Medicare Open Enrollment Starts Now – What You Can (and Can’t) Do

Understanding Medicare Basics

Medicare is a federal health insurance program primarily for individuals aged 65 and older, along with certain younger people with disabilities. It consists of several parts designed to cover different healthcare needs.

Original Medicare includes:

  • Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people qualify for premium-free Part A based on their work history.
  • Part B (Medical Insurance): Covers outpatient services such as doctor visits, preventive care, lab tests, and durable medical equipment. Part B requires a monthly premium and typically has deductibles and coinsurance.

Medicare Advantage (Part C) plans are offered by private insurers approved by Medicare. These plans combine Parts A and B coverage and often include additional benefits such as:

  • Prescription drug coverage
  • Vision, dental, and hearing services
  • Wellness programs
  • Network restrictions may apply depending on the plan.

Medicare Part D provides prescription drug coverage through private insurance companies. It is optional but recommended to help manage medication costs. Plans vary widely in formularies, premiums, and copayments, so reviewing options annually is important.

Medigap (Medicare Supplement Insurance) policies help fill gaps in Original Medicare by covering out-of-pocket costs like deductibles, copayments, and coinsurance. These standardized plans offer flexibility to see any provider that accepts Medicare without network limits.

Staying informed about Medicare updates ensures you select the best coverage tailored to your health needs and budget.

What is the Medicare Open Enrollment Period (OEP)?

The Medicare Open Enrollment Period is an important time each year for beneficiaries to review and make changes to their Medicare coverage. This annual enrollment period runs from October 15 to December 7, providing a specific timeframe to make significant adjustments to your Medicare health and drug plans.

What can you do during the OEP?

During this open enrollment period, Medicare recipients have the opportunity to:

  1. Switch between different Medicare Advantage (Part C) plans.
  2. Enroll in, change, or drop Part D prescription drug plans.
  3. Transition from a Medicare Advantage plan back to Original Medicare if preferred.

The purpose of the OEP is to give individuals the flexibility to reassess their current plan choices based on evolving health needs, coverage options, and costs. Plans often update benefits, premiums, and provider networks annually, so this window ensures you can select a plan that fits your situation for the coming year.

Changes made during this period take effect on January 1 of the next year, allowing a seamless transition to new coverage. It’s essential to use this opportunity wisely since outside of this timeframe, options for modifying Medicare coverage are limited unless qualifying for certain Special Enrollment Periods.

Knowing when and how to act within the Medicare Open Enrollment window empowers you to maintain control over your healthcare choices and avoid unexpected expenses in 2026.

What You Can Do During Medicare Open Enrollment

Medicare Open Enrollment Starts Now – What You Can (and Can’t) Do. This period, running from October 15 to December 7, allows you to make important adjustments to your Medicare coverage for 2026.

Key actions you can take during this time include:

  • Switch Medicare Advantage Plans: If your current Medicare Advantage plan no longer meets your needs, you can change to a different Medicare Advantage plan that might offer better coverage, lower costs, or a preferred provider network.
  • Change Prescription Drug Plans (Part D): Review your current Part D plan and switch to another if it provides better pricing or covers your medications more comprehensively. This flexibility helps manage out-of-pocket drug expenses effectively.
  • Enroll in Part D Prescription Drug Coverage: If you previously opted out of Part D but now want prescription drug coverage, the Open Enrollment Period is the time to enroll without penalty.
  • Drop Part D Coverage: Conversely, if you have Part D but no longer need it—perhaps due to other coverage—you can choose to drop this coverage during the enrollment window.
  • Return to Original Medicare: If you’re currently enrolled in a Medicare Advantage plan but prefer the traditional Original Medicare coverage (Parts A and B), you can disenroll from your Advantage plan and switch back.

Each option is designed to provide flexibility in managing your healthcare needs and costs. Carefully comparing plans available for 2026 ensures you select coverage aligned with your health requirements and budget. Local resources and experienced agents can assist in navigating these choices confidently.

What You Cannot Do During Open Enrollment

Medicare Open Enrollment allows many changes, but certain restrictions apply—especially regarding Medigap (Medicare Supplement Insurance) policies.

Medigap Restrictions:

  • You cannot purchase or switch Medigap policies at any time during the year.
  • The initial 6-month Medigap Open Enrollment Period begins the month you turn 65 and enroll in Part B.
  • During this period, insurers must sell you any Medigap policy regardless of health status or pre-existing conditions.
  • After this window closes, insurers can deny coverage or charge higher premiums based on your health.

Guaranteed Issue Rights:

Guaranteed issue rights protect beneficiaries from being denied Medigap coverage in specific situations, such as:

  1. Losing Medicare Advantage coverage involuntarily.
  2. Moving out of a Medicare Advantage plan’s service area.
  3. Your Medicare Advantage plan ceasing to offer coverage.
  4. Other qualifying events defined by Medicare rules.

