Medicare Open Enrollment Period (OEP) 2020

What Is the Medicare Open Enrollment Period (OEP) for 2020?

Each year, Medicare Advantage and Part D drug plan providers make changes that they announce in the Fall. Once these changes are announced, people enrolled in Medicare have the opportunity to review those changes and decide if the plan(s) they are currently enrolled in are the best options for them.

Starting in 2019, Medicare beneficiaries were able to take advantage of the Medicare Advantage Open Enrollment Period (OEP or MA OEP). The OEP runs January 1 through March 31 annually.

If you’re already enrolled in a Medicare Advantage Part C plan you can make a one-time change.

The OEP was reintroduced because beneficiaries were often confused about Medicare Advantage plans and made choices based on their lack of understanding which they later regretted.

For example, many people did not realize that Part C plans had networks, or that certain drugs might not be covered under a plan’s formulary, or that co-pays might be required.

Beneficiaries might also change their Part C plan is if they discover that their doctor was leaving their network or their network became more restrictive.

If you’re happy with your current coverage, you don’t need to do anything during the OEP.

What you can do during the Open Enrollment Period (OEP)

During the OEP, you can:

  • Change from one Medicare Advantage plan to another Medicare Advantage plan
  • Change from a Medicare Advantage plan with prescription drug coverage to Original Medicare with Part D prescription drug coverage
  • Change from Medicare Advantage to Original Medicare only, with the option to add a prescription drug plan

You cannot switch from one Part D plan to another during the OEP.

Why should I consider re-evaluating my current Medicare coverage during Open Enrollment?

Your health conditions and insurance needs may change from year to year. To make sure you have the coverage that is right for you, it’s critical to review your coverage after you know what changes are coming for the following year so that you can best protect yourself medically and financially.

Medicare plans can be complicated and confusing, so in addition to doing some of the analysis yourself, it’s often smart to work with a Medicare agent who is well versed in healthcare costs, benefits, and coverages.

You can also get answers to your questions by calling 1-800-MEDICARE or visiting the Medicare website.

How do I re-evaluate my current Medicare coverage during Open Enrollment?

Each fall that you are enrolled in Medicare, you’ll receive an Annual Notice of Change (ANOC) or an Evidence of Coverage (EOC) statement from Medicare or your provider.

These documents will advise you of any changes that are rolling out for the coming year to your policy. You will need to review what changes are taking place and match them up with your current and anticipated needs to decide if you want to make any changes.

If your current coverage still provides you with the best options, then you won’t need to do anything.

Changes to Medicare in 2020 

Several changes have gone into effect for Medicare for 2020:

  • The Part A premium is now $458 unless you qualify for Part A premium-free coverage (Part A is free if you or your spouse have 40 quarters or more of Medicare paid tax work history). Deductibles and coinsurance amounts are also higher.
  • The Part B premium has increased to $144.60 per month.
  • In an attempt to reduce Medicare costs, people who enter the program after January 1, 2020, will not be allowed to purchase Medicare Supplement plans that pay for the Part B deductible. You will have to pay the $198 deductible first. This change was made to try and save Medicare money by encouraging people to only visit the doctor when necessary.
  • Medicare Supplement Plan F and Plan C are no longer available if you became eligible after January 1, 2020. If you already are enrolled in Medicare Part A, and you have an existing Plan F or Plan C, you can keep those policies.
  • A Plan G High-Deductible is being introduced in 2020. Medicare will cover its portion, and you will pay your out-of-pocket costs the high deductible amount of $2,340. Once you have reached this deductible amount, your Medicare Supplement plan will pay the rest of the costs for your Medicare-approved treatment.
  • The Medicare Part D Donut Hole will begin closing in 2020. The Donut Hole is the part of your Part D plan with the highest costs. As the Donut Hole closes, your costs and the percentage that you pay in your coverage gap will go down. If you’re in the Donut Hole, you’ll get a bigger discount on brand-name and generic drugs until the Donut Hole is closed. For example, in 2019, Medicare paid for 56% of the price of your generic drugs and you were responsible for the remaining 44%. However, in 2020, the amount you’re responsible for will drop down to 25%.
  • The threshold for the Part D catastrophic coverage has increased to $6,350. Once you pass this threshold, your out-of-pocket spending decreases significantly.
  • The Medicare Plan Finder tool has been updated for the first time in ten years.
  • Changes have been made to Medicaid for 2020 and vary from state to state. To see what the changes to Medicaid are where you live, go here. 

Open Enrollment Period for Original Medicare (Part A and Part B)

There is also an Open Enrollment Period for Medicare Part A and Part B. It runs from October 15 through December 7 annually. It is often referred to as the Annual Enrollment Period (AEP).

