Medicare Open Enrollment in Central Ohio: The Six Weeks That Set Next Year's Bills
A thin envelope arrives before the end of September. Most families in Franklin, Delaware and Licking counties set it on the counter with the grocery ads. It is the only document all year that tells you exactly what your parent's coverage will cost in January.
The Envelope Nobody Opens
Every Medicare Advantage and Part D drug plan is required to mail an Annual Notice of Change — the ANOC — by September 30. It is not marketing. It is a legally required statement of what that same plan, the one your parent already has, will charge and cover starting January 1.
It reads like a phone bill and gets treated like one. And that is how a retired teacher in Gahanna ends up in February discovering that the drug she has taken for eleven years moved to a higher cost tier, or that the cardiology group she has seen since her bypass is no longer in her plan's network — changes that were printed on page four of a document that arrived in her mailbox in September, while there were still ten weeks to do something about it.
Between October 15 and December 7, that decision is fully reversible. On December 8 it is not. For most people the next opening is a limited one in the first quarter, and for some it is a full year away.
What the Window Actually Lets You Change
Medicare's Annual Enrollment Period runs October 15 through December 7, and anything selected during it takes effect January 1. Inside that window a beneficiary can:
- Join, switch, or drop a Medicare Advantage plan
- Join, switch, or drop a stand-alone Part D prescription drug plan
- Move from Original Medicare to Medicare Advantage, or back the other way
There is a second, narrower window — the Medicare Advantage Open Enrollment Period, January 1 through March 31 — that lets someone already enrolled in an Advantage plan switch to a different Advantage plan or return to Original Medicare. It does not allow a person on Original Medicare to join an Advantage plan, and it is a one-change opportunity, not a shopping season.
What the fall window does not do is open the Medicare Supplement market. That distinction costs Ohio families real money, and it gets its own section below.
What Is Changing for the 2027 Plan Year
Two Part D figures move for 2027, and both are worth knowing before comparing plans. The annual out-of-pocket cap on covered prescription drugs is set at $2,400 for 2027, up from $2,100 in 2026 — once a beneficiary's own spending on covered drugs reaches that ceiling, covered drugs cost nothing for the remainder of the year. The standard Part D deductible rises to $700 for 2027, up from $615.
Those are national parameters, not plan-specific ones. Individual plans set their own premiums, tiers and networks within the rules, and they vary substantially from one plan to the next across central Ohio. Treat the numbers above as the frame and the ANOC as the actual answer for the plan in front of you.
The other thing that moves every year, quietly, is which plans are offered at all. Insurers add, shrink and withdraw plans county by county, and a plan available in Franklin County is not automatically available in Madison or Pickaway County. If a plan is being discontinued, the notice arrives in the fall — and a discontinuation creates its own enrollment rights, so that letter is one to read the day it arrives, not in January.
The Four Things to Check, in Order
A useful review takes about ninety minutes with the ANOC, a current medication list, and a laptop. Work in this order, because the first two questions decide more than the premium ever will.
1. The drug list. Write down every prescription your parent takes, with exact dosages. Then run them through the official Plan Finder at medicare.gov, which prices each plan against that specific list at a specific pharmacy. A plan with a low premium and a bad formulary match is the most common expensive mistake families make. Check the pharmacy too — plans have preferred pharmacies, and the same drug can cost different amounts at a preferred versus a standard counter a mile apart.
2. The doctors and hospitals. If your parent is in a Medicare Advantage plan, networks are the whole ballgame. Central Ohio families are usually anchored to a health system and a set of specialists, and network participation is renegotiated annually. Do not rely on a plan's online directory alone; call the physician's office and ask whether they will be contracted with that specific plan for the coming year. Ask about the hospitals too, and about the skilled nursing facilities the plan uses after a hospital stay, because that is where a network gap does the most damage.
3. The real out-of-pocket exposure. Compare the plan's maximum out-of-pocket limit, the specialist copays, and the cost-sharing for a skilled nursing stay — not just the monthly premium. Many Advantage plans begin charging a daily copay for rehab far earlier than Original Medicare does.
