicare Part D plan, and possibly a Medigap plan).
- Switch from one Medicare Advantage plan to another.
- Switch from one Medicare Part D prescription drug plan to another.
- Enroll in a Medicare Part D plan if you didn’t enroll when you were first eligible for Medicare. If you haven’t maintained other creditable coverage, a late-enrollment penalty may apply.
Prior to 2021, patients with end-stage renal disease were unable to enroll in Medicare Advantage plans unless there was a Medicare Special Needs plan available in their area for ESRD patients. But that changed as of 2021, under the terms of the 21st Century Cures Act. People with ESRD gained the option to enroll in Medicare Advantage as of 2021, and CMS expected more than 40,000 to do so. This can be particularly advantageous for beneficiaries with ESRD who are under age 65 and living in states that don’t guarantee access to Medigap plans for people under the age of 65.
Medicare sign up: What you can’t do
The annual Medicare open enrollment period does not apply to Medigap plans, which are only guaranteed issue in most states during a beneficiary’s initial enrollment period, and during limited special enrollment periods.
If you didn’t enroll in Medicare when you were first eligible, you cannot use the fall open enrollment period to sign up. Instead, you’ll use the Medicare general enrollment period, which runs from January 1 to March 31.
Medicare’s general enrollment period is for people who didn’t sign up for Medicare Part B when they were first eligible, and who don’t have access to a Medicare Part B special enrollment period. It’s also for people who have to pay a premium for Medicare Part A and didn’t enroll in Part A when they were first eligible.
If you enroll during the general enrollment period, your coverage will take effect July 1.
How to sign up for and change Medicare plans
Once you’re enrolled in Medicare, you’ll have various opportunities to change certain aspects of your coverage. Here’s an overview:
During the annual open enrollment period (October 15 – December 7), you can make a variety of changes, none of which involve medical underwriting:
- Switch from Medicare Advantage to Original Medicare or vice versa.
- Switch from one Medicare Advantage plan to another.
- Switch from one Part D prescription plan to another. It’s highly recommended that all beneficiaries use Medicare’s plan finder tool each year to compare the available Part D plans, as opposed to simply letting an existing drug plan auto-renew.
- Join a Medicare Part D plan. (Late-enrollment penalty might apply.)
- Drop your Part D coverage altogether. (Re-enrolling in a later year will include a late-enrollment penalty if you’re not maintaining other creditable drug coverage.)
During the Medicare Advantage open enrollment period (January 1 – March 31), Americans who are already enrolled in Medicare Advantage can:
- Switch to Original Medicare (and enroll in a Part D plan; access to Medigap might require medical underwriting, depending on the circumstances.)
- Switch to a different Medicare Advantage plan.
Only one plan change is allowed during this window (unlike the fall enrollment period, when a person can change their mind multiple times, with the last plan selection taking effect on January 1).
During the five-star enrollment period (December 8 – November 30), people who live in an area with a five-star Medicare Part D or Medicare Advantage plan can switch to that plan if they choose to do so.
During the first year a person is enrolled in Medicare Advantage, they can switch to (or back to) Original Medicare and a Part D plan. And with some exceptions, they also have guaranteed-issue access to a Medigap plan.
Any time during the year, a person enrolled in Original Medicare can apply for a different Medigap plan. But if it’s not during the person’s one-time Medigap enrollment window, the insurer will likely use medical underwriting to determine whether to issue the policy and at what price (note that some states have continuous or annual windows when at least some Medigap plans are guaranteed issue).
For most Americans, Medicare eligibility goes hand in hand with turning 65, but some people become eligible for Medicare earlier. Most Medicare beneficiaries receive Medicare Part A without a monthly premium, but some have to pay for it. And some beneficiaries have to pay more than the standard amount for their Medicare Part B and Part D coverage.
Here’s our detailed overview of eligibility for all parts of Medicare coverage. In summary:
- Most Americans become eligible for Medicare when they turn 65.
- But 14% of all Medicare beneficiaries are under 65, and became eligible after receiving Social Security disability benefits for two years or being diagnosed with ALS or end-stage renal disease.
- In order to enroll in Medicare Advantage, you must enroll in both Medicare Part A and Part B. Your Medicare Advantage plan will take the place of both parts, and will likely also include Medicare Part D prescription drug coverage.
- In order to get Medicare Part A without having to pay a monthly premium, you or your spouse must have worked for at least 10 years in the United States, paying Medicare taxes during that time.
- If your income is high, you’ll pay more than other people for your Part B coverage and your Part D coverage. High income is defined in 2021 as having had a 2019 income of more than $88,000 for a single person or $176,000 for a couple. This is projected to increase to $91,000 and $182,000 in 2022; the determination is always based on income earned two years prior, so the determination for 2022 will be based on income that was earned in 2020.
