When Can You Change Medicare Plans?
Key Takeaways
- Medicare plans can only be changed during specific enrollment periods: the Annual Enrollment Period (Oct. 15–Dec. 7), the Medicare Advantage Open Enrollment Period (Jan. 1–Mar. 31), or during a Special Enrollment Period triggered by qualifying life events.
- Factors like changing health needs, plan costs or coverage, a doctor leaving your network, dissatisfaction with your insurance company, or relocating may prompt you to explore new Medicare plan options.
- When evaluating plans, consider costs, provider networks, prescription drug coverage, and the reputation of the insurance company. Working with a licensed agent or broker can help ensure you find a plan suited to your needs and budget.
You can only change your Medicare plan during an enrollment period. Anyone with Medicare can adjust their coverage during the Annual Enrollment Period, which lasts about eight weeks and runs from October to December. People with Medicare Advantage have another enrollment period every January through March.
Outside of these times, you cannot change Medicare plans unless you qualify for a Special Enrollment Period. Learn when each period occurs, what you can do, and how to prepare so you can mark your calendars for the next enrollment period.
Why Change Medicare Plans?
Your budget, health, and living situation may all change in the months and years after you first enroll in Medicare. If you have not changed your Medicare coverage in a few years, it is possible that your current plan may no longer be the best one for your needs. Consider the following common reasons for changing Medicare plans.
- Your priorities change. Maybe you’re seeking a specific benefit, or you received a diagnosis that your plan doesn’t adequately cover.
- Your plan changes. Private Medicare Advantage plans can change costs, coverage, or preferred providers yearly.
- Your doctor leaves the network. Medicare Advantage plans utilize healthcare networks, providing coverage for services if you seek doctors, hospitals, and pharmacies within their networks. If your preferred doctor leaves the network, change your plan to the one they join.
- You aren’t satisfied with your insurance company. If your insurer is challenging to work with, you might look for better customer service elsewhere.
- You moved. Your plan options depend on your location.
If you aren’t satisfied with your Medicare plan, each enrollment period presents an opportunity to reconsider your options. Changing from Original Medicare to Medicare Advantage has increased since 2016, with about 7.4% of Medicare beneficiaries switching in 2022. In comparison, about 1.2% of consumers switched to Original Medicare.
Even if you don’t intend to change plans, you might benefit from shopping around during the enrollment periods. You may discover a better match for your healthcare needs or budget. Keep in mind, though, that you can only change your plan during scheduled enrollment periods unless you qualify for a Special Enrollment Period.
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Enrollment Periods to Change Your Medicare Plan
There are two scheduled enrollment periods: the Annual Enrollment Period and Medicare Advantage Open Enrollment Period. The third enrollment period only occurs when you experience a qualifying life event.
Annual Enrollment Period (AEP)
- When: October 15 – December 7
- Who is eligible: Anyone with Medicare or Medicare Advantage
- What you can do:
- Switch from Original Medicare to Medicare Advantage
- Switch from one Medicare Advantage plan to another
- Switch from Medicare Advantage back to Original Medicare
- Join a Part D plan if you switched back to Original Medicare
- Switch from one Part D plan to another
During AEP, all parts of Medicare are open, meaning you can change your Original Medicare, Medicare Advantage, or prescription drug coverage.
This period is typically the easiest time to change your plan, and it’s the only recurring enrollment period for people with Original Medicare. Any changes you make go into effect January 1. If you don’t make any changes, your existing plan will renew automatically.
Medicare Advantage Open Enrollment Period (MAOEP)
- When: January 1 – March 31
- Who is eligible: Anyone with Medicare Advantage
- What you can do:
- Switch from one Medicare Advantage plan to another
- Switch from Medicare Advantage back to Original Medicare
- Join a Part D plan if you switched back to Original Medicare
MAOEP allows people with Medicare Advantage to change insurance plans or companies. You cannot join Medicare Advantage for the first time during this period. However, if you switched from Original Medicare to Medicare Advantage during AEP and then changed your mind, you can switch back during MAOEP. You can also purchase a Part D prescription drug plan. Your new coverage starts the first of the month after the plan receives your request.
Special Enrollment Period (SEP)
If you experience a qualifying life event, you can change your healthcare plan outside the standard enrollment periods. Common qualifying life events include:
- Moving to a new address
- Moving into or out of a healthcare facility
- Gaining or losing Medicaid eligibility
- Leaving employer-sponsored coverage
- Getting diagnosed with a chronic condition
- Gaining or losing eligibility for Extra Help
- Your plan changing its contract with Medicare
In most scenarios, you can join or switch Medicare Advantage and Part D plans. However, the exact timing and rules depend on your situation. Changes typically go into effect the month after you choose a new plan.
How to Explore Your Medicare Plan Options
If you’re ready to change your plan or explore your options, set a reminder for Medicare’s enrollment periods. As you shop around, consider the following factors.
- Cost. Ensure you understand the plan’s monthly premium, deductibles, and cost-sharing structure.
Preferred provider network. If you choose a Medicare Advantage or Part D plan, check whether your preferred healthcare providers are considered in network. - Prescription drugs. Confirm that your Medicare Advantage or separate Part D plan covers your medications.
- Insurance company reputation. Look for reputable companies with a strong track record of fair service.
Original Medicare vs. Medicare Advantage
Enrollment periods also allow you to reevaluate whether you want Original Medicare or a Medicare Advantage plan, or whether you want to change from your current Medicare Advantage plan to another.
Original Medicare and Medicare Advantage offer the same basic coverage, but Medicare Advantage plans are offered by private insurance companies and typically bundle Part A and Part B benefits with Part D prescription drug coverage. However, these plans may charge an additional premium and they can set their own costs and coverage terms. Most plans also require you to see in-network healthcare providers.
If you want to change your plan during an enrollment period, consider working with a licensed insurance agent or broker. They can help you evaluate your current and future needs, shop around, and find a plan that fits your budget.
What You’ll Need to Change Medicare Plans
- Social Security Number: You’ll need to prove your identity to apply for a new plan.
- Medicare Number: Keep your Medicare card handy. You need to provide your Medicare number for the licensed insurance agent or broker to verify your enrollment status.
- Current plan information: To make an informed decision, make sure you understand your current costs and benefits.
- Benefits, budget, and other preferences: List out your must-haves to guide your research and narrow down your options.
Putting It All Together
Medicare offers two enrollment periods each year: AEP, when all parts of Medicare are open, and MAOEP, which applies to Medicare Advantage and Part D plans. Otherwise, you can only change your Medicare plan if you qualify for a Special Enrollment Period. If you’re considering switching Medicare plans, a licensed insurance broker or agent can help you navigate your options during an enrollment period.
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Sources
Medicare Switching. HealthAffairs.org