There are a number of reasons why you might opt to change your Medicare coverage. First of all, you may want to switch plans to get access to new or more benefits.
Secondly, your health situation may change as you get older – new doctors, new drugs – these changes may mean your current plan is no longer sufficient.
Some common reasons that drive people to switch plans include:
- Moving from Original Medicare to Medicare Advantage (MA) because of the bundled benefits offered by these plans
- Budget, medical needs, availability of prescription drugs
- A plan’s CMS star ratings
- The need to better manage out-of-pocket costs
- Some people may move states and have to find a new plan in their new area
When is the best time to change Medicare coverage?
Generally, you are only allowed to change Medicare coverage during specific enrollment windows. The most common enrollment windows include the:
| Enrollment Period | Window / Dates | What You Can Do |
|---|---|---|
| Initial Enrollment Period (IEP) | •A seven-month period that starts three months before the month of your 65th birthday •If you qualify for Medicare because of disability, ALS or, ESRD, the date is based on the date your Social Security benefits start. | •Enroll in Original Medicare Part A and Part B •Enroll in a Part D plan •Enroll in a Part C plan |
| General Enrollment Period (GEP) | •January 1 to March 31 •Coverage starts 1st of the month after you apply | •Enroll in Part A and/or Part B if you missed your IEP |
| Annual Enrollment Period (AEP) | •October 15 to December 7 •Coverage starts on January 1 of following calendar year | •Switch from Original Medicare to Part C plan •Switch from Part C plan to Original Medicare •Switch Part C plans •Enroll, change or drop Part D plans |
| Medicare Advantage Open Enrollment Period (MA-OEP) | •January 1 to March 31 •Coverage starts 1st of the month after you apply | •Switch Part C plans •Switch from Part C plan to Original Medicare, and if needed, sign up to a Part D plan •Enroll in or change a Medigap plan |
Outside of these periods you generally will only be allowed to switch plans during a year when there has been a special event that triggers a Special Enrollment Periods (SEP). Here are some examples of qualifying events for an SEP:
1. Change in residence
- Moving back to the US after living overseas
- Moving out of your plan’s service area
- Moving within your plan’s service area but the plan has new options
- Release from incarceration
- Moving into or out of a skilled nursing facility or a long-term care hospital
2. Loss of coverage
- Not eligible for Medicaid anymore
- From your job (or your spouse’s job) or union (including COBRA)
- Insufficient creditable drug coverage
- Disenrollment from a Medicare cost plan
- Dropping out of a PACE plan
3. Opportunities to get better coverage
- From plans offered through your work or union
- Enrolling in drug coverage plans (like Tricare or VA) that are equivalent to Medicare
- Enrolling in a PACE plan
- Enrolling in a plan which has received a five-star rating from Medicare
4. Change in your current plan’s contract with Medicare
- Sanctions
- Terminations
- Non-renewal
5. Other reasons
- Becoming eligible for both Medicare and Medicaid
- Qualifying for Medicaid or LIS
- Enrolling in or losing eligibility for a State Pharmaceutical Assistance plan
- Dropping from Medigap to join a Medicare Advantage plan
- Qualifying or disenrolling from a Chronic Condition Special Needs Plan (C-SNP)
- Federal employee error
- Being misinformed about creditable coverage
- You switched to a Medicare Advantage plan within 12 months of enrolling in your Medicare Supplement plan, and you want to switch back to the same Medicare Supplement plan within that same 12 month period.
The dates you can use your SEP vary depending on the case.
The exception to the rule: switching between Medicare Supplement policies
With a Medicare Supplement policy there is no restriction to switching during a calendar year. However, you may have to go through health questions in order to become eligible to switch.
Note that this only applies for people who are already in a Medicare Supplement plan (or currently otherwise on Original Medicare by itself). You can not purchase a Medicare Supplement plan during the year if you are in Medicare Advantage – the reason being you do not have an eligible enrollment period to switch back to Original Medicare, which is the underlying requirement.
Conclusion
It is always a good idea to research your options before the next Medicare enrollment period arrives. You can change Medicare plans to suit your health, budget, and lifestyle. Remember to make sure you enroll on time!
CoverRight dedicated benefits consultant who can explain the options available to you, help you select the plan that best meets your needs and preferences, and ensure you avoid gaps in your health coverage.
