2021 Medicare Open Enrollment: A Guide to Dates, Costs and Eligibility

Everything you need to know about Medicare’s Annual Election Period (AEP) dates, costs, eligibility, and opportunities to change your Medicare insurance coverage this Fall.

What’s in this 2021 Medicare AEP guide?

Medicare’s open enrollment period for 2021 coverage starts October 15th. Our 2021 Medicare Annual Election Period guide will walk you through what you need to know to get the coverage you need.

(Note: Most of the costs cited in this guide are 2021 cost estimates from the most recent Medicare Trustees Report. The finalized costs will be published by CMS in October.)

3 Frequently Asked Questions

When is Medicare’s Open Enrollment Period for 2021 Coverage?

Medicare open enrollment – which CMS calls the Medicare Annual Election Period – starts each year on 15 October and ends on 7 December. During this open enrollment time period, Medicare beneficiaries can take stock of their healthcare and financial needs and choose new coverage. Coverage begins on January 1, 2021.

Although AEP is specific to Medicare Advantage and Medicare Part D plan enrollment, it’s also a time for beneficiaries to evaluate how well Medicare Advantage or Original Medicare and supplemental Medicare insurance meets their needs. During this period, beneficiaries can make the decision to switch from a private plan back to Original Medicare, or visa versa.

During the Medicare Annual Election Period, beneficiaries can:

• Switch from Original Medicare to Medicare Advantage (you must be enrolled in both Medicare Part A).
• Switch from Medicare Advantage back to Original Medicare.
• 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 (Note: if did not creditable coverage from an employer or union, a late-enrollment penalty may apply).

What You Can’t Do During Medicare’s Open Enrollment Period

The annual election period only applies to Medicare Advantage and Medicare Part D plans.  Medicare Supplement plans, which in most states, only have guaranteed-issue rights during your initial enrollment period and special enrollment periods.

This simply means that if you failed to get enrolled when you were first eligible for Medicare, you won’t be able to enroll in the fall during open enrollment. However, you can use Medicare’s general enrollment period, which begins 1 January 1 and ends on 31 March.

Medicare created the general enrollment period for folks who missed enrolling in Medicare Part B when they were first eligible. This enrollment period is also available to beneficiaries who must pay a premium for their Medicare Part A because they didn’t work the requisite 40 quarters. Coverage from enrollment during this period begins on 1 July.

How to Enroll in a New Medicare Plan for 2021

Once you’re in a Medicare plan, you’ll have various opportunities to change your plan election or coverage. Here are the basics:

• The Fall Annual Election Period (October 15 – December 7) allows you to make a variety of changes that do not require you to go through medical underwriting. During this period you can:
  1. Switch from Original Medicare to Medicare Advantage or vice versa.
  2. Switch from one Medicare Advantage plan to another.
  3. Join a stand-alone Medicare Part D plan.
  4. Switch from one Part D prescription plan to another.
  5. Drop your Part D coverage altogether. (you must maintain creditable drug coverage or a penalty will apply if you enroll again later.)
• The Medicare Advantage Open Enrollment Period (January 1 – March 31) is for people who already have a Medicare Advantage plan but are unhappy with their choice. During this period you can:
  • Switch back to Original Medicare (and enroll in a Part D plan; access to Medicare Supplement insurance may require medical underwriting).
  • Switch to a different Medicare Advantage plan.

Note: Only one plan change is allowed during this period.

• The First Year of Medicare Advantage Enrollment offers another opportunity to switch plans. Enrollees new to the Medicare Advantage program can switch back to Original Medicare and a Part D plan at any time. Plus, with limited exceptions, they also have guaranteed-issue rights to supplemental Medicare insurance.
• The Five-Star Special Enrollment Period (December 8 – November 30) permits beneficiaries who live in a county with one or more five-star plans (Medicare Advantage or Part D) to switch to a five-star plan if they so choose.
• Original Medicare Beneficiaries May Apply for Different Medicare Supplement Coverage. However, applying for a Medigap plan outside of your Initial Enrollment Period may require medical underwriting. Different states have different rules.