- You’re eligible to enroll in Medicare Part D as long as you have either Medicare Part A or Part B.
- If you’re enrolled in both Medicare Part A and Part B (but not Medicare Advantage or Medicaid), you’re eligible to enroll in a Medigap plan to supplement your Medicare coverage. You’ll have a six-month guaranteed-issue window during which you can sign up for any Medigap plan available in your area. In most states and most circumstances, you’ll have to go through medical underwriting if you decide to apply for a Medigap plan after that window ends.
How to sign up for Medicare
This section walks you through the basics of enrolling in Medicare. But first, you’ll want to read our tips for deciding between Original Medicare plus Medigap and Part D coverage, versus a Medicare Advantage plan.
Enrolling in Original Medicare
If you’re already receiving Social Security or Railroad Retirement Board benefits and you’re a U.S. resident, the federal government automatically enrolls you in both Medicare Part A and Medicare Part B at age 65. You’ll receive your Medicare card in the mail about three months before you turn 65, and your coverage will take effect the first of the month you turn 65.
Medicare Part B has a monthly premium, which will be deducted from your Social Security or Railroad Retirement check. The standard Part B premium is $148.50/month in 2021, and is expected to increase in 2022. For the upcoming year, CMS doesn’t finalize the new Part B premium until fairly late in the year, but the Medicare Trustees Report projects a Part B premium of $158.50/month for 2022 (the cost-of-living adjustment for 2022 is projected to be substantial, and will allow the full premium increase to be implemented for most enrollees; here’s more about how that works).
You can opt out of Part B and avoid the premiums, but it’s generally only a good idea to do that if you’ve got health insurance from your current employer or your spouse’s current employer, and the employer has at least 20 employees.
If you are turning 65, but you’re not yet receiving Social Security or Railroad Retirement benefits, you won’t be automatically enrolled in Original Medicare. Instead, you’ll be able to enroll during a seven-month enrollment period that includes the three months before your birth month, the month you turn 65, and the three following months. So if you’ll be 65 on July 14, your open enrollment period will be April through October.
You’ll enroll through the Social Security Administration. And although your enrollment window is seven months long, you need to enroll during the three months prior to your birthday month in order to have coverage that takes effect the first of the month that you turn 65. If you enroll during your birthday month or one of the three following months, your coverage effective date for Part B will be delayed.
If you’re disabled and receiving Social Security Disability benefits, your Medicare coverage will start automatically in the 25th month that you’re receiving disability benefits. (If you have ALS or end-stage renal disease, you do not have to wait two years to get Medicare.)
Enrolling in Medicare Advantage
To join a Medicare Advantage Plan, you will need to have Original Medicare (Part A and Part B) coverage and live in an area where an Advantage plan is offered. (Most parts of the country have Medicare Advantage plans available, but some rural areas do not.)
A Medicare Advantage plan will wrap your Medicare Part A and Part B (and in most cases, Part D) coverage into one plan. But you’ll still have to pay the government a premium for Part B, in addition to the premium you pay for Medicare Advantage (which might be $0, depending on the plan).
You can enroll in a Medicare Advantage plan when you’re first eligible for Medicare, or during the annual Medicare open enrollment period in the fall (October 15 to December 7).
Enrolling in Medicare Part D
The first opportunity for Medicare Part D sign up is when you’re initially eligible for Medicare – during the seven-month period beginning three months before the month you turn 65, or during the seven-month period beginning three months before your 25th month of disability. (Eligibility rules are different if a person is enrolling in Medicare due to a diagnosis of ALS or end-stage renal disease.)
In both of these cases – whether you’re turning 65 or are eligible for Medicare because of a disability — you likely have the option of selecting a Medicare Advantage plan that includes Part D prescription drug coverage, and using that in place of Medicare A, B, and D
If you enroll in Medicare during the January – March General Enrollment Period, you can enroll in a Medicare Advantage plan (most of which include Part D) between April 1 and June 30. But if you already had premium-free Medicare Part A and you’re just using the General Enrollment Period to sign up for Part B, you’ll have to wait until the fall open enrollment period (October 15 to December 7) to sign up for a stand-alone Part D plan. This is because Part D can be purchased when you have Part A or Part B, whereas Medicare Advantage requires you to have both. So if you’ve already had premium-free Part A, you were eligible for Part D as of when your Part A coverage took effect. But your eligibility for Medicare Advantage would only begin when you’re enrolled in both Part A and Part B.
If you’re enrolled in a Medicare Advantage plan and use the Medicare Advantage open enrollment period (January 1 to March 31) to switch to Original Medicare, you’ll also have the option to sign up for a Part D plan to supplement your Original Medicare coverage.
Enrolling in a Medicare Supplement (Medigap)
During your initial Medigap enrollment period (the six months starting with the month you’re at least 65 years old and enrolled in Medicare A and B) you can’t be denied Medigap coverage or be charged more for the coverage because of your medical history.
