How to Change Medicare Advantage Plans When Moving

Medicare Advantage plans offer an alternative way to receive Medicare benefits through private insurance companies. These plans often combine hospital, medical, and prescription drug coverage into a single package, potentially including additional benefits not covered by Original Medicare. Understanding how significant life events, such as moving to a new residence, can impact these plans is important for maintaining continuous healthcare coverage. The structure and availability of Medicare Advantage plans are closely tied to geographical locations, making a move a critical event for your coverage.

Understanding How Moving Affects Your Plan

Medicare Advantage plans, also known as Medicare Part C, operate within specific geographic boundaries called service areas. A service area defines the region where a health insurance plan accepts members and maintains a network of in-network medical providers. These service areas can range from a single county to multiple states, and the plan’s network of doctors and hospitals is typically confined to this defined region.

Moving outside your current Medicare Advantage plan’s service area means you will no longer be eligible for that plan. Your existing plan cannot provide routine, non-emergency services once you relocate beyond its designated coverage zone. While Original Medicare (Parts A and B) is a federal program that provides coverage nationwide, private Medicare Advantage and Part D prescription drug plans have geographical limitations. Therefore, a change of residence often necessitates a change in your Medicare Advantage coverage to ensure continued access to healthcare services in your new community.

Special Enrollment Periods for Moving

Moving to a new address often qualifies you for a Special Enrollment Period (SEP), allowing you to make changes to your Medicare Advantage plan outside of standard enrollment windows. These SEPs are time-limited opportunities designed to prevent gaps in coverage due to life changes. One common scenario for a moving SEP is relocating to a new address that falls outside your current plan’s service area. This eligibility extends to moves within the same state or to a different state entirely.

Another qualifying moving scenario occurs if you move to a new address that is still within your plan’s service area, but where new plan options become available. Returning to the U.S. after living abroad can also trigger a moving SEP. The timing for using these SEPs is specific; if you notify your plan before you move, your opportunity to switch plans typically begins the month before your move and continues for two full months after the move. If you notify your plan after you have moved, the SEP generally begins the month you inform them and continues for two full months thereafter.

Steps to Choose a New Plan

Selecting a new Medicare Advantage plan after a move involves careful research to ensure your healthcare needs are met in your new location. A primary resource for comparing plans is the Medicare.gov Plan Finder tool, where you can enter your new zip code to view available options. This online tool helps you assess plans based on costs, covered benefits, and provider networks. Additionally, licensed insurance agents or brokers can provide personalized guidance and help navigate plan selection.

When evaluating potential plans, verify that your preferred doctors, hospitals, and other healthcare providers are included in the new plan’s network. Understanding the plan’s formulary, which is the list of covered prescription drugs, is important to ensure your current medications will be covered and to estimate potential costs. Assess the financial aspects, including monthly premiums, deductibles, copayments, coinsurance, and the annual out-of-pocket maximum. Many Medicare Advantage plans also offer supplemental benefits not covered by Original Medicare, such as dental, vision, hearing, and fitness programs.

The Enrollment Process and Coverage Transition

Once you have selected a new Medicare Advantage plan, the enrollment process can typically be completed through several methods. You can enroll online directly via the Medicare.gov website’s plan comparison tool, by contacting the chosen plan directly through their website or phone, or with the assistance of a licensed insurance agent. During the enrollment application, you will need to provide personal details, including your Medicare number and your new address.

Enrolling in a new Medicare Advantage plan generally results in automatic disenrollment from your previous Medicare Advantage plan. The effective date for your new plan’s coverage is typically the first day of the month after the plan receives your completed enrollment request, provided you meet the SEP requirements. After successful enrollment, you should expect to receive confirmation notices from both the new plan and Medicare, along with new plan materials such as an identification card and an Evidence of Coverage document.