When Can I Change My Medicare Advantage Plan?

Medicare Advantage plans, offered by private companies approved by Medicare, provide an alternative way to receive Medicare benefits. These plans cover all Medicare Part A (hospital insurance) and Part B (medical insurance) services, and many include prescription drug coverage (Part D) as well as additional benefits like vision, hearing, and dental. Understanding when and how you can make changes to your Medicare Advantage plan is important for ensuring your coverage continues to meet your healthcare needs. The ability to switch plans is governed by specific enrollment periods throughout the year, each with its own set of rules and allowances.

Annual Enrollment Period

The Annual Enrollment Period (AEP) provides an opportunity each year to review and adjust Medicare coverage. This period runs from October 15 through December 7. Any changes made during this time become effective on January 1 of the following year.

During the AEP, beneficiaries can switch from Original Medicare to a Medicare Advantage plan. Those currently in a Medicare Advantage plan can disenroll and return to Original Medicare coverage. This allows individuals to reassess if a private plan or government-administered Medicare aligns better with their healthcare preferences.

The AEP also permits individuals to change from one Medicare Advantage plan to a different Medicare Advantage plan in their service area. Beneficiaries can enroll in a new Medicare Part D prescription drug plan, switch from one Part D plan to another, or drop their Part D coverage entirely if they are already in Original Medicare.

Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period (MA OEP) offers an opportunity for individuals already enrolled in a Medicare Advantage plan to make a single plan change. This period occurs annually from January 1 through March 31. The MA OEP is for individuals who may have enrolled in a Medicare Advantage plan during the AEP but have since decided the chosen plan does not meet their needs.

During this period, an individual can switch from their current Medicare Advantage plan to a different Medicare Advantage plan. Beneficiaries can also use the MA OEP to disenroll from their Medicare Advantage plan and return to Original Medicare. If they choose this path, they can enroll in a Medicare Part D prescription drug plan to cover medication costs.

This period does not allow individuals to switch from Original Medicare to a Medicare Advantage plan. If you are currently in Original Medicare, you cannot use the MA OEP to make changes to your Part D plan only; this period is specifically for those already in a Medicare Advantage plan.

Special Enrollment Periods

Special Enrollment Periods (SEPs) allow individuals to make changes to their Medicare Advantage or Part D plans outside of standard enrollment windows, provided they experience certain qualifying life events. These periods are triggered by specific circumstances. The duration of an SEP varies depending on the event.

One common SEP trigger is moving to a new service area where your current Medicare Advantage plan is not available, or where new plan options become accessible. Another qualifying event involves losing other creditable coverage, such as employer-sponsored health insurance or COBRA, which then permits enrollment in a Medicare Advantage plan.

Gaining or losing eligibility for Medicaid also triggers an SEP. Qualifying for Extra Help, the Low-Income Subsidy for Medicare Part D prescription drug costs, allows for changes to Part D plans. Individuals diagnosed with certain severe and disabling chronic conditions, such as diabetes or heart failure, may qualify for a Special Needs Plan (SNP), which can be enrolled in through an SEP at any time.

If you are involuntarily disenrolled from your Medicare Advantage plan, such as the plan leaving the Medicare program, an SEP is granted. Individuals affected by a declared disaster or emergency by the Federal Emergency Management Agency (FEMA) may also be granted an SEP. Release from incarceration can also qualify an individual for an SEP to enroll in Medicare coverage.

Making Your Plan Change

Once you have identified an eligible enrollment period, you can switch plans through several methods. These include using the official Medicare.gov website, calling 1-800-MEDICARE, or directly contacting the new Medicare Advantage plan you wish to join.

When applying for a new plan, you will need to provide specific identifying information. This includes your Medicare number and the effective date of your Medicare Part A and/or Part B coverage. You will also be asked for personal details such as your full name, address, and date of birth.

After you submit your application, the new plan will process your enrollment and provide confirmation. You will typically receive a welcome packet, including your new plan materials and a new member identification card, before your coverage becomes effective. When you enroll in a new Medicare Advantage plan, your new plan automatically disenrolls you from your previous Medicare Advantage plan.