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Open Enrollment is Just around the Corner

[fa icon="calendar"] Oct 2, 2020 7:45:00 AM / by Donna Smith, BCPA

Donna Smith, BCPA

Closeup portrait of health care professional, dr or md with stethoscope pointing to sign that says healthcare reform now???, isolated on white backgroundWhether your health insurance is through your employer, a private policy, or Medicare, you’re headed for open enrollment. This is when insurers make cost and benefit changes that will be effective January 1st. Your insurer is required to notify you in writing of upcoming plan benefit changes. Take the time to study those changes and the benefit details in any plan you are considering for your 2021 coverage. The choice you make will be in effect through December 31, 2021 unless you have a qualifying event, such as loss of coverage, that allows you to change coverage mid-year.

Here are three common changes to look for :

  1. Increased Costs: An increase in your premiums and/or what you pay for medical treatment, such as: office visits, lab work, x-rays, or hospitalizations.
  2. Prescription Drugs: Two common benefit changes for the drugs you take are:
    1. They are no longer covered.
    2. The drugs have been moved to a different tier, which often means moving from a lower-cost tier, such as Brand Name, to a higher cost tier, like Specialty Drugs.
  3. Physician Changes: Your physician may no longer be in-network or accept your insurance. Since patients are rarely notified by the physician or insurance company when these changes occur, call your insurer to ask if your physician will still be in-network as of January 1st.  If the answer is no, here are two things you should do right away:   
    1. Ask your doctor if she will be in-network with any of the other plans you can choose from.
    2. If you need to find a new doctor, ask your doctor if she can recommend someone who will remain in-network with your current insurance plan.   


If you are currently enrolled in Medicare, you have probably received the 2021 Medicare Handbook  in the mail. Hold on to that book for benefit details you may need during the plan year. For now, here are some key facts about Medicare open enrollment:


  • Open Enrollment runs from October 15 – December 7
  • Changes made during open enrollment are effective January 1, 2021

Changes You Can Make to Current Medicare Coverage

  • Select a different Medicare Advantage Plan
  • Change to a different Part D Prescription Drug Plan
  •  Switch from a Medicare Advantage Plan to Original Medicare.   To understand all of the details for this type of change, call your plan or Medicare at 1-800-MEDICARE.  
  • Switch from Original Medicare to a Medicare Advantage Plan 


  •  Rates for the new year are usually released in early November and posted on the Medicare website.    Please note, the rates you see now are for 2020.
  • Because of their income level, some people pay more than the standard Part B premium. This adjustment is called the Income-Related Monthly Adjustment Amount (IRMAA). Your income amount is based on your earnings two years ago. For example, your 2021 premium will be based on your 2019 earnings. Like Medicare premiums, IRMAA costs typically increase each year. Those new rates will be included on the Medicare website page mentioned above.
  • Click here  for more detailed information about Medicare costs.

Open Enrollment only comes around once a year. Make the most of it. Choose the best plan for your health care needs.

Topics: Medicare, Insurance, open enrollment

Donna Smith, BCPA

Written by Donna Smith, BCPA

I use my 30 years experience managing health insurance plans and advocating for employees of small and large employers to help people navigate through a complex insurance system and get the benefits they are entitled to receive. You can find me at

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