When can you change your Medicare coverage?

The coverage provided by Medicare changes every year. Therefore, it is essential to understand these changes and developments to ensure you always have adequate coverage.
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Why do people change Medicare coverage?

There are a number of reasons why you might opt to change your Medicare coverage. First of all, you may change Medicare plans to get access to more benefits.

  • Some people may consider moving from Original Medicare to Medicare Advantage (MA) because of the bundled benefits offered by these plans.
  • Others switch MA plans based on their budget, medical needs, availability of prescription drugs, and their plan’s CMS star ratings.
  • To help manage out-of-pocket costs, people may also choose to switch from a Medicare Advantage policy to one of ten Medigap policies.

Second, some people may be forced to change Medicare policies when they lose their coverage.

Some seniors may also miss their chance to join Medicare for reasons like living overseas for many years after initially becoming eligible.

Lastly, specific life events may trigger some people to re-assess and change Medicare coverage.

 

When is the best time to change Medicare coverage?

Generally, you are allowed to change Medicare coverage during the following enrollment periods:

There are implications to missing these enrollment periods:

  • Late enrollment penalties can apply when you miss your IEP
  • There is a risk of getting disapproved from Medigap when you miss MS-EOP
  • You may also lose out on potential plan’s benefits

The good news is that Medicare does allow you to change your Medicare coverage under certain special circumstances.

 

What circumstances will allow you to change Medicare coverage outside the enrollment periods?

Medicare allows you to change Medicare plans during certain 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

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

The dates you can use your SEP vary depending on the case.

 

What circumstances will allow you to change Medicare coverage outside the enrollment periods?

Case 1: Switch to another MA plan

You can use CoverRight’s Medicare Advantage marketplace tool to find and compare Medicare Advantage options in your area. Click here to access our tool.

You will be disenrolled from your old MA plan soon as your new plan takes effect.

Case 2: Switch from MA to Original Medicare

Inform your current MA plan about your decision to join Original Medicare. Then, call 1-800-MEDICARE to enroll in Original Medicare.

Tip: it is advisable to add a standalone prescription drug plan and a Medigap policy when enrolling in Original Medicare. Traditional Medicare does not cover prescriptions and out-of-pocket expenses. You can also use CoverRight’s Medicare Supplement marketplace to review your Medicare Supplement options. Click here to access our tool. The CoverRight team can also help you find a Prescription Drug Plan by contacting a licensed agent directly at +1 (888) 969-7667.

Case 3: Switch to another Part D plan

The CoverRight team can help you review your Prescription Drug Plan options to find a plan that minimizes your out-of-pocket expenses. Contact a CoverRight licensed sales agent directly at +1 (888) 969-7667.

After enrollment in a new Part D, your previous plan will expire.

Case 4: Switch to another Medigap policy

You can switch anytime if you have guaranteed issue rights or the following situations happen:

  • Your older Medigap policy is no longer offered, so you need a replacement.
  • Your current Medigap policy is less than six months old, and you have a pre-existing condition.
  • You moved to another state. Although you can keep your current Medigap plan, you may save money by enrolling in a new plan.
  • You have a Medicare Select policy, but you moved out of its coverage area. You can either get a new policy from your current insurer or use your guaranteed issue rights to buy from other insurers.
  • 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.
  • You are still within the six-month Medigap open enrollment period.

Upon approval of your Medigap coverage, you have a 30-day “free look” period to decide if you want to keep it. But remember – you should not cancel your old policy until you have agreed to proceed with the new one.

After you decide to proceed with the new policy, terminate your old policy. You will typically be required to fill out some paperwork to end your coverage.

 

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.

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