Here’s What You Can and Can’t Do During Medicare OEP

Updated: Feb 10

We are part way into the annual Medicare Advantage Open Enrollment Period. Each year from January 1 – March 31, members of a Medicare Advantage (MA) Plan have a one-time opportunity to switch to a different Medicare Advantage Plan or back to Original Medicare with a separate Medicare drug plan if they wish. There are some basic switches that members of MA Plans can and cannot make during this period. The available changes can affect medical and hospital coverage, out of pocket expenses and prescription drug coverage so it’s important to understand what they are. If you would like to make a change, contact your Medicare agent to discuss your options.

What changes can I make to my health insurance during the Medicare Advantage Open Enrollment Period?


There are two basic changes that Medicare enrollees can make during the Medicare Advantage Open Enrollment period:

  • Seniors who are enrolled in a Medicare Advantage Plan (that does or doesn’t have prescription drug coverage) have the option to change to a different Medicare Advantage Plan (that does or doesn’t have prescription drug coverage).

  • Seniors who are enrolled in a Medicare Advantage Plan can move back to Original Medicare. Original Medicare covers Part A (hospital insurance) and Part B (medical insurance). Since Original Medicare does not include prescription drug coverage, seniors who return to Original Medicare during this time are also given the option to join a Medicare drug plan.

What changes to my health insurance are not allowed during the Medicare Advantage Open Enrollment period?


There are three changes that seniors enrolled in Medicare cannot make during the Medicare Advantage Open Enrollment period:

  • Seniors who are enrolled in Original Medicare cannot switch to a Medicare Advantage Plan.

  • Seniors who are already enrolled in Original Medicare cannot join a Medicare drug plan.

  • Seniors who are enrolled in Original Medicare cannot switch from one Medicare drug plan to another.

What are Medicare Advantage Plans?


Medicare Advantage Plans (Part C) are private health insurance plans offered to seniors who qualify for Medicare. These plans cover Parts A and B of Medicare insurance and typically also include prescription drug coverage and other services such as hearing and dental that Original Medicare does not cover.


Medicare Advantage Plan options


If you are considering switching from one Medicare Advantage Plan to another during the Medicare Advantage Open Enrollment period, you might be wondering about your options. To start, there are four common kinds of Medicare Advantage Plans:

  • Health Maintenance Organization (HMO) Plans

  • Preferred Provider Organization (PPO) Plans

  • Private Fee-for-Service (PFFS) Plans

  • Special Needs Plans (SNPs)

There are also other less common types of Medicare Advantage Plans that may be available, including HMO Point of Service (HMOPOS) Plans and Medicare Medical Savings Account (MSA) Plans.


Each of these types of plans will have several options available from a range of private insurers. Speak to your Medicare Agent to discuss the MA Plans available to you that will best meet your needs.


What are Medicare drug plan options?


If you are switching from a Medicare Advantage Plan back to Original Medicare, you may be wondering about your prescription drug plan options. Seniors on Original Medicare must purchase a Part D plan to get prescription drug coverage. Private Medicare insurance companies offer Medicare Part D Plans. Each insurer offers their own plans and typically there are a few options with a range of co-pays and deductibles to meet different needs.


Contact a PBC Agent for Help


Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.


At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.