Medicare Eligibility

Most people associate Medicare eligibility with Social Security, but the two are no longer linked to turning age 65. Many people are choosing to take their Social Security benefits at age 62, while the full Social Security retirement age is now 67. Meanwhile, most of us will receive our Medicare benefits at age 65.

In summary:

• Most people are eligible for Medicare Part A and Part B when they turn 65.
• Beneficiaries under 65 are eligible for Medicare after receiving Social Security disability benefits for 24 months or when diagnosed with ALS or end-stage renal disease.
• Premium-free Medicare Part A is available to those who worked a minimum of 10 years (40 quarters) and paid into Medicare and Social Security taxes.
• If your income is higher than $87,000 for a single person or $174,000 for a married couple, you’ll pay more than other people for your Medicare Part B coverage and your Part D coverage.
• Medicare Advantage enrollment requires that you be enrolled in both Medicare Part A and Part B. Medicare Advantage replaces Part A and Part B coverage benefits and may include Part D benefits for coverage of outpatient medications.
• You’re eligible to enroll in a Medicare Part D plan as long as you have either Medicare Part A or Part B.
• If you’re enrolled in both Medicare Part A and Part B you’re eligible to enroll in a Medigap plan to supplement your Medicare coverage. Medigap coverage is not compatible with Medicare Advantage or Medicaid benefits (you may not have both).

How to Enroll in Medicare for the First Time

This section guides you through the basics of enrolling in Medicare for the first time. However, you might want to read our tips on Medicare coverage and benefits first.

Getting Enrolled in Original Medicare

The Social Security Administration (SSA) enrolls most people in Medicare Part A automatically when they turn 65. However, if you choose to delay receiving your Social Security retirement benefits or Railroad Retirement Benefits (RRB) beyond age 65, it is your responsibility to initiate Medicare Part A enrollment when you decide to retire.

To make sure you’re enrolled on-time, contact the SSA or RRB three months before you turn 65 or retire. You can stop by your local SSA office, log on to the SSA website (http://www.ssa.gov/), or call them at 1-800-772-1213. The RRB toll-free number is 1-877-772-5772.

If you declined Medicare Part B automatic enrollment because you have creditable coverage, or if you were not automatically enrolled, there are several enrollment periods where you can enroll later. Your Initial Enrollment Period (IEP) is a seven-month period that begins three calendar months before you first become eligible for Medicare and lasts for three calendar months after your month of eligibility. For most of us, that means three months before our 65th birthday.

If you are eligible due to a disability, your IEP begins on the 25th month after you first start collecting disability benefits from the SSA. If you have Lou Gehrig’s Disease, your enrollment into Medicare will be automatic. If you are diagnosed with End-Stage Renal Disease (kidney failure), you must call Medicare to start your Part B enrollment.

Getting Enrolled in a Medicare Advantage Plan

The Medicare Advantage enrollment process varies slightly by the plan, but in all cases, you must be enrolled in Medicare Part A and Part B in order to enroll. You can enroll in a Medicare Advantage plan during your IEP or during the Medicare Advantage Open Enroll, starting 15 October and ending 7 December.

During the Fall open enrollment, you can add, drop, or change your Medicare Advantage plan. During this period you may change your enrollment in any Medicare Advantage plan without any penalties and without having to go through medical underwriting.

If you enroll in a Medicare Advantage plan during the open enrollment period, and then later change your mind, you can drop the plan and go back to Original Medicare (Parts A and B) during the Medicare Annual Disenrollment Period (MADP), which starts on 1 January. If you don’t dis-enroll during this time period, you must keep your plan for the rest of the year. The only exception is if you qualify for a Special Enrollment.

For agent assistance, call 1-855-266-4865 to speak with our plan partner, who can help you find a Medicare Advantage plan in your area.

