Jeffrey Wade
There are certain times when you can change your Medicare insurance plan, known as enrollment periods. The main one is the Medicare Annual Enrollment Period, which runs from October 15 to December 7 each year. During this time, anyone with Medicare can make coverage changes that will take effect the following year. There is also a Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year. To be eligible to make changes during this time, you must already be enrolled in a Medicare Advantage plan. Additionally, you may be able to change your Medicare plan outside of these enrollment periods if you experience a qualifying life event, such as moving to a new location that is outside of your current plan's service area, losing other coverage, or having your medication denied at the pharmacy because it is not covered by your plan.
| Characteristics | Values |
|---|---|
| Medicare Annual Enrollment Period | October 15 to December 7 each year |
| Medicare Advantage Open Enrollment Period | January 1 to March 31 each year |
| Special Enrollment Periods | When certain life events happen, like moving or losing coverage |
| Switching between Medigap plans | Any time, but a one-time 6-month open enrollment period is available when you turn 65 |
| Switching between Medicare Advantage or Part D plans | Monthly, for beneficiaries in institutions like nursing homes |
| Switching between Medicare Advantage plans | Within the first 3 months of having Medicare Part A and B |
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What You'll Learn
Medicare Annual Enrollment Period (October 15 to December 7)
The Medicare Annual Enrollment Period, also known as the Medicare Open Enrollment Period, takes place from October 15 to December 7 every year. During this period, individuals can make changes to their existing Medicare coverage or enroll in a new healthcare or prescription drug plan. This includes switching from traditional Medicare to a Medicare Advantage plan, or vice versa, as well as changing from a Medicare Advantage plan with drug coverage to one without, or the other way around.
It is important to note that any changes made during the Annual Enrollment Period will take effect on January 1 of the following year. For those who are happy with their current coverage, there is no need to make any changes, as most Medicare plans will automatically renew on January 1.
In addition to the Annual Enrollment Period, there are other opportunities to make changes to Medicare coverage throughout the year, known as Special Enrollment Periods (SEPs). These periods are triggered by certain life events, such as moving to a new location outside of your current plan's service area, losing other coverage, or Medicare terminating your current Medicare Advantage plan. For example, if you lose creditable coverage or your coverage becomes non-creditable, you have two full months after the month you lose coverage or receive notification to join a Medicare Advantage Plan with or without drug coverage or a standalone Medicare drug plan.
Some beneficiaries, such as those in nursing homes, can change their coverage from month to month. Additionally, those with Medicare Advantage plans have a second Open Enrollment Period from January 1 to March 31, during which they can switch to another Medicare Advantage plan or to traditional Medicare. This period is not available to those with traditional Medicare unless they switch to a Medicare Advantage plan before January 1.
When an individual turns 65, they enter their Initial Enrollment Period, which lasts for seven months, including the three months before and after their birthday month. During this time, they can enroll in original Medicare Parts A and B, a Medicare Advantage plan, or a standalone Medicare prescription drug plan.
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Medicare Advantage Open Enrollment Period (January 1 to March 31)
Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31, is the second Open Enrollment Period specifically for people already enrolled in a Medicare Advantage plan. During this time, you can make changes to your existing Medicare Advantage plan or disenroll from your current plan and return to Original Medicare.
The Medicare Advantage Open Enrollment Period is different from the Medicare Annual Enrollment period, which runs from October 15 to December 7. The Annual Enrollment period is for anyone who has Medicare and wants to make coverage changes for the upcoming year. In contrast, the Medicare Advantage Open Enrollment Period is only for those enrolled in a Medicare Advantage plan.
During the Medicare Advantage Open Enrollment Period, you can switch from Medicare Advantage to Original Medicare or vice versa. You can also switch from your current Medicare Advantage plan to another Medicare Advantage plan.
Special Enrollment Periods (SEPs) are also available outside of the standard enrollment periods. SEPs allow you to make changes to your Medicare Advantage and Medicare drug coverage when certain life events occur, such as moving to a new location outside your current plan's service area, losing other coverage, or experiencing a significant change in your current coverage.
Additionally, some beneficiaries can change their coverage on a quarterly or even monthly basis. For example, beneficiaries in certain institutions, such as nursing homes, can switch Medicare Advantage or Part D plans once a month for as long as they reside there.
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Special Enrollment Periods (triggered by life events)
Special Enrollment Periods (SEP) allow you to make changes to your Medicare Advantage and Medicare drug coverage when certain events happen in your life. These life events trigger a chance to switch plans or sign up for Medicare outside of the standard Medicare enrollment periods.
- Moving to a new location: If you move to a new address that is outside of your current plan's service area, you may qualify for an SEP. You can either switch to a new Medicare Advantage Plan or Medicare drug plan, or choose to go back to Original Medicare. Your chance to switch plans begins when you move and continues for two full months after you move. If you notify your plan before moving, your chance to switch starts one month before you move and continues for two full months after.
- Loss of coverage: Losing other drug coverage that is as good as Medicare drug coverage (creditable coverage) may trigger an SEP. This includes losing coverage due to termination of Medicaid eligibility or Medicare terminating its contract with your private insurer. You will have two full months after the month you lose your creditable coverage, or two full months after being notified that your current coverage is no longer creditable, to make changes.