During this period, you can enroll in health and drug plans if you did not sign up during your Initial Enrollment Period. Specifically, during this time: 

  • Anyone with Medicare Parts A and Part B can add a Part C plan.
  • Anyone with Medicare Part C can switch back to Part A and Part B.
  • Anyone who has or is signing up for Medicare Parts A or B can join, drop or switch a Part D prescription drug plan.
  • Anyone with Medicare Part C can switch to a new Part C plan.

With any of these changes, your coverage starts on January 1 of the following year.

If you sign up during the Original Medicare Open Enrollment Period instead of your IEP, you may have to pay penalties for both Part A and Part B coverage.

Open Enrollment Period for Medicare Prescription Drug Plans (Part D)

There are several times a year that you can enroll in a Medicare Part D prescription drug plan that are the equivalent of an open enrollment period.

The first of these is during your Initial Enrollment Period when you first turn 65. You have a 7-month period wrapped around your birthday and you must also enroll in Original Medicare during that time as well.

You can also enroll, make changes or drop your Part D plan during the Annual Enrollment Period that runs from October 15 through December 7.

During a Special Enrollment Period, which can take place at any time of the year when you have a qualifying event (i.e., moving from a plan service area or losing drug coverage through your employer, etc.), you can also make changes to your Part D coverage.

When you qualify for Medicare Extra Help you can also enroll in a Part D plan. Extra Help assists low income and limited asset people pay for prescription drugs.

Free Prescription Drug Card

Medicare Supplement (Medigap) Open Enrollment Period

If you’re 65 or older, your Medigap Open Enrollment Period starts on the first day of the month you enroll in Part B. Most people choose to enroll in Part B during their IEP to avoid premium penalties.

During your Medigap OEP, you have 6 months to buy any policy sold in your state. During the Medigap OEP, you also can’t be denied coverage, even if you have underlying health issues (guaranteed right issue).

If you apply after your Medigap OEP, you may be denied coverage or you may have to pay a higher premium. During Medigap OEP, you can buy any policy that a company sells for the same price as people who are in good health.

If you’re under 65, some states require Medigap insurers to sell you a policy. But the federal government does not. You’ll need to check with the laws in your state to see what the rules are.

Also, if you’re covered through an employer’s group insurance, you can enroll in Part B at a later date without an enrollment penalty. Your Medigap OEP would start at that time.

Some states may also let you buy a Medigap policy called Medicare SELECT. This policy requires you to use in-network hospitals and in some cases, in-network doctors to enjoy full benefits.

What to do if you miss the Medicare Open Enrollment Period

If you miss the OEP, you have a few options you can pursue, depending on your circumstances.

During the MA OEP, which runs from January 1 through March 31 annually, if you already have a Medicare Advantage plan, you can switch to another plan or disenroll from your current plan and revert back to Original Medicare, along with the option to enroll in a Part D plan.

You may also qualify for a Special Enrollment Period if you have an allowable life event (ie., you move, lose other coverage, etc.).

You may also be able to purchase a Medicare Supplement (Medigap) plan. Specific criteria also apply in this case as well.

Under Medicare’s rating system, beneficiaries can also switch to a five-star Medicare Advantage Plan or Medicare Prescription Drug Plan once per calendar year between December 8 and November 30. You cannot change to any plans that are not rated five stars. 

Other Medicare Enrollment Periods

You have several enrollment options throughout the year if you meet both general eligibility requirements and requirements that are specific to each enrollment period.

Medicare general eligibility requirements

Before you can enroll in Medicare, there are general requirements you must meet. They include:

You’re must be 65 or older and a US citizen. You also are eligible if you’re a permanent legal resident and you have lived in the United States for at least five consecutive years.

You can qualify if you’re under 65 and have certain disabilities or diseases.

You’re disabled and receiving Social Security Disability Insurance or Railroad Retirement disability insurance benefits. In most cases, there is a two-year waiting period when you first start receiving disability benefits, except for end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (Lou Gehrig’s disease or ALS).

If you have ESRD at any age and your kidneys no longer work, you need regular dialysis or you have had a kidney transplant you can qualify for benefits. You’re also eligible if you have ESRD and you worked the required amount of time as a government employee, under Social Security, or the Railroad Retirement Board. In addition, you also qualify if you’re the spouse or dependent child who meets any of these requirements as well.

If you have been diagnosed with ALS, there is no waiting period. Medicare benefits kick in when your SSDI benefits begin.

Medicare Part A is generally free if you or your spouse paid enough Medicare taxes during your working lives. For free Part A, you must have paid taxes at least 40 quarters (10 years). If you didn’t pay taxes for that long, you can still qualify for Part A, but you’ll have to pay a premium in most cases. 

Initial Enrollment Period

Most people enroll in Medicare when they turn 65 during their Initial Enrollment Period (IEP). Your IEP is a seven-month window that begins three months before the month you turn 65, includes the month you turn 65, and the three months afterward. You are actually enrolled in Medicare the first day of the month you turn 65. 