Getting Enrolled in Medicare Part D

As soon as you are eligible for Medicare you should have creditable prescription drug coverage. If you don’t have coverage as soon as you are eligible, and then later need it, Medicare can charge you a late penalty. For most of us, it’s best to enroll in a Part D plan as soon as we’re eligible.

There are three ways to get creditable prescription drug coverage.  You can get it as part of a Medicare Advantage plan, through a Medicare Part D plan, or if available, you can get it through an employer group plan.

You can enroll in a Medicare Part D Plan during your Initial Enrollment Period (IEP) or during the Annual Election Period (15 October through 7 December). Also, if you drop a Medicare Advantage plan and return to Original Medicare during the Medicare Annual Disenrollment Period you can join a Part D Plan at that time.

As a reminder, your IEP is 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 you are enrolling in Medicare after being diagnosed with ALS or end-stage renal disease.

Getting Enrolled in a Medigap Plan (supplemental coverage)

Medigap plans are supplemental coverage that is optional. There are no specific enrollment periods.  However, you must enroll when first eligible in order to preserve your guaranteed issue rights (e.g., no insurance underwriting process). You only have a guaranteed right to buy a Medigap insurance policy in the six months beginning with the first month your turn 65 and are enrolled in Medicare Part B.  After that, in most states an insurance carrier can refuse to sell you insurance and will require you to go through medical underwriting.

Also, Medicare supplement insurance is not compatible with Medicare Advantage, but it is compatible with Part D. You can apply for a Medigap plan with any insurance carrier that offers supplemental Medicare insurance in your state. They will handle all of the paperwork and explain the insurance benefits. You can use our plan finder to compare rates.

For agent assistance, call 1-855-266-4865 to speak with our plan partner, who can help you find a Medigap plan in your area.

2021 Medicare Coverage Costs at a Glance

Each part of Medicare has various costs (premiums, deductibles, copays, coinsurance, etc). Here’s an outline of what you can expect in 2021.

Medicare Part A (inpatient coverage)

2021 Medicare Part A Monthly Premium

• No monthly premium (free) for most beneficiaries.
• $263/month for beneficiaries who paid into Medicare for 7.5 to 10 years.
• $478/month for beneficiaries who paid into Medicare for less than 7.5 years.

2021 Medicare Part A Deductible

• $1,452 per benefit period
• Covers up to 60 days in the hospital
• A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility (SNF). The benefit period ends when you haven’t gotten any inpatient hospital care (or skilled nursing care in a SNF) for 60 days in a row.
• Supplemental Medicare coverage will pay some or all of the Part A deductible, depending on your Medigap policy.

2021 Medicare Part A Coinsurance:

• $363 per inpatient day, days 61-90 of the benefit period.
• $726 per inpatient day for day 91 and beyond of the benefit period (lifetime reserve days).
• $181.50 (projected) per day for skilled nursing facility care (day 21+). Medicare Part A covers 100 percent of the cost of skilled nursing facility care for the first 20 days so long as you had at least a three-night inpatient hospital stay prior to the skilled nursing facility stay.
• Supplemental Medicare coverage helps pay some or all of your Part A coinsurance. All of the standardized Medicare Supplement Plans cover an additional 365 days in the hospital after Medicare benefits are exhausted.

Medicare Part B (medical coverage)

2021 Medicare Part B Monthly Premiums:

• $153.30 per month (projected) is what most beneficiaries will pay in 2021. Your actual rate will depend on Social Security cost of living adjustment (COLA) for 2021.
• Part B premiums for high-income beneficiaries are projected to range from about $245/month to $368/month. High-income enrollees pay a higher Part B premium (the high-income threshold is $87,000 for an individual and $174,000 for a married couple).
• Part B premiums will be higher if you delayed your enrollment (due to a late enrollment penalty).

