Can I change my Medicare plan after open enrollment?

Do I have to change my plan every year? What happens if my doctors stop taking my plan in the middle of the year? Am I actually missing out on new benefits? I don’t like my new plan; I want to go back to the old one! We hear questions like these constantly. Changing Medicare Advantage plans throughout the year is possible, but it does depend on the situation. You will need to have a valid enrollment period to make changes. Let’s take a take a look at those enrollment periods!

Initial Enrollment Period (IEP)

The Initial Enrollment period is a 7-month window surrounding the 65th birthday of Medicare eligibles. This is the first enrollment opportunity for most Medicare beneficiaries. During this period you can apply for Original Medicare and also secondary coverage like prescription plans, Medigap, or Medicare Advantage plans.

If your birthday falls between the 2nd and the 31st your Medicare will start the 1st day of your birth month. In this case the IEP window would be the 3 months before your birth month, your birth month, and the 3 months following your birth month. If your birthday falls on the 1st of the month, then your Medicare will start the 1st day of the month prior to your birth month. In this scenario you still have a 7-month window: the 4 months prior to your birth month, your birth month, and the 2 months following.

It is important to enroll in Medicare in a timely manner. Outside of this 7-month window there is limited opportunity to enroll into Medicare Part A and B. Delaying Medicare without creditable coverage could result in a lifetime late enrollment penalty.

Annual Enrollment Period (AEP)

The Annual Enrollment period, some call it open enrollment, happens between October 15-December 7 each year. Surely you’ve seen the commercials and craziness that goes along with this time of year. AEP is most important to prescription plan enrollees and Part C enrollees as these plans have an annual contract and are subject to change every January 1. During AEP Medicare beneficiaries can change from Original Medicare to a Medicare Advantage plan, change from Medicare Advantage back to Original Medicare, change Medicare Advantage plans, and make any Part D plan changes (join, drop, or switch.)

One feature of enrollment sets AEP apart from all the other enrollment periods. During AEP a member can fill out as many applications as they need to. If they change their mind about the plan selection there is no need to cancel the prior application. Submitting a new application will cancel the old, and the last application submitted will be the plan that goes into effect on January 1st. This has caused problems for some members who receive phone calls from sales agents nonstop. It can be confusing speaking to many charismatic sales agents making promises of bigger and better benefits. At the end of the enrollment period they are not sure which plan was selected and have to deal with the aftermath in January.

Be aware that if you have Original Medicare with a Medigap policy and you switch to Medicare Advantage, you may not be able to get a Medigap policy again if you switch back.

Medicare Advantage Open Enrollment Period (OEP)

After the Annual Enrollment Period ends, we have a short beak before Medicare Advantage Open Enrollment begins. OEP is from January 1-March 31 every year. This enrollment period was created for Medicare Advantage enrollees to fix any plan issues, like the ones mentioned in the previous section, also to give those who enrolled in a new plan the chance to make sure it works for them, with an option to choose a new plan if necessary. During this enrollment period each Medicare Advantage plan enrollee can only make 1 plan change. The plan selection will go into effect the month following the application. During this time Medicare Advantage enrollees can join a new plan, mentioned above, cancel a plan and return to Original Medicare, or enroll into a standalone Part D plan.

General Enrollment Period

Following the same dates as OEP, the general enrollment from January 1 - March 31 is for those who have yet to enroll into Medicare. During this time anyone eligible can apply to Social Security for their Part A and Part B.

Special Enrollment Period (SEP)

Special Enrollment Periods are not a designated time of the year, but a variety of circumstances and situations that create and enrollment window for an individual.

Moving: Medicare Advantage and Prescription Drug plans vary by plan area; if you move to an address outside of your plan’s service area this opens a window to change plans. This window is one month before the move and up to two months after.

Loss of Coverage: If you lose your current coverage whether employer or union plans, COBRA, PACE, or Medicaid, or other creditable coverage you will have an enrollment window to join a Medicare Advantage plan or Prescription Drug plan. The window is for the 2-3 months after your coverage ends, depending on the type of coverage.

5 Star Plans: If there is a plan with a 5 star rating in your area, you can enroll into the plan at any time of the year. This selection can only be made once in a calendar year.

C-SNP: Those with chronic conditions may qualify for a Special Needs plan called a C-SNP. These plans are designed to allow additional coverage for the chronic condition and complications that come along with it. One can enroll at anytime of the year that they meet the qualifications for the plan. Similarly losing coverage of a C-SNP plan allows enrollment into another Medicare Advantage or Prescription Drug plan.

State Pharmaceutical Program: If you are enrolled in a State Pharmaceutical Program or lose eligibility to a State Pharmaceutical Program you may be able to join either a Medicare Advantage plan or a Prescription Drug plan. Find out which states offer these programs here.

Extra Help & Medicaid: Those enrolled in Medicaid or Extra Help programs have a special enrollment opportunity once a quarter for the first three quarters of the year. While it is not recommended to change your plan frequently the opportunity is there under the requirements for Part D drug management programs.

Conclusion

There are some more unique situations that create an enrollment window. If you are unhappy with current coverage, please reach out to our team or another reliable independent broker who can help you through the process. We have helped clients who thought they were stuck with no options based off a conversation with their insurance carrier. The insurance carriers benefit from keeping members on their plan. As independent brokers we look out for your best interests no matter what company that may be!