- Change in plan's provider network: If there is a significant change in your plan's provider network, you may qualify for an SEP. This includes situations where you joined a plan based on misleading or incorrect information from a plan representative or a State Health Insurance Assistance Program.
- Living abroad: If you are moving back to the US after living abroad, you may be eligible for an SEP.
- Living in an institution: If you live in certain institutions, such as nursing homes, you may be able to switch Medicare Advantage or Part D plans once a month for as long as you live there.
- Working past 65: If you are working past the age of 65 and qualify to delay Medicare with creditable employer coverage, you may be eligible for an eight-month Special Enrollment Period to enroll in Part A, Part B, Part C, and Part D without late penalties. However, you only have the first two months of this period to enroll in Part C or Part D without penalty.
It is important to note that the types of changes you can make and the timing of your Special Enrollment Period may depend on your specific life event. If you have questions or need help making enrollment changes, you can call 1-800-MEDICARE (1-800-633-4227) for assistance.
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Switching Medigap plans (possible at any time)
Switching Medigap plans is possible at any time, but there are certain windows of time that are better for switching than others. For example, if you are enrolled in a Medicare Advantage plan and would like to switch to traditional Medicare, you may do so during the Medicare Open Enrollment period, which runs from October 15 through December 7 each year. During this time, you can also switch to another Medicare Advantage plan. If you are enrolled in traditional Medicare, you can switch Part D plans or switch to a Medicare Advantage plan during the same Medicare Open Enrollment period. There is also a second Open Enrollment Period for those in Medicare Advantage plans, which runs from January 1 through March 31.
Medigap plans are standardized policies that can help reduce the out-of-pocket costs of Medicare. People can only have Medigap alongside Original Medicare and cannot enroll if they have Medicare Advantage. There is a one-time six-month open enrollment period for Medigap that starts when an individual is 65 years old and has a Medicare Part B plan. This is generally the most cost-effective time to switch between Medigap plans, as an insurance company cannot deny coverage or charge more due to any pre-existing health conditions. During this time, if you buy a Medigap policy and decide you don’t like it, you can switch to a different Medigap policy.
Outside of the open enrollment period, you can still switch Medigap plans, but you may have to pay a higher premium. There are certain situations that qualify you for a Special Enrollment Period (SEP) that allows you to switch plans. These include moving to a new location outside of your current plan's service area, moving back to the U.S. after living abroad, moving into or out of a facility, or termination of Medicaid eligibility. Some beneficiaries can also change coverage on a quarterly basis, including enrollees who receive assistance from Medicaid and enrollees who receive help paying their Medicare drug plan premiums.
If you switch Medigap plans, you should apply directly with the private insurer that provides the new plan. If your application is accepted, you should then notify your current insurance company that you wish to switch. By law, there is a 30-day "free look" or trial period, during which you can cancel your plan and receive a refund if you are unsatisfied.
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Medicare supplemental insurance (possible at any time)
Medicare Supplement Insurance, also known as Medigap, is extra insurance that can be purchased from a private health insurance company. It helps to cover out-of-pocket costs in Original Medicare, such as coinsurance, copayments, and deductibles. Medigap policies are standardized, meaning policies with the same letter offer identical basic benefits, regardless of the insurance company. The price is the only difference between policies with the same letter sold by different companies.
You can switch between Medigap plans at any time, although you may have to pay a higher premium. It is important to note that you can only buy Medigap if you have Original Medicare (Part A and Part B). Additionally, you get a one-time, 6-month open enrollment period for Medigap that starts when you turn 65 and have Medicare Part B. During this period, insurance companies cannot deny coverage or charge more due to pre-existing health conditions. After this period, purchasing a Medigap policy may be more difficult or expensive.
Some beneficiaries can change their coverage on a quarterly or monthly basis. For example, enrollees receiving assistance from Medicaid can switch plans once per calendar quarter in the first three quarters of the year. Additionally, beneficiaries in certain institutions, such as nursing homes, can switch plans once a month for as long as they reside there.
Special Enrollment Periods (SEPs) also allow individuals to make changes to their Medicare Advantage and drug coverage when specific life events occur, such as moving to a new location outside of their current plan's service area or losing other creditable coverage. During an SEP, individuals have the opportunity to join a Medicare Advantage Plan or a Medicare drug plan. The timing and types of changes permitted depend on the specific life event that triggered the SEP.
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Frequently asked questions
The Medicare Annual Enrollment Period runs from October 15 to December 7 each year.
The Medicare Advantage Open Enrollment Period runs from January 1 to March 31 each year.
Yes, you can change your Medicare plan at any time during the year if you qualify for a Special Enrollment Period (SEP). An SEP may be triggered by a qualifying life event, such as moving to a new address outside of your current plan's service area, losing coverage, or experiencing a natural disaster or emergency.
There is no explicit limit to the number of times you can change your Medicare plan during the year, as long as you are eligible for an enrollment period. However, keep in mind that switching plans too frequently may impact your coverage and benefits.
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