Choosing a Medicare plan can be a confusing process. Despite your best efforts, it’s possible your needs may change, or you may choose a plan that doesn’t work for you.
The good news is that every year, you have the option to change your plan during what’s called the annual “election” or “open enrollment” period. This period runs from October 15 to December 15, with coverage changes taking effect on January 1 of the following year.
It’s even possible to change your Medicare plan outside of the annual election period if you meet certain criteria.
In this article, we cover everything you need to know about switching your original Medicare, Medicare Advantage, Medicare Part D, and Medigap plans.
Medicare Part A and B are what’s known as “original Medicare.” These parts cover inpatient hospital care (Part A) and outpatient care and equipment (Part B). When you turn 65, you are automatically enrolled in Part A. If you have health insurance benefits through your employer or spouse, you don’t have to enroll in Part B when you turn 65.
If you have original Medicare (Medicare parts A and B), you can choose to enroll in a Medicare Advantage Plan (Medicare Part C) during the annual election period of October 15 to December 7.
If you are new to Medicare, you can switch out of original Medicare and into a Part C plan during the 7 months called the Initial Enrollment Period (IEP) when you first become Medicare-eligible.
If you want to disenroll from Medicare Part C and return to original Medicare, you can do so during the Annual Election Period (October 15 to December 7) or during the Medicare Advantage Open Enrollment Period (January 1 to March 31).
Medicare Part D covers prescription drugs. Part D plans are sold by private insurance companies.
If you already have Medicare and want to enroll in a Medicare Part D prescription plan, you can usually only do so during the Annual Enrollment Period (October 15 to December 7) each year. Typically, you can only switch once per year.
If you are enrolling in Medicare Part D for the first time during a time that is not the original enrollment period when you first become Medicare-eligible, the time to enroll is April 1 to June 30.
If you qualify for the Extra Help program that assists with the costs of Medicare Part D, you can switch into a different plan at any time.
If you have any of the following circumstances, Medicare will make an exception so that you can switch plans and maintain prescription drug coverage:
- you move out of your plan’s coverage area
- you need to move into a nursing home or assisted care facility
- you discover that your current Part D plan is ending its coverage
Medicare Advantage (Medicare Part C) plans are private insurance policies that are legally required to cover everything that Medicare covers. Sometimes, these plans cover things that original Medicare doesn’t cover. Monthly premiums for Part C plans may be higher than the premiums for original Medicare.
You can switch from one Medicare Advantage Plan to another, or disenroll from Medical Advantage and go back to original Medicare, during the Annual Election Period (October 15 to December 7) or the Medicare Advantage Open Enrollment Period (January 1 to March 31).
Medicare Supplement plans, also called Medigap, cover some Medicare-associated costs, like co-pays, coinsurance, and deductibles. When you enroll in Medicare, you have a one-time window when you can enroll in any Medigap plan you’d like without any required medical underwriting. This means your medical history cannot be used to refuse coverage.
If you want to switch Medigap plans later, you can theoretically switch at any time. However, this is something you’ll have to work out with the private insurance companies who sell the Medicare Supplement Plan that you are considering, and they have the right to deny you coverage based on any pre-existing condition that you might have.
If you switch Medigap policies, it’s important to communicate with your previous insurance company as well as your new insurance company. Medigap providers are required to give you a 30-day “free look” so you can decide if you want to keep your new policy or switch plans. Keep in mind that the “free look” isn’t exactly free – you have to pay the premiums for both policies during the month you try out your new provider.
You can enroll in original Medicare (parts A and B) starting 3 months before, the month of, and three months after your 65th birthday. During this enrollment period, you can choose any Medicare, Medicare Advantage, or Medicare Part D plan that you would like, regardless of your health history and the time of year.
You can enroll in Medigap (Medicare Supplement) during the original enrollment period when you become eligible for Medicare. You can try to switch plans later during any time of the year, but there is no guarantee that your application will be accepted by the Medigap provider with whom you wish to enroll.
If you miss your original enrollment period, you can enroll in a Medicare plan or a Medicare Advantage policy from January 1 to March 31 of each year. Keep in mind that there may be penalties and fees for not signing up when you are first eligible, and coverage won’t start until July 1.
Medicare Part D enrollment
If you decline prescription coverage when you are first eligible for Medicare, you can enroll in a Part D plan from April 1 to June 30 every year. There is a late enrollment penalty if you go without prescription drug coverage for more than 63 days after you are first eligible, and you may be required to pay a permanent penalty based on how long you have gone without coverage.
Plan change enrollment
During the open enrollment period each year, you can enroll in, drop out of, or change Medicare Advantage plan or prescription coverage. This period occurs annually from October 15 to December 7.
There are specific circumstances that can give you access to a “special” enrollment period of 8 months during which you can enroll or switch your plan. Circumstances that make you eligible for special enrollment periods include:
- moving to a different coverage area
- losing your current coverage due to a plan being phased out, a change in your plan being “creditable” according to Medicare guidelines, or a change in financial or employment status
- becoming newly eligible for Medicaid, PACE, a Special Needs Plan, or Special Help programs
- communication errors on the part of Medicare in which your coverage wasn’t properly described to you
The best time to enroll in Medicare, Medicare Advantage, prescription drug coverage, and Medicare supplement plans is during the initial eligibility period when you first turn 65. After you make those initial decisions, your plans don’t have to be set in stone. Staying aware of the annual cycle of Medicare deadlines can help you plan for your financial and healthcare needs.