4. Prior authorization. Ask what services require it. It is not a reason to reject a plan on its own, but it is a real difference in how quickly care gets approved when something urgent happens.
The Ohio Medigap Trap
Here is the single most misunderstood point of the season, and the one where an otherwise sensible October decision can close a door permanently.
Families often decide during open enrollment to leave a Medicare Advantage plan and return to Original Medicare — usually to escape a network or a prior-authorization fight. Returning to Original Medicare is straightforward. Buying the Medicare Supplement (Medigap) policy that makes Original Medicare affordable is not.
Ohio is not one of the handful of states that guarantee an annual right to buy or switch a Medigap policy. Outside of a protected enrollment window, an Ohio insurer may generally apply medical underwriting: it can ask health questions, and it can decline the application or charge more based on the answers. The strongest protection is the six-month Medigap open enrollment period that begins when someone is 65 or older and enrolled in Part B, and it does not come back.
Federal guaranteed-issue rights still exist in defined situations — among them the trial right for a person who joined a Medicare Advantage plan when first eligible for Medicare and leaves within twelve months, and certain plan terminations. Whether a given family qualifies is a specific factual question with a specific answer, and it should be answered before the Advantage plan is dropped, not after. This is exactly the question OSHIIP exists to answer, at no cost.
Where Central Ohio Families Get Free Help
The mailbox fills with plan advertising in October, and the television ads are relentless. None of it is neutral. Three sources are.
OSHIIP — the Ohio Senior Health Insurance Information Program, run by the Ohio Department of Insurance — provides free, one-on-one Medicare counseling and sells nothing. It has operated since 1992. Reach it at 1-800-686-1578, or find its fall Medicare Check-Up event calendar and virtual one-on-one appointment scheduler at insurance.ohio.gov. Sessions are held both in person and online, and the counselors will sit with an actual drug list rather than talk in generalities.
The Central Ohio Area Agency on Aging (COAAA) coordinates aging services across eight counties, including all seven this site covers — Franklin, Delaware, Fairfield, Licking, Madison, Pickaway and Union. Reach COAAA at 614-645-7250 or 1-800-589-7277 for connections to local benefits help and, often, to nearby counseling appointments.
Medicare itself answers at 1-800-MEDICARE twenty-four hours a day, and the Plan Finder at medicare.gov is the same tool the counselors use. It is free, it is official, and it prices plans against a real medication list in about fifteen minutes once the drugs are entered.
One practical warning worth repeating to a parent who lives alone: a legitimate Medicare representative will not call unannounced asking for a Medicare number, a bank account, or a credit card, and open enrollment season is peak season for people who do.
When Money Is the Constraint
If the honest problem is that the premiums and copays do not fit the budget, check two programs before concluding nothing can be done. Extra Help, the Part D Low-Income Subsidy, reduces or eliminates drug plan premiums, deductibles and copays for people under set income and resource limits and is applied for through the Social Security Administration. Medicare Savings Programs, administered in Ohio through Ohio Medicaid and county Job and Family Services offices, can cover Part B premiums and, at some levels, more. Limits are adjusted annually; verify the current figures rather than trusting a number from two years ago.
If a Move Is Coming
Families relocating a parent to central Ohio should know that a permanent address change to a new plan service area generally opens a Special Enrollment Period, so the parent is not stuck waiting for October. A move from Cincinnati or from out of state to a community in Westerville usually qualifies. A move from Upper Arlington to Dublin usually does not, because the service area has not changed. Report the address change to the plan and to Social Security promptly — the enrollment window tied to a move is time-limited.
A Six-Week Calendar That Works
Late September: find the ANOC and read the premium, deductible, out-of-pocket maximum and drug tier pages. Make the medication list, with dosages.
Early October: call each of your parent's doctors and ask about next year's plan participation. Book an OSHIIP appointment now — the calendar fills through October and November.
Mid-October to mid-November: run the medication list through the Plan Finder and compare the top two or three plans on total annual cost, not premium. Confirm the pharmacy.
By Thanksgiving: decide. Enroll. Waiting until the first week of December means competing for phone lines with everyone else who waited.
Early January: confirm the new card arrived, verify the plan shows correctly at the pharmacy on the first refill, and keep the old card until it does.
