Can You Change Part D Plans in the Middle of the Year?
Navigating Medicare Part D changes mid-year? Understand the limited circumstances and practical steps to adjust your prescription drug coverage.
Medicare Part D provides prescription drug coverage. While generally you cannot change your Medicare Part D plan in the middle of the year, specific, limited situations permit such changes. These exceptions are known as Special Enrollment Periods (SEPs). This article outlines these circumstances and the process for making a mid-year Part D plan change.
Standard Enrollment Periods
Most beneficiaries enroll in or make changes to their Part D plans during established enrollment periods. The primary period for existing enrollees is the Annual Enrollment Period (AEP), which occurs each year from October 15 to December 7. During AEP, beneficiaries can join a Part D plan, switch to a different plan, or drop their current coverage. Any changes made during this window become effective on January 1 of the following year.
Another standard enrollment opportunity is the Initial Enrollment Period (IEP), available to new Medicare beneficiaries. This seven-month period typically begins three months before an individual turns 65, includes the month of their 65th birthday, and extends for three months afterward. Outside of these defined enrollment periods, beneficiaries are committed to their chosen Part D plan for the remainder of the calendar year. Mid-year changes are only allowed under specific qualifying conditions.
Situations Allowing Mid-Year Changes
While Part D plans usually remain fixed for the year, certain life events trigger a Special Enrollment Period (SEP), allowing a mid-year change. These circumstances involve significant shifts in a beneficiary’s situation that impact their coverage needs.
A common qualifying event is a change in residence, such as moving outside the current plan’s service area, relocating to an area with new plan options, or moving into or out of a long-term care facility. Depending on when the plan is notified, the SEP can begin the month before the move and last for two full months after, or start the month of notification plus two additional months.
Another situation that permits a mid-year change is the loss of other creditable prescription drug coverage. This includes losing employer-sponsored health coverage or eligibility for Medicaid. Typically, a beneficiary has a two-month SEP to enroll in a Part D plan after losing such coverage.
Changes to your current Part D plan can also create an SEP; for instance, if your plan terminates its contract with Medicare, changes its service area, or experiences significant changes to its formulary or network during the year. If Medicare terminates a plan’s contract, an SEP usually begins one month before the termination and continues for two months afterward.
Individuals who become eligible for or lose eligibility for Medicare’s Extra Help program, also known as the Low-Income Subsidy (LIS), also qualify for an SEP. This program helps with Part D costs, and beneficiaries with Extra Help can typically change plans once per quarter during the first three quarters of the year, with coverage becoming effective the first day of the following month. SEPs may also be granted by the Centers for Medicare & Medicaid Services (CMS) due to exceptional circumstances, such as an enrollment error.
Initiating a Plan Change
Once you qualify for a Special Enrollment Period, initiating a Part D plan change involves several steps. The most common method is to use the official Medicare Plan Finder tool available on Medicare.gov/plan-compare. This online tool allows you to compare available plans in your area based on your specific prescription drugs and pharmacies. You can also enroll directly through this portal.
Alternatively, you can call 1-800-MEDICARE (1-800-633-4227), a helpline available 24/7, except for some federal holidays. This service can assist you with understanding your options and completing the enrollment process over the phone. Another option is to contact the new Part D plan directly, as many plans offer enrollment assistance through their customer service departments. In some cases, a paper enrollment application form might be available and can be submitted.
When enrolling, you will typically need to provide essential information such as your Medicare card number, personal contact details, and the effective date of the qualifying SEP event. When you enroll in a new Part D plan, the new plan usually notifies your previous plan of your disenrollment.
Impact of a Mid-Year Change
Changing your Medicare Part D plan mid-year through a Special Enrollment Period has immediate consequences. Generally, the effective date of your new plan is the first day of the month following the month your enrollment application is received. This ensures continuity of coverage and helps avoid gaps in prescription access.
Upon enrollment in a new plan, your financial obligations, such as deductibles and out-of-pocket maximums, typically reset, meaning any amounts paid towards these limits under your old plan usually do not carry over. You will begin contributing towards the new plan’s deductible and its out-of-pocket maximum from scratch. Your premiums for the new plan will commence, while premiums for the old plan will cease, usually aligning with the coverage effective date. You can expect to receive new plan materials, including a member ID card, a formulary (list of covered drugs), and an Evidence of Coverage document, within a few weeks of your enrollment.