2021 Medicare Part B Deductible:

• The Part B deductible for 2021 is $203. If you receive a Part B-covered service during the year you will pay all costs out-of-pocket until the Part B deductible is met.
• Medicare Plan C and Plan F will pay your Part B deductible for you, but these plans are no longer available for newly-eligible Medicare enrollees. (Plan G is the same as Plan F, except you pay the Part B deductible yourself.)

2021 Medicare Part B Coinsurance:

• After your Part B deductible is paid you pay 20 percent of all Medicare-approved cost for the Part B services. And, unlike Medicare Advantage coverage, there’s no maximum out-of-pocket limit. Fortunately, you can get a Medigap plan to cover some or all of the Part B coinsurance.
• Your doctor may charge you up to 15% more for Part B services if they don’t accept Medicare assignment (some states impose a lower limit), however, Medigap Plan F and Plan G cover excess charges for you.

Medigap (Medicare Supplements)

Medigap Premiums:

• On average, you can expect to pay about $140 per month for a Medigap Plan G in 2021. But, it’s important to note that rates vary widely by location, age, gender, and your use of tobacco products.
• Plan G, which is generally less expensive overall than full-coverage Plan F, is the most comprehensive plan available to newly eligible beneficiaries. The lower cost is due to the fact that Plan G does not pay the Part B deductible.
• Healthy seniors can save on their premiums by choosing Medigap Plan N. This plan is an ideal plan for people who do not have chronic health conditions and don’t mind sharing minor costs (e.g., you pay up to $20 to see your doctor).

Medicare Medicare Advantage (Part C)

2021 Medicare Advantage Plan Premiums:

• With Medicare Advantage, you pay your Part B premium (projected to be $153.30/month in 2021) + the monthly Medicare Advantage premium.
• In 2020, the average monthly premium for Medicare Advantage plans that include Part D coverage is about $36/month in 2020. The 2021 Medicare Advantage plan premium will be announced by CMS no later than the first week of October.

2021 Medicare Advantage Maximum Out-of-Pocket (MOOP) Limit:

• $7,550 maximum MOOP in 2021. The maximum out-of-pocket limit on a Medicare Advantage plan does not include prescription drug costs or the monthly premium. The annual MOOP has been $6,700 for a few years. The jump to $7,550 for 2021 is significant. New Medicare beneficiaries should consider Medigap Plan K as an alternative.

2021 Medicare Part D Prescription Drug Plans

2021 Part D Monthly Premiums:

• The average monthly premium is expected to be about $30.50/month in 2021 for basic plans. Enhanced plans will be higher. In some states, premiums for Part D plans are expected to be as low as $15 per month.
• High-income beneficiaries pay a higher Part D premium.

2021 Medicare Part D Deductible:

• The maximum Part D deductible in 2021 is $445 (up from $435 in 2020).

2021 Medicare Part D Out-of-Pocket Costs:

• Not to exceed 25 percent of the cost of brand-name and generic costs.
• The dreaded donut hole is finally gone at the pharmacy. However, a gap still exists when it comes to plan copays and coinsurance that affects how total drug costs are calculated and who covers the bulk of the cost of the drugs (the drug plan versus the manufacturer).
• The catastrophic coverage threshold is $6,550 in 2021 (up from $6,350 in 2020).
• Additional out-of-pocket costs in catastrophic coverage are capped at the greater of 5 percent of the cost of the drug or a copay of $3.70 for generics and $9.20 for brand-name drugs.
• All plans now cover a broad range of insulin for $35 or less per month.

Special Note About IRMAA and Medicare Part B and D Premiums

A Medicare beneficiary’s income may affect what they pay for Medicare Part B and Medicare Part D. The income-related monthly adjustment amount (IRMAA) is an Affordable Care Act surcharge that increases monthly premiums for Medicare Part D and Part B when a beneficiary’s income exceeds $87,000 as an individual or $174,000 as a married couple. Income limits apply are indexed for inflation.