When can i switch Medicare Advantage plans?

Medicare open enrollment is a crucial time for beneficiaries to review their current plans and consider making changes. Whether you’re dissatisfied with your current Medicare Advantage plan or simply want to explore other options, understanding how and when to switch plans is essential. In this comprehensive guide, we’ll walk you through the process of changing Medicare Advantage plans, highlighting important considerations and providing step-by-step instructions.

Understanding Medicare Advantage Plans

Before diving into the process of changing Medicare Advantage plans, it’s important to have a solid understanding of what these plans entail. Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare (Part A and Part B). These plans are offered by private insurance companies approved by Medicare and provide all the benefits of Original Medicare, along with additional coverage options such as prescription drugs, vision, dental, and hearing services.

Medicare Advantage plans often come in various forms, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Special Needs Plans (SNPs). Each plan has its own network of healthcare providers and coverage rules, so it’s crucial to review the details of any plan you’re considering.

Medicare Advantage Open Enrollment Period

The Medicare Open Enrollment Period is an annual period when beneficiaries can make changes to their Medicare coverage. It runs from October 15th to December 7th each year. During this time, you can switch from Original Medicare to Medicare Advantage, switch between different Medicare Advantage plans, or join, switch, or drop Medicare Part D prescription drug coverage.

It’s important to note that any changes made during the Open Enrollment Period will take effect on January 1st of the following year. This means that if you decide to switch plans, you will have coverage under the new plan starts from the beginning of the next calendar year.

Special Enrollment Periods

While the Medicare Open Enrollment Period is the primary opportunity to make changes to your coverage, there are also Special Enrollment Periods (SEPs) that allow for plan changes outside of the regular enrollment period. These SEPs are triggered by specific life events and provide beneficiaries with additional opportunities to switch Medicare Advantage plans. Let’s explore some common scenarios that may qualify you for a Special Enrollment Period.

Moving to a new address

If you have recently moved or are planning to move to a new address, you may be eligible for a Special Enrollment Period. The specifics of this SEP depend on whether your new address falls within your current plan’s service area or outside of it.

Switching plans outside of service area: If your new address is outside of your current Medicare Advantage plan’s service area, you have the option to switch to a new Medicare Advantage Plan or return to Original Medicare. It’s important to note that if you choose not to join a new Medicare Advantage Plan, you will automatically be enrolled in Original Medicare.

To initiate the plan switch, you must inform your current plan before or after you move. If you notify your plan before the move, the SEP begins the month prior to your move and lasts for two full months after the move. If you notify your plan after the move, the SEP begins in the month of notification and lasts for two full months plus the additional two months.

Switching plans within service area: If your new address is still within your current plan’s service area but offers new plan options, you have the flexibility to switch to a new Medicare Advantage Plan or Medicare drug plan. The timing for this SEP is the same as in the previous scenario.

Moving back to the U.S. from abroad

If you have been living outside of the United States and are returning, you have a Special Enrollment Period to join a Medicare Advantage Plan or Medicare drug plan. This SEP lasts for two full months after the month you move back to the U.S.

Transitioning in or out of an institution

If you are moving into, currently reside in, or moving out of an institution such as a skilled nursing facility or long-term care hospital, you have several options for changing your Medicare Advantage plan or Medicare drug coverage. During this SEP, you can join a Medicare Advantage Plan, switch from your current plan to another Medicare Advantage Plan or Medicare Prescription Drug Plan, drop your Medicare Advantage Plan and return to Original Medicare, or drop your Medicare prescription drug coverage.

The duration of this SEP extends as long as you live in the institution and for two full months after you leave the institution.

Release from jail

If you were incarcerated and kept paying for your Part A and Part B coverage while in jail, you have a Special Enrollment Period of two full calendar months after your release to join a Medicare Advantage Plan or Medicare drug plan. It’s important to note that you must sign up for Medicare before you can join a plan.

These are just a few examples of the Special Enrollment Periods that may apply to your situation. It’s always recommended to contact Medicare or a licensed insurance agent to determine your eligibility and understand the specific details of each SEP.

Losing current coverage

Life circumstances can sometimes lead to the loss of your current healthcare coverage. In such situations, you may be eligible for a Special Enrollment Period to make changes to your Medicare Advantage plan. Let’s explore some common scenarios where you might lose your coverage and the options available to you.

