When Can You Change Your Medicare Part D Plans?

Medicare Part D plans help individuals manage prescription medication costs. These plans, offered by private insurance companies approved by Medicare, cover a wide range of prescription drugs. While enrollment in a specific Part D plan is generally for a full calendar year, defined periods and circumstances allow individuals to change their coverage. Understanding these times and situations ensures continuous prescription drug coverage.

Key Enrollment Periods for Changes

Individuals have specific opportunities each year to change their Medicare Part D coverage during established enrollment periods. The Annual Enrollment Period (AEP) is the main time for most beneficiaries to adjust their plans. This period runs annually from October 15 to December 7, with changes effective January 1 of the following year. During AEP, individuals can switch Part D plans or transition between Original Medicare with a Part D plan and a Medicare Advantage Plan that includes drug coverage.

The Medicare Advantage Open Enrollment Period (MA OEP) takes place from January 1 to March 31 each year. This period is for individuals already enrolled in a Medicare Advantage Plan. During the MA OEP, a person can switch to a different Medicare Advantage Plan, or disenroll and return to Original Medicare. If returning to Original Medicare, they can also enroll in a standalone Medicare Part D plan. This period does not allow individuals already in Original Medicare to switch between standalone Part D plans.

Special Circumstances for Changing Plans

Beyond regular annual enrollment periods, certain life events or changes can trigger a Special Enrollment Period (SEP), allowing individuals to change their Medicare Part D plan outside of standard periods. A common reason for an SEP is moving to a new address. If an individual moves outside their current plan’s service area or to an area with new plan options, they may qualify for an SEP, generally allowing two months to make a change.

Losing other creditable prescription drug coverage also qualifies an individual for an SEP. This includes loss of employer-sponsored health benefits, termination of Medicaid eligibility, or discontinuation of other comprehensive drug coverage. If a current Medicare Part D plan leaves the Medicare program, reduces its service area, or fails to meet its contractual obligations, affected individuals receive an SEP to choose a new plan.

Individuals who qualify for Medicare’s Extra Help program for limited income and resources are granted a continuous SEP. This allows them to switch Part D plans at any time throughout the year. Other SEPs exist for specific situations, such as living in a nursing home or qualifying for a Medicare Special Needs Plan due to a chronic health condition.

Factors for Choosing a New Plan

When considering a new Medicare Part D plan, evaluating factors helps ensure the chosen coverage aligns with individual needs. The plan’s formulary, or list of covered drugs, is a primary consideration. Verify that all current prescription medications are included on the formulary and understand which tier each drug falls into, as tiers directly influence out-of-pocket costs. Higher-tier drugs have higher copayments or coinsurance.

The plan’s pharmacy network should also be examined. Confirm that preferred pharmacies are part of the network to avoid higher out-of-network costs. Understanding cost components is essential, including the monthly premium and the annual deductible. The deductible is the amount paid out-of-pocket before the plan begins to pay.

Compare copayments and coinsurance for different drug tiers. Knowing the plan’s out-of-pocket maximum shows the most an individual might pay for covered drugs in a year. Medicare’s Star Ratings (one to five stars) measure a plan’s quality and performance, which can also inform the decision-making process.

Steps to Change Your Part D Plan

After deciding on a new Medicare Part D plan, the official Medicare website, Medicare.gov, provides a Plan Finder tool. This tool is useful for comparing plans and initiating enrollment. It allows individuals to enter their specific prescriptions and preferred pharmacies to see how different plans would cover their costs.

Enrollment in a new plan can be completed through several methods. Individuals can enroll directly online via the Medicare.gov Plan Finder or through the specific plan’s website. Calling the new plan directly or contacting Medicare by phone are also options.

When enrolling in a new Medicare Part D plan, or a Medicare Advantage plan that includes drug coverage, the previous plan is automatically disenrolled. This prevents duplicate coverage and simplifies the transition. Following enrollment, individuals should expect to receive confirmation from their new plan, including a new member ID card and coverage details.