If you’re already getting Social Security or Railroad Retirement Board benefits at 65, then you’re automatically enrolled in Part A and Part B Medicare. You will be mailed a Medicare card three months before you turn 65.

Otherwise, you’ll have to enroll on your own.

If you don’t qualify for free Part A coverage, you can still sign up during your IEP, but you will have to pay a premium unless you qualify for financial relief. The amount of your premium will vary depending on how long you worked and paid Medicare taxes. 

Also, if you don’t enroll during your IEP, you may have to pay a premium penalty for both Part A and Part B if you decide to enroll later on. You could also have a gap in coverage if you don’t enroll during your IEP.

During your IEP, you can also enroll in Part C and Part D Prescription coverage as long as you also enroll in Part A and Part B coverage.

People who already have Medicare before 65 due to a disability have another Part D IEP for when they turn 65 years old.

Special Enrollment Period (SEP)

If you delay enrolling in Part B because you or your spouse already have employer group coverage, you can enroll in Part B during a Special Enrollment Period (SEP). You also qualify for a SEP when you stop working or your employer no longer covers you.

The SEP can take place at any time throughout the year and is the 8-month period after the end of your employment or your employer’s group coverage, including COBRA, whichever is earlier.

If you qualify to enroll during your SEP, you don’t have to pay a late enrollment penalty that you would normally pay if you didn’t sign up during your IEP.

If you’re younger than 65 and you become eligible for Medicare because you are disabled but you also have coverage through you or your spouse’s employer, you can also delay enrollment in Part B.

However, if you have ESRD, you will not have the same SEP. Different rules will apply.

For Part C and Part D coverage, a SEP will apply in several situations, including:

  • If you move and you have different insurance options, your SEP will allow you to either change plans or revert back to Original Medicare.
  • If coverage ends through your employer or your union group health plan, you have a 2 month SEP that starts the month after your coverage ends.
  • If you’re eligible for Medicaid, you have an open-ended SEP to enroll or change Part C or Part D plans.
  • If you lose your Medicaid benefits, you have a 3-month SEP to switch to a Part C and Part D plan This starts the month you’re notified that you are losing Medicaid eligibility.
  • If you qualify for Extra Help (low-income subsidies), you have an open-ended SEP for as long as you qualify for Extra Help. When you no longer qualify for Extra Help, you have a 3-month SEP starting the month you’re notified you are losing your low-income subsidy.
  • If you live in an area with a Part C or Part D plan that has a plan performance rating of 5 stars, you can join that plan from December 8 through November 30.

There are other instances that allow you to use SEPs to enroll in Part C and Part D coverage. Your best bet is to contact Medicare to see whether you qualify or not.

General Enrollment Period (GEP)

You can sign up for Medicare Part A and Part B during the General Enrollment Period (GEP) if you miss your IEP. The GEP runs from January 1 through March 31 annually and your coverage begins the following July 1.

When you enroll during the GEP, you might have to pay late enrollment penalties.

For Part A, these penalties increase by 10% for twice the number of years you could have been enrolled but chose not to do so. For example, if you delay signing up for Part A by two years, you would have to pay a Part A late enrollment penalty for four years.

Your Part B premium could also go up 10% for every 12-month period you were eligible but did not enroll. Delaying Part B enrollment for two years means you would pay a 20% enrollment penalty for as long as you’re enrolled in Part B from that point on.

What will Medicare cost in 2020?

If you qualify, Part A coverage will continue to be free. Otherwise, you could pay as much as $458 in premiums. You’ll also have deductibles and copays as well. Those will vary depending on which services you use.

For Part B, the standard monthly premium is $144.60 for 2020. This is a bump up by $9.10 from 2109. Some beneficiaries won’t pay the full standard premium because of a provision that prevents Part B premiums from rising more than their Social Security cost-of-living adjustment.

The annual Part B deductible is now $198, up $13 from 2019.

You may also have to pay extra based on income-related adjustment amounts. This is expected to impact about 7% of all beneficiaries.

Part C and Part D drug costs, and Supplemental Plans will also vary depending on which plan and coverage you choose.

Compare medicare plans for 2020

Enrolling in the right types of coverage for your particular circumstances is essential to making sure you’re fully covered in a financially responsible way.

There are a lot of decisions you may have to make based on the number of choices available to you.

It is a process that will require you to do your homework, compare coverages, decide if you need added coverage, and then determine how much you’ll have to pay.

You can start your due diligence on the Medicare website. Review your plan options and use the Medicare Plan Finder tool.

After you learn more about what’s available and have an idea of what you’ll want for coverage, reach out to an experienced Medicare agent to walk you through the pros and cons, specific benefits, costs, and how each type of insurance you have will work to give you maximum protection.

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