Question: I am confused about what I can do with my insurance now that I have signed up for Medicare. This year during February I signed up for a Medicare Advantage HMO plan that started in March because I turned 65. Now my friends say I have to choose my insurance during October, November, and December. Why is it different this year?

Answer: This topic is especially difficult to understand, so I will try to explain it as simply as I can. You enrolled in the early part of the year in 2024, because YOU turned 65. The age of 65 is when Original Medicare begins for most individuals. The time of year we turn 65 is different for everyone, therefore everyone’s initial enrollment period comes at a different time.

Once you are enrolled into Medicare you must adhere to the same timelines as everyone else on Medicare. Medicare plans are almost always calendar year plans, so they are different every calendar year. The Annual Open Enrollment Period is when you can evaluate your plan for the next calendar year and compare it to other plans available to you. You can decide whether to change your coverage for the next calendar year.

Each year the annual open enrollment period is October 15th to December 7st. This is a period of time when you can make changes to your prescription drug coverage and for you that comes as part of your Medicare Advantage HMO plan. In other words, you may change the company you get your health insurance and prescription drug coverage from, or the way you get your health insurance and your prescription drug coverage. If you aren’t currently in a prescription drug plan, this would be the period where you can join for the first time. If you are already in a prescription drug plan you can switch to an alternate plan. Whatever change you make it will begin the first of the year, 1-1-2024.

If you decide to stay with your current plan during the Annual Open Enrollment Period, you have another chance to make changes to your coverage, the Medicare Advantage Open Enrollment Period which is the period from January 1st to March 31st each year.

During this Medicare Advantage Open Enrollment Period, those individuals that are enrolled in Medicare Advantage Plans, including HMO’s, and PPO’s can switch to any other plan they wish.

January 1 to March 31 you can switch to a different plan within the same company, or you can switch to a plan offered by a different company. The key to this time period is your Part D status must not change, i.e.; if you have it to begin with you must keep it and if you don’t have it you can’t get it. (‘drug plan to drug plan’ or ‘no drug plan to no drug plan’).

So in thinking about what you will do with your insurance after your Initial Enrollment Period (turning 65), you must adhere to the rules that apply to everyone who has Medicare. Essentially it becomes something that you think about at least annually.

While these two annual enrollment periods are the most common times to make changes to your coverage, it is important to understand there are many Special Enrollment Periods that may be available to you. Special Enrollment Periods (SEP) are circumstances that apply to you during special situations. These SEP’s are usually related to changes in your situation, like moving to another county or state, or losing your Medicaid eligibility. These SEP’s are not always available but should be researched if you feel a change to your insurance coverage is necessary.

The best way to learn more about your insurance situation and alternatives, is to use the www.medicare.gov website, or refer to your Medicare & You handbook that you get. You can also call Medicare to ask questions at 800-633-4227.

Another useful resource is the Medicare Right Centers, at www.medicarerights.org or 800-333-4114.

You also can talk to someone right in your local community, like Office for Aging or a licensed Insurance Broker who specializes in Medicare products.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.