When can you change your Medicare coverage?

There are a number of very good reasons why you might opt to change your Medicare coverage. First of all, you may want to actively switch plans to gain access to new, money-saving benefits.

Secondly, your health situation naturally may change as you get older — you might need new doctors, new prescription drugs, or specialized care. These life changes may mean your current plan is simply no longer sufficient to protect you.

Some common, practical reasons that drive people to switch plans include:

• Moving from Original Medicare to Medicare Advantage (MA) to take advantage of the bundled benefits uniquely offered by these plans
• Straining to balance your budget, shifting medical needs, or the availability of crucial prescription drugs
• A plan's official CMS star ratings changing
• The urgent need to better manage and predict your out-of-pocket costs
• Moving to a new state and needing to carefully select a new plan in your new area

When is the best time to change Medicare coverage?

Generally, you are only allowed to legally change your Medicare coverage during specific, scheduled enrollment windows. The most common enrollment windows include the:

Outside of these set periods, you generally will only be permitted to switch plans during the year if there has been a specific life event that triggers a Special Enrollment Period (SEP). Here are some critical examples of qualifying events for an SEP that protect you when life throws a curveball:

1. Change in residence

• Moving back to the US after living overseas
• Moving permanently out of your current plan's service area
• Moving within your plan's service area but discovering the plan has new localized options
• Release from incarceration
• Moving into or safely out of a skilled nursing facility or a long-term care hospital

2. Loss of coverage

• No longer being eligible for Medicaid
• Losing coverage from your job (or your spouse's job) or union (including COBRA)
• Losing sufficient creditable drug coverage
• Involuntary disenrollment from a Medicare cost plan
• Dropping out of a PACE plan

3. Opportunities to get better coverage

• Accessing exciting new plans offered through your work or union
• Enrolling in dedicated drug coverage plans (like Tricare or VA) that are equivalent to Medicare
• Enrolling in a PACE plan
• Enrolling in a high-quality plan which has officially received a five-star rating from Medicare

4. Change in your current plan's contract with Medicare

• Federal sanctions placed on the plan
• Plan terminations
• Unexpected non-renewal of your plan

5. Other nuanced reasons

• Becoming dually eligible for both Medicare and Medicaid
• Qualifying for Medicaid or the Extra Help (LIS) program to ease your financial burden
• Enrolling in or unfortunately losing eligibility for a State Pharmaceutical Assistance plan
• Dropping out of Medigap to join a Medicare Advantage plan
• Qualifying for or disenrolling from a Chronic Condition Special Needs Plan (C-SNP)
• A damaging federal employee error impacting your enrollment
• Being misinformed by an authority about creditable coverage
• You switched to a Medicare Advantage plan within 12 months of initially enrolling in your Medicare Supplement plan, and you securely want to switch back to the same Medicare Supplement plan within that exact same 12-month period.

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

The exception to the rule: switching between Medicare Supplement policies

With a Medicare Supplement policy, there is reassuringly no restriction on switching during a calendar year. However, you may have to go through medical underwriting and answer health questions in order to become eligible to switch policies, which could result in a denial or higher costs based on pre-existing conditions.

Note that this flexibility only applies for people who are already safely enrolled in a Medicare Supplement plan (or currently otherwise on Original Medicare by itself). You cannot legally purchase a Medicare Supplement plan during the year if you are currently enrolled in a Medicare Advantage plan — the primary reason being you do not have an eligible enrollment period to switch back to Original Medicare, which is the absolute underlying requirement.

Conclusion

It is always a smart financial move to carefully research your options well before the next Medicare enrollment period arrives. You have the right to change Medicare plans to better suit your shifting health, budget, and lifestyle. Remember to mark your calendar and make sure you enroll on time!