None of this is complicated work. It is simply work that has a deadline, arrives disguised as junk mail, and is worth more per hour than almost anything else a family will do for an aging parent this fall.
Frequently Asked Questions
When is Medicare open enrollment, and what does it actually let me change?
Medicare's Annual Enrollment Period runs October 15 through December 7 each year, and anything chosen in that window takes effect the following January 1. During it a beneficiary may join, switch or drop a Medicare Advantage plan, join, switch or drop a stand-alone Part D drug plan, or move between Original Medicare and Medicare Advantage. It is not, however, an open season for Medicare Supplement (Medigap) policies, which follow separate rules under Ohio law. A second, narrower window called the Medicare Advantage Open Enrollment Period runs January 1 through March 31 and allows someone already in an Advantage plan to switch to a different Advantage plan or return to Original Medicare.
My parent likes their plan. Do they still need to do anything before December 7?
Yes, at minimum they should read the Annual Notice of Change. Medicare Advantage and Part D plans must send that notice by September 30, and it lists next year's premium, deductible, copays, out-of-pocket maximum and formulary changes for the same plan. Liking a plan in 2026 says nothing about what that plan will charge in 2027, and the two changes that hurt central Ohio families most are quiet ones: a drug moving to a higher cost tier, and a physician group or hospital system leaving the plan network. Doing nothing renews the plan as it will exist next year, not as it exists today.
Can we switch from Medicare Advantage back to Original Medicare during open enrollment in Ohio?
Switching back to Original Medicare during the Annual Enrollment Period is allowed anywhere, including Ohio. The complication is the supplement. Ohio is not among the small number of states that guarantee an annual right to buy or change a Medicare Supplement policy, so outside of a protected enrollment window an Ohio insurer may generally use medical underwriting and may decline an applicant or charge more because of health history. Federal guaranteed-issue rights still apply in specific situations, including the trial right for someone who joined a Medicare Advantage plan when first eligible for Medicare and wants out within the first twelve months. Because the details decide the outcome, confirm the specific situation with OSHIIP before dropping Advantage coverage.
Where can a central Ohio family get free, unbiased Medicare help?
The Ohio Senior Health Insurance Information Program, known as OSHIIP, is run by the Ohio Department of Insurance and provides free one-on-one Medicare counseling. It sells nothing and earns no commission. OSHIIP can be reached at 1-800-686-1578, and it publishes a calendar of Medicare Check-Up events and virtual counseling appointments at insurance.ohio.gov each fall. The Central Ohio Area Agency on Aging, which coordinates services across eight counties including Franklin, Delaware, Fairfield, Licking, Madison, Pickaway and Union, can be reached at 614-645-7250 or 1-800-589-7277 and connects families to local benefit help. Medicare itself answers at 1-800-MEDICARE around the clock and hosts the official Plan Finder at medicare.gov.
My parent is moving to assisted living in Franklin County. Does that change their Medicare options?
It depends on where the move starts. A permanent move to a new address outside a plan's service area generally creates a Special Enrollment Period, so a parent relocating from another state or another region of Ohio to central Ohio can usually change plans outside the October to December window. A move across town, from Upper Arlington to a community in Westerville, typically does not, because the plan's service area has not changed. There is also a separate ongoing enrollment right for people moving into, living in, or moving out of an institution such as a skilled nursing facility, which is a narrower category than assisted living. Report the address change to the plan and to Social Security promptly, then verify with OSHIIP which window applies.
What help exists if the premiums and drug costs are more than my parent can afford?
Two federal programs are worth checking before assuming the answer is no. Extra Help, also called the Part D Low-Income Subsidy, reduces or eliminates drug plan premiums, deductibles and copays for people under set income and resource limits, and is applied for through the Social Security Administration. Medicare Savings Programs, administered in Ohio through Ohio Medicaid and county Job and Family Services offices, can pay Medicare Part B premiums and sometimes more. Income and asset limits change annually, so verify current figures rather than relying on numbers heard from a neighbor, and ask OSHIIP or the Central Ohio Area Agency on Aging to help with the application.
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