These rights allow enrollment in Medigap without medical underwriting outside the initial open enrollment period. However, guaranteed issue rights do not apply during the general Medicare Open Enrollment Period for switching plans.

Understanding these limitations helps avoid surprises and ensures that decisions about Medigap are made at the right time. For those beyond their initial enrollment period without guaranteed issue rights, options can be limited until the next special enrollment event.

Protecting Yourself from Medicare Fraud During Open Enrollment

Medicare fraud prevention is crucial during the busy Open Enrollment Period when scammers ramp up their efforts. Common scams include:

  • Impersonation Calls or Visits: Fraudsters pretending to be Medicare representatives or insurance agents may ask for personal information like your Medicare number, Social Security number, or bank details.
  • Fake Plan Offers: Offers of “free” or “special” Medicare plans that sound too good to be true often lead to unauthorized enrollment or identity theft.
  • Phishing Emails and Texts: Unsolicited messages requesting sensitive data or offering to review your Medicare plan might be traps designed to steal your information.

Education on recognizing these tactics strengthens your defenses. Be cautious if someone pressures you to enroll immediately, asks for payment upfront, or insists on personal details without proper identification.

Identifying legitimate insurance agents and counseling services involves:

  1. Confirming they are licensed and authorized by Medicare.
  2. Using trusted resources like the State Health Insurance Assistance Program (SHIP) or local agencies such as Elizabeth Bryson Insurance Group.
  3. Verifying credentials through official channels, including Medicare.gov or Connect for Health Colorado.

Keep records of all communications and never share your Medicare number unless you initiated the contact. If you suspect fraud, report it promptly to the Medicare hotline or your local Senior Medicare Patrol.

Understanding your rights includes access to an appeals process if you experience billing errors or unauthorized charges. Knowing how to navigate this process ensures protection against fraudulent activities while optimizing your coverage choices.

Special Considerations for Seniors in Monument and Northern El Paso County

Navigating Colorado Medicare plans can feel overwhelming without the right local support. Seniors in Monument and Northern El Paso County have access to a range of Medicare options tailored to meet diverse health needs and budgets.

Medicare plan options available locally include:

  • Medicare Advantage (Part C): These plans combine hospital (Part A), medical (Part B), and often prescription drug coverage (Part D) into one package. Many offer extra benefits such as dental, vision, hearing, and wellness programs.
  • Medigap (Medicare Supplement Insurance): Designed to cover out-of-pocket costs left by Original Medicare, Medigap policies provide flexibility to see any provider that accepts Medicare.
  • Part D Prescription Drug Plans: Standalone plans available to supplement Original Medicare or Medicare Advantage, helping manage medication costs with various formularies.

Access to trustworthy local resources eases the challenge of comparing plans:

  • Connect for Health Colorado: Offers user-friendly tools and personalized assistance for selecting the right plan.
  • Medicare.gov Plan Finder: Enables side-by-side comparisons of coverage, costs, and provider networks specific to your ZIP code.

Financial assistance programs play a vital role in reducing healthcare expenses for many seniors:

  • Medicaid: Provides additional coverage for eligible low-income individuals.
  • Extra Help: Helps with Part D prescription drug costs for those who qualify.
  • Qualified Medicare Beneficiary (QMB) program: Covers Medicare premiums, deductibles, and coinsurance for qualifying beneficiaries.

Awareness of these local options and resources empowers seniors to make informed decisions during the open enrollment period and ensures they find the best fit when choosing or changing plan options.

How Elizabeth Bryson Insurance Group Can Help You with Your Medicare Plan Choices for 2026

Navigating Medicare options can feel overwhelming. Elizabeth Bryson Insurance Group is here to provide free Medicare counseling in Monument, CO, tailored to your individual needs.

Services Include:

  • Personalized Medicare enrollment assistance ensuring you select plans that fit your health needs and budget.
  • Educational workshops designed to clarify complex Medicare topics and empower you with knowledge.
  • Detailed comparisons of Medicare Advantage, Medigap, and Part D plans available in Northern El Paso County.

Consultation Options

Consultation options are flexible to match your preferences:

  • In-office meetings for face-to-face guidance in a comfortable setting.
  • Telephone consultations for those who prefer discussing their options from home.
  • Virtual Zoom sessions offering convenience without sacrificing personalized attention.

Elizabeth Bryson Insurance Group prioritizes clear communication and care, helping you avoid costly mistakes while maximizing your benefits. Whether you’re enrolling for the first time or reviewing your plan for 2026, Elizabeth’s dedicated support saves you time and money by thoroughly comparing carriers on your behalf. Reach out today to take advantage of expert assistance tailored just for you.