Chelsea Lang calls it “the Medicare maze.” Lang is the benefits counseling supervisor at the Dallas Area Agency on Aging. A big part of her job is helping people understand their Medicare options so they can pick the plans and coverage that works best for them. And that means she’s very familiar with how overwhelming the process can be for the people who come to her office. “Once they get to ...

Everyone must review their current Medicare coverage and see what changes are coming to their current coverage for 2027.

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Chelsea Lang calls it “the Medicare maze.”

Lang is the benefits counseling supervisor at the Dallas Area Agency on Aging. A big part of her job is helping people understand their Medicare options so they can pick the plans and coverage that works best for them.

And that means she’s very familiar with how overwhelming the process can be for the people who come to her office.

“Once they get to us,” Lang said, “they’re pretty much confused.”

Wading though the Medicare enrollment — or re-enrollment — process can be both time-consuming and draining. That’s probably a big part of why, according to research from KFF, the vast majority of Medicare beneficiaries don’t review their coverage. During the 2021 open enrollment period, that research found, about 7 in 10 beneficiaries did not compare their options.

It’s vitally important for seniors and other Medicare beneficiaries to pick options that work for them — so they can keep seeing their existing providers and have the coverage they need for predictable and unexpected healthcare needs.

Medicare open enrollment season is here. Here are some things you should know, to make the maze a little easier to navigate.

Who does open enrollment apply to?

Medicare’s open enrollment season runs from Oct. 15 through Dec. 7. Coverage selections made during this period will take effect on Jan. 1.

Open enrollment is the annual period during which Medicare enrollees can make changes to their coverage. Enrollees can switch from Medicare Advantage to Original Medicare (or the other way around); they can switch from one Medicare Advantage plan to another; or they can switch between drug coverage plans.

Open enrollment is not to be confused with the initial enrollment period, which is different for each individual person.

The initial enrollment period is for people who have just become eligible for Medicare. For many people, that happens when they turn 65.

For those folks, the initial enrollment period begins three months before their 65th birthday and extends three months after their 65th birthday. For example, a person who turns 65 on June 15 would have an initial enrollment period that runs from the beginning of March through the end of September.

There is one exception: For birthdays on the first day of a month, the initial enrollment period begins four months before and extends two months after. For example, a person who turns 65 on June 1 would have an initial enrollment period that runs from the beginning of February to the end of August.

If you are just becoming eligible for Medicare, your initial enrollment period may overlap with the open enrollment period. These two time frames, however, are calculated separately.

If you miss your initial enrollment period, you may face late enrollment penalties.

How do I avoid penalties for late enrollment?

The easiest way to avoid penalties for late enrollment is to sign up for Medicare coverage during your initial enrollment period.

However, some people may put off Medicare enrollment beyond their 65th birthday because they still have employer-provided insurance. In that case, your initial enrollment period is effectively deferred.

You will instead be eligible to enroll in Medicare up to eight months after your other coverage or employment ends.

Carl Burlbaw, senior insurance counselor at The Senior Source in Dallas, said most folks in this situation can enroll in Medicare Part A, which comes at no cost for many people. That way, Part A can be used as secondary insurance while employer-provided insurance is still in effect.

Note that there are exceptions to this for employees of companies with fewer than 20 employees.

What are the different “Parts” of Medicare?

Medicare coverage is split into different “Parts.”

—Part A: Hospital coverage, largely for inpatient medical care, as well as hospice and home health.

—Part B: Medical coverage, for most outpatient services. This part also covers durable medical equipment — such as wheelchairs and walkers — and home health.

—Part C: Medicare Advantage plans, which are covered in more detail below. Part C is not required, and is an alternate path that typically provides Part A, Part B and Part D together, through a private insurer.

—Part D: Prescription drug coverage.

—Medigap: Supplemental insurance from a private insurer, to help cover the costs of Original Medicare. Note that this cannot be combined with a Medicare Advantage plan (Part C).

That’s a lot! Said more simply: Part A is inpatient care, Part B is outpatient care, Part D is drug coverage and Part C is a private, alternate plan that offers bundles of Parts A, B and D.

What is Medicare Advantage?

