When Can Medicare Advantage Plans Be Changed?
Learn when and how to adjust your Medicare Advantage plan, from regular enrollment windows to special life events, ensuring your coverage fits your needs.
Medicare Advantage plans, offered by private insurance companies approved by Medicare, bundle together Part A (hospital insurance) and Part B (medical insurance), often including Part D (prescription drug coverage) and additional benefits like vision, dental, and hearing services. The ability to switch between these plans or revert to Original Medicare is restricted to specific periods or qualifying life events. Understanding these defined windows is important for beneficiaries to manage their healthcare coverage effectively.
Annual Enrollment Period Changes
The Annual Enrollment Period (AEP) provides a broad opportunity for Medicare beneficiaries to review and adjust their healthcare coverage. This period occurs annually, beginning on October 15 and concluding on December 7. During this timeframe, individuals can make various changes to their Medicare Advantage and prescription drug plans.
Beneficiaries have the option to switch from Original Medicare to a Medicare Advantage plan. It is also possible to transition from one Medicare Advantage plan to a different Medicare Advantage plan. Additionally, individuals enrolled in a Medicare Advantage plan can choose to switch back to Original Medicare during this period.
The AEP also facilitates adjustments to prescription drug coverage. Beneficiaries can join a Medicare Prescription Drug Plan (Part D), switch between different Part D plans, or drop their existing Part D coverage entirely. All changes made during the Annual Enrollment Period become effective on January 1 of the following year.
Medicare Advantage Open Enrollment Period Changes
The Medicare Advantage Open Enrollment Period (MA OEP) offers a more limited opportunity for individuals already enrolled in a Medicare Advantage plan to make specific changes. This period runs from January 1 through March 31 each year. It is designed to provide a chance for beneficiaries to adjust their coverage shortly after the new year begins, should their current plan not meet their needs.
During the MA OEP, beneficiaries can switch from one Medicare Advantage plan to another Medicare Advantage plan. This allows for a single change if the initial choice made during the AEP proves unsuitable. Furthermore, individuals can use this period to disenroll from their Medicare Advantage plan and return to Original Medicare. If they choose to return to Original Medicare, they can also enroll in a Medicare Prescription Drug Plan (Part D) at the same time.
It is important to note the restrictions during the MA OEP. Individuals cannot switch from Original Medicare to a Medicare Advantage plan during this time. Similarly, those already on Original Medicare cannot use this period to join a Part D plan unless they are simultaneously disenrolling from a Medicare Advantage plan. Only one change can be made during the MA OEP, and any changes become effective on the first day of the month after the plan receives the enrollment request.
Special Circumstance Changes
Special Enrollment Periods (SEPs) provide opportunities to make changes to Medicare Advantage and prescription drug plans outside of the standard enrollment periods. These periods are triggered by specific life events, allowing beneficiaries flexibility when circumstances necessitate a change in coverage. Certain common events frequently qualify individuals for these enrollment windows.
Moving to a new address is a common trigger for an SEP, particularly if the new residence is outside the current plan’s service area. An SEP also applies if the move is within a new area where different plan options become available. Losing other creditable coverage, such as employer-sponsored health insurance or COBRA, also initiates an SEP, allowing individuals to transition to Medicare coverage.
Qualifying for Extra Help with prescription drug costs or becoming eligible for Medicaid are additional events that create an SEP. Entering or leaving an institution, such as a nursing home or skilled nursing facility, also triggers an SEP.
Other specific situations can also lead to an SEP, including when a Medicare Advantage plan leaves the Medicare program or significantly reduces its service area. Events like declarations of severe weather or other emergencies that disrupt access to healthcare services in a specific area may also qualify beneficiaries for an SEP. The timeframe for making a change during an SEP typically varies, often lasting for a period around the qualifying event, such as one month before and two months after the event.