What changes are available during Medicare’s AEP?

In August, my husband and I enrolled in a Medicare Supplement, which has not paid a medical claim because we are in a Medicare Advantage plan. We could not leave the Advantage plan and return to Original Medicare due to Medicare rules.

I was told that Medicare’s Annual Enrollment is when Sonny and I can disenroll from this Advantage plan and return to Medicare, but I do not know what to do.

Toni, can you please explain in simple terms what we need to do since Medicare’s enrollment period is beginning? Thank you.

--Laura from Las Vegas

Hello Laura:

The biggest no-no in the Medicare insurance world is when an insurance agent sells a Medicare beneficiary (which is what you and Sonny are) who has a Medicare Advantage plan a new Medicare Supplement without advising the client how to disenroll properly from their Medicare Advantage plan.

The proper time to disenroll from the Medicare Advantage plans that you and Sonny are currently in is during Medicare’s Annual Enrollment Period (AEP) from Oct. 15 to Dec. 7. By enrolling in Medicare Part D to return to Original Medicare, you can begin to use the Medicare Supplement which you applied for in August starting Jan. 1.

The AEP is when one can enroll or change either a stand-alone Medicare Prescription Drug (Part D) plan or a Medicare Advantage (Part C) plan with or without a prescription drug plan. Enrolling in a Medicare Supplement or changing Medicare Supplement plans is not included in Medicare’s AEP rules. Underwriting rules for Medicare Supplements usually apply during AEP, or at anytime of the year for those enrolled in Part B longer than 6 months.

The changes that can be made during Medicare’s Annual Enrollment Period (AEP) are:

-- Return to Original Medicare by enrolling in a stand-alone Medicare Prescription Drug (Part D) Plan. (Laura, this is the Medicare AEP option for you and Sonny to begin using the Medicare Supplement you enrolled in in August.)

-- Return to Original Medicare by enrolling in a stand-alone Medicare Prescription Drug (Part D) Plan and purchase a Medicare Supplement (underwriting rules may apply).

-- Enroll in a Medicare Prescription Drug (Part D) Plan, for late or initial enrollment.

-- Change from one Medicare Prescription Drug (Part D) Plan to a new Part D Medicare Prescription Drug Plan.

-- Enroll in a Medicare Advantage (Part C) Plan with Prescription Drugs.

-- Change from one Medicare Advantage (Part C) Plan with or without Prescription Drug plan to a new Medicare Advantage (Part C) Plan.

-- Return to Original Medicare with no Part D plan. Please note there is a penalty for not enrolling in a Medicare Prescription Drug (Part D) plan when first eligible.

Many Medicare Advantage and Part D plans have changed for 2025. For those who already have either a Medicare Advantage (Part C) plan with or without prescription drugs or a stand-alone Medicare Prescription Drug (Part D) plan, Medicare’s AEP is the time to make sure your drug plan or Advantage plan still meets your needs! Use www.medicare.gov to verify that your prescription drugs are covered in your 2025 MAPD or Part D plan formulary. If your prescriptions are not covered by your existing plan for 2025, you will have to pay 100% of that prescription cost out of your pocket!

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. For a Medicare checkup, call the Toni Says call center at (832) 519-8664 or email info@tonisays.com regarding your Medicare plans and options. Toni Says Medicare Survival Guide Advanced edition is available at www.tonisays.com.