But after that window ends, Medigap insurers in most states can use medical underwriting to determine your premiums and eligibility for coverage. (New York, Connecticut, Massachusetts, Maine, Missouri, California, Oregon, and Washington have rules making it easier for people to enroll or switch to a new Medigap plan after the initial enrollment period ends. There are also limited federal guaranteed-issue rights for Medigap plans.)
If you’re under 65 and eligible for Medicare because of a disability, there are 33 states that provide some sort of guaranteed issue period during which you can purchase a Medigap plan. But in the majority of those states, the carriers can charge additional premiums for people under 65. You can click on a state on this map to see how Medigap plans are regulated in the state.
To find out about Medigap policies in your state, contact your State Department of Insurance or your State Health Insurance Assistance Program, or call 1-855-593-5633 to speak with one of our partners, who can help you find a plan in your area.
2022 Medicare costs
Each part of Medicare has costs that go along with it, either in the form of premiums, out-of-pocket costs when you need medical care, or both. Here’s a summary of what to expect. Note that official numbers for most 2022 costs will not be available until October/November 2021; we’ve updated the items where 2022 data are already available, and used the 2021 Medicare Trustees Report for 2022 projections. We will continue to update this page as more data become available:
Medicare Part A (inpatient care)
2022 Part A premium
- No premium – for most beneficiaries who paid into Medicare through payroll taxes.
- PROJECTED: $274/month – for those who worked / paid into Medicare between 7.5 and 10 years (up from $259/month in 2021)
- PROJECTED: $499/month – for those with a work history of less than 7.5 years (up from $471/month in 2021)
2022 Part A deductible
- PROJECTED: $1,556 (up from $1,484 in 2021)
- Covers up to 60 days in the hospital
- Deductible is per benefit period, NOT per year. Once a beneficiary has been out of the hospital for at least 60 days, a new benefit period would start if and when they needed to be hospitalized again.
- Supplemental coverage, including Medigap plans, will pay some or all of the Part A deductible on your behalf.
2022 Part A coinsurance:
PROJECTED: $389 per inpatient day (days 61-90 in the benefit period for which the deductible applied; up from $371 per day in 2021)
PROJECTED: $778 per inpatient day for day 91 and beyond during the benefit period (up from $742 per day in 2021). These are your lifetime reserve days, and you only get 60 of them over the course of your lifetime. They only start to be used up once you’ve spent 90 days in the hospital during a single benefit period. But if you do use up all your lifetime reserve days and don’t have supplemental coverage, you’re responsible for all hospital costs after the lifetime reserve days are used up.
Medicare Part A covers 100% of the cost of skilled nursing facility care for the first 20 days, as long as you had at least a three-night inpatient hospital stay prior to the skilled nursing facility stay. After the first 20 days, your skilled nursing facility coinsurance in 2021 is $185.50 per day for days 21-100 (after that, Medicare no longer covers skilled nursing facility charges, so you’ll pay the full cost). That skilled nursing facility coinsurance for days 21-100 is projected to increase to $194.50/month in 2022.
Supplemental coverage, including Medigap plans, is designed to pay the Part A coinsurance on your behalf. And all of the standardized Medigap plans will also pay for up to 365 additional days in the hospital after Medicare benefits are exhausted. Most Medigap plans also cover at least a portion of skilled nursing facility coinsurance costs.
Medicare Part B (outpatient care)
2022 Part B premiums:
The standard Part B premium for 2021 is $148.50 per month. It has not yet been finalized for 2022, but the Medicare Trustees Report projects a 2022 Part B premium of $158.50/month.
The increase in the Part B premiums for 2021 was limited by the short-term government spending bill that was signed into law on October 1, 2020. The Part B premium for most enrollees was $144.60/month in 2020, and the spending bill capped the increase for 2021 at a quarter of what it would otherwise have been. Earlier in 2020, the Medicare Trustees Report had projected a Part B premiums of $153.30 per month for most enrollees in 2021. The actual price that people pay can also also be limited by the Social Security cost of living adjustment (COLA) that beneficiaries receive, but the 1.3% COLA for 2021 was adequate to allow the full standard Part B premium to be deducted from most beneficiaries’ Social Security checks.
High-income enrollees pay a higher Part B premium. The high-income threshold begins at $88,000 for an individual and $176,000 for a couple as of 2021 (determination based on 2019 income). And the Part B premium for high-income beneficiaries ranges from $207.90/month to $504.90/month. For 2022, the high-income threshold is projected to increase to $91,000 for an individual and $182,000 for a couple (determination based on 2020 income).
Part B premiums are also higher (due to a penalty) for some beneficiaries who delayed their enrollment.
