When and How Can You Change Your Medicare Plan?

Medicare offers various coverage options. Beneficiaries are not permanently tied to their initial plan choices, as opportunities exist to adjust coverage. Understanding when and how to make these changes is important for aligning healthcare coverage with evolving personal circumstances.

Understanding Medicare Plan Options

Medicare offers several plan types, each providing different levels of health and drug coverage. Original Medicare, the federal government’s program, includes Part A (Hospital Insurance) and Part B (Medical Insurance). Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Part B covers doctor’s services, outpatient care, medical supplies, and many preventive services. With Original Medicare, beneficiaries can use any doctor or hospital nationwide that accepts Medicare.

Medicare Advantage (Part C) is an alternative to Original Medicare, offered by private companies. These plans typically bundle Part A, Part B, and often Part D (prescription drug coverage). Medicare Advantage plans may also include additional benefits not covered by Original Medicare, such as vision, hearing, dental care, and fitness programs. Common structures include Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), which may have network restrictions.

Medicare Part D provides prescription drug coverage, helping lower medication costs. Offered through private insurance companies, it can be a stand-alone plan supplementing Original Medicare or included in a Medicare Advantage plan. Each Part D plan has a formulary, a list of covered drugs, often tiered to determine cost-sharing amounts.

Medicare Supplement Insurance (Medigap) helps cover out-of-pocket costs not paid by Original Medicare, such as copayments, coinsurance, and deductibles. Medigap policies work with Original Medicare and cannot be used with Medicare Advantage plans. These policies are standardized, meaning plans with the same letter offer the same basic benefits regardless of the insurance company.

Standard Opportunities for Plan Changes

Medicare provides specific annual periods for beneficiaries to change their health and drug coverage. The Annual Enrollment Period (AEP) runs from October 15 to December 7. Changes made during AEP become effective on January 1 of the following year.

During AEP, individuals can switch between Original Medicare and a Medicare Advantage plan. They can also change Medicare Advantage plans, enroll in a Medicare Part D plan, or switch between Part D plans. This period allows adjustments to align coverage with changing health needs or financial considerations.

The Medicare Advantage Open Enrollment Period (MA OEP) runs from January 1 to March 31 each year. This period is for individuals already in a Medicare Advantage plan. During MA OEP, beneficiaries can switch Medicare Advantage plans or disenroll and return to Original Medicare. If returning to Original Medicare, they can also enroll in a stand-alone Medicare Part D plan. Changes made during MA OEP take effect on the first day of the month following enrollment.

During MA OEP, individuals cannot switch from Original Medicare to a Medicare Advantage plan, nor can they join or switch only a Part D plan without changing their Medicare Advantage plan.

Special Enrollment Circumstances

Beyond standard annual enrollment periods, certain life events may qualify individuals for a Special Enrollment Period (SEP). SEPs allow beneficiaries to change Medicare Advantage or Part D plans outside regular windows. The specific changes and SEP duration vary by qualifying event.

Common SEP triggers include moving to a new service area affecting plan availability, or losing other creditable health coverage like employer-sponsored insurance. Other qualifying events include changes in a plan’s contract with Medicare, such as the plan leaving your area or significantly reducing its network.

Individuals qualifying for Extra Help with Medicare prescription drug costs or gaining/losing Medicaid eligibility may also get an SEP. Additional circumstances include leaving a long-term care facility or being released from incarceration. The SEP timeframe is generally limited, often two months from the qualifying event or notification date.

Process for Switching Medicare Plans

Once a new Medicare plan is identified and eligibility confirmed, the process for switching is straightforward. A common method is using the official Medicare Plan Finder tool on Medicare.gov, which allows beneficiaries to compare plans and enroll directly.

Alternatively, individuals can call 1-800-MEDICARE or contact the new plan directly for enrollment. When initiating a change, provide your current Medicare card details and basic personal information.

Enrolling in a new Medicare Advantage or Part D plan usually results in automatic disenrollment from the previous plan. Beneficiaries typically do not need to contact their old plan to cancel coverage, as the new enrollment triggers termination. After submitting a change request, expect confirmation notices from Medicare or the new plan, outlining details and effective date.

Changing Medicare Supplement Insurance (Medigap) policies differs from changing Medicare Advantage or Part D plans. Outside specific enrollment periods, such as your initial Medigap Open Enrollment Period, switching Medigap plans may involve medical underwriting. This means insurers can consider health status, potentially leading to coverage denial or higher premiums. Unless specific guaranteed issue rights apply, the ability to switch Medigap plans freely is limited.