One of the biggest points of confusion for new enrollees is Original Medicare vs. Medicare Advantage.

When people talk about “Original Medicare,” they mean the traditional Part A and Part B, which is inpatient and outpatient coverage. Part D, drug coverage, can also be selected separately for enrollees of Original Medicare.

However, enrollees can instead opt for Medicare Advantage (Part C) plans. These are still Medicare plans, but they are administered by private insurers. These plans bundle Part A and Part B together, and often include Part D as well.

Medicare Advantage plans may also often offer benefits that aren’t included under Original Medicare, such as vision and dental or gym memberships.

There are a whole range of Medicare Advantage plans, with various added benefits and with various price tags associated.

Medicare Advantage plans are designed to cover all the same medically necessary services that Original Medicare covers. However, the private versions of the plans may require prior authorization for some services or prescriptions.

Medicare Advantage enrollees are also not eligible for Medigap, the supplemental insurance that’s designed to help cover costs for Original Medicare.

More on that below.

Can I switch from Medicare Advantage to traditional Medicare?

There are a couple things folks should know before they choose a Medicare Advantage plan, and if they’re considering switching from Medicare Advantage to traditional Medicare.

First, you can switch from Medicare Advantage to traditional Medicare.

But, second, there are some considerations in making that switch.

Enrollees of traditional Medicare also have the option to enroll in Medigap, which is a supplemental insurance plan that helps with the cost of deductibles, co-pays and the like. Upon enrollment, a new enrollee has a six-month “guaranteed issue” period for Medigap. During that period, enrollees can purchase any Medigap plan, regardless of the enrollee’s pre-existing conditions.

In other words, during that “guaranteed issue” period, purchasing Medigap will cost less for most enrollees.

If, however, an enrollee wants to add Medigap after that “guaranteed issue” period, they will be subject to the underwriting process. The insurance carriers will be able to evaluate the enrollee’s existing conditions and set a higher price — or deny access to certain plans — because of that.

For folks with Medicare Advantage plans, then, switching to traditional Medicare is completely allowed and doable. But if they need or want Medigap as well, they may face steeper costs.

How do I pick a good option for me?

Both Burlbaw and Lang said the top consideration for most enrollees will be making sure their existing medical providers accept their selected health coverage plan.

The vast majority of providers accept Original Medicare, but Medicare Advantage plans will vary. If you select a plan that is not accepted by your existing medical providers, you may need to change providers.

“If it doesn't allow you to see your doctors or your providers or get the treatments you need,” Burlbaw said, “then it's not working for you.”

During open enrollment season, Burlbaw said, seniors are often inundated with Medicare-related ads and phone calls, especially for Medicare Advantage plans. He advised ignoring those advertisements.

It’s not that plans with advertisements are necessarily a bad choice, but that basing a decision on ads may cause you to overlook downsides to a plan or miss a better-suited plan. Instead, Burlbaw and Lang both advocated for finding unbiased resources. More on that below.

Lang pointed to a related scenario she sees often: Enrollees picking plans because a family member or friend is on that plan. Lang discouraged this type of decision-making, too, because everyone’s needs are different.

Do I really need to look at my coverage each year?

If you’re already enrolled in coverage, you’re not necessarily required to review your selection heading into the new year. Many, many enrollees don’t review their options during open enrollment.

But Burlbaw encourages all enrollees to do so.

“It’s worth the time,” Burlbaw said.

Plans may change, in coverage or in cost, from year to year. And your needs may change, too, as your medical care shifts or if you’re given new prescriptions.

The plan that was best for you this year might not be best for you next year.

Lang similarly said everyone should look at their plans each year, and should pay attention to any notices they’re sent about changes to their coverage.

Lang said she works with some enrollees who see her each year to review their coverage.

Where can I go if I need additional help?

The Medicare maze can be overwhelming. There are resources out there to help you navigate it better.

First, the federally run website medicare.gov has explainers on the various choices you make during the enrollment or re-enrollment process. The plan finder tool is also a useful resource, and will ask you a series of questions to narrow down your options.

From the Medicare homepage, there’s also an option to talk with someone, which will give you options to live chat online or to call 1-800-MEDICARE.