2021 Part B deductible:
PROJECTED: $217 in 2022. Enrollees who receive Part B-covered treatment during the year must pay the Part B deductible before Medicare starts to pick up 80% of the cost of the care. In 2021, the Part B deductible is $203 (up from $198 in 2020).
Medigap plans C and F will pay the Part B deductible for you, but they’re no longer available for newly-eligible Medicare enrollees. (Plan G is still available for newly eligible enrollees; it’s the same as Plan F except enrollees cover the Part B deductible themselves.)
Part B coinsurance:
Once you’ve paid your Part B deductible, you’ll be responsible for 20% of the Medicare-approved amount for the Part B services you receive, and there’s no limit on how high your coinsurance bills can get. But Medigap plans cover some or all of the Part B coinsurance.
If your doctor doesn’t accept assignment, they can charge you up to an additional 15%, unless your state imposes a lower limit. (Medigap plans F and G cover this excess charge; Plan G is still available to newly eligible enrollees, although Plan F is not.)
Learn more about Medicare Part B.
The average Medigap Plan F cost $143/month in 2018, although the cost varied from one location to another. Plan F was the most comprehensive (and popular) plan at that point, but it’s no longer available to people who are newly-eligible for Medicare.
Plan G, which tends to be a little less expensive than Plan F (because it doesn’t cover the Part B deductible) is now the most comprehensive plan available to newly eligible enrollees, and more than a quarter of Medigap enrollees nationwide were already enrolled in Plan G as of 2019.
There are eight other standardized Medigap plan options with premiums that vary from one insurer to another, although not all plan designs are available in all areas.
Medigap out-of-pocket costs
The out-of-pocket costs you’ll pay after your Medigap plan pays its share will depend on the plan design you select.
Medicare Part C (Medicare Advantage)
2022 Medicare Advantage premiums:
Part B premium (projected to be $158.50/month for most enrollees) + Medicare Advantage premium.
The average premium for Medicare Advantage plans with integrated Part D coverage is about $21/month in 2021, although nearly two-thirds of enrollees pay no additional premiums other than the cost of Part B. So the average premium is heavily weighted by the fact that the majority of Medicare Advantage enrollees are in zero-premium plans (ie, all they pay is the Part B premium), which brings down the average premium considerably.
2021 Medicare Advantage maximum out-of-pocket:
$7,550 in 2021 (does not include prescription drug costs). This could be changed for 2022, although CMS postponed that decision in a rule that was issued in early 2021. $7,550 is the upper limit; the average Medicare Advantage plan tends to have an out-of-pocket cap below the maximum that the government allows.
Medicare Part D prescription drug coverage
2021 Part D premiums:
The average premium for Medicare Part D coverage is about $38/month in 2021. There continue to be a wide range of Part D plan options available. Premiums for Part D plans start as low as about $7/month in 2021, down from a low of about $13/month in 2020. On the higher end, plans can have premiums of up to $100/month or more, so there is a great deal of variation — in price and benefits — across the available plans.
High-income enrollees pay a higher Part D premium. The threshold for high-income began to be indexed as of 2020. The income threshold for 2021 is $88,000 for a single person and $176,000 for a couple. It’s expected to increase to $91,000 and $182,000 as of 2022 (the high-income determination is always based on income earned two years prior to the plan year in question).
Part D deductible:
Maximum of $480 in 2022, up from $445 in 2021. (Some plans have no deductible at all).
Part D out-of-pocket costs after deductible:
Not to exceed 25% of the cost of brand-name and generic costs.
There is no longer a donut hole in terms of the maximum amount that enrollees can be charged when they fill prescriptions. But the donut hole still exists in terms of how insurers design their coverage (ie, with different copay or coinsurance amounts before and after the donut hole threshold), how total drug costs are counted, and who covers the bulk of the cost of the drugs (the drug plan versus the manufacturer; see Figure 4 here).
After a beneficiary’s costs reach the catastrophic coverage threshold (this threshold will be $7,050 in 2022, up from $6,550 in 2021), additional out-of-pocket costs are capped at the greater of 5% of the cost of the drug or a copay of $3.95 for generics and $9.85 for brand-name drugs. (Both of these amounts are a slight increase from 2021.)
Certain Part D plans are required to cover a broad range of insulins for no more than $35/month as of 2021.
A Medicare beneficiary’s income can also affect the premiums they pay for Medicare Part B and Medicare Part D. The income-related monthly adjustment amount (IRMAA) is a surcharge that’s added to premiums for Medicare Part D and Part B if a beneficiary has an income of more than $88,000 ($174,000 for a married couple). These income limits apply in 2021 (but are based on tax returns that were filed for 2019), and are indexed for inflation. For 2022, they’re projected to be a little higher, at $91,000 and $182,000 respectively (based on income that was earned in 2020).
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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