Ineligibility for Medicaid

If you were previously eligible for Medicaid but are no longer eligible, you have a three-month Special Enrollment Period to join a Medicare Advantage Plan or Medicare drug plan, switch from your current plan to another Medicare Advantage Plan or Medicare drug plan, drop your Medicare Advantage Plan and return to Original Medicare, or drop your Medicare prescription drug coverage. This SEP lasts for three full months from the date you become ineligible or are notified of the loss, whichever is later.

Employer or union coverage ends

If you had coverage through your employer or union, including COBRA coverage, and that coverage ends, you have a two-month Special Enrollment Period to join a Medicare Advantage Plan or Medicare drug plan. This SEP begins two full months after the month your coverage ends.

Loss of creditable coverage

If you involuntarily lose other drug coverage that is as good as Medicare drug coverage (creditable coverage), or your other coverage changes and is no longer credible, you have a two-month Special Enrollment Period to join a Medicare Advantage Plan with drug coverage or a Medicare drug plan. This SEP begins two full months after the month you lose your creditable coverage or are notified that your current coverage is no longer creditable, whichever is later.

Dropping a Medicare cost plan

If you had drug coverage through a Medicare Cost Plan and you decide to drop the plan, you have a two-month Special Enrollment Period to join a Medicare drug plan. This SEP begins two full months after you drop your Medicare Cost Plan.

Leaving a PACE plan

If you were enrolled in a Program of All-inclusive Care for the Elderly (PACE) plan and decide to drop the coverage, you have a two-month Special Enrollment Period to join a Medicare Advantage Plan or Medicare drug plan. This SEP begins two full months after you drop your PACE plan.

It’s essential to take advantage of these Special Enrollment Periods if you find yourself in any of these situations. Missing the enrollment window could result in a gap in coverage, so be sure to explore your options and make changes accordingly.

Changes in Medicare contract

Sometimes, changes in the contract between Medicare and your current plan can trigger a Special Enrollment Period. Let’s explore some scenarios where this may occur and the options available to you.

Plan sanctioned by Medicare

If your Medicare Advantage Plan or Medicare drug plan undergoes an official action, known as a “sanction,” due to a problem that affects beneficiaries, you have the option to switch to another plan. The timing for this SEP is determined by Medicare on a case-by-case basis.

Medicare terminates plan’s contract

If Medicare terminates the contract with your Medicare Advantage Plan or Medicare drug plan, you have a Special Enrollment Period to switch to another plan. This SEP begins two months before the contract ends and lasts one full month after the contract termination.

Non-renewal of the plan’s contract

If your Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan’s contract with Medicare is not renewed, you have the opportunity to join another Medicare Advantage Plan or Medicare drug plan. This SEP occurs from December 8th to the last day in February.

Other special situations

In addition to the scenarios mentioned above, there are several other special situations that may qualify you for a Special Enrollment Period. Let’s explore these situations and the options available to you.

Dual eligibility for Medicare and Medicaid

If you are eligible for both Medicare and Medicaid, you have a chance to join, switch, or drop your Medicare Advantage Plan or Medicare drug coverage during specific periods throughout the year. These periods include January to March, April to June, and July to September. Any changes made during these periods will take effect on the first day of the following month.

Extra help for prescription drug coverage

If you qualify for extra help, a program that assists with paying for Medicare prescription drug coverage, you may be able to make changes to your coverage during specific periods. Similar to dual eligibility, these periods include January to March, April to June, and July to September. Any changes made during these periods will begin on the first day of the following month.

Enrollment in State Pharmaceutical Assistance Program (SPAP)

If you are enrolled in a State Pharmaceutical Assistance Program (SPAP), you have the opportunity to join either a Medicare drug plan or a Medicare Advantage Plan with drug coverage. This SEP occurs once during the calendar year.

Loss of SPAP eligibility

If you were enrolled in a State Pharmaceutical Assistance Program (SPAP) but lost eligibility, you have a Special Enrollment Period to join either a Medicare drug plan or a Medicare Advantage Plan with drug coverage. This SEP begins either in the month you lose eligibility or the month you are notified of the loss, whichever is earlier. It ends two months after either the month of the loss of eligibility or the notification of the loss, whichever is later.

Dropping Medicare Advantage Plan during trial period

If you dropped a Medigap policy the first time you joined a Medicare Advantage Plan and are still in a “trial period” and eligible for the guaranteed issue of a Medigap policy, you have the opportunity to drop your Medicare Advantage Plan and enroll in Original Medicare. During this period, you have special rights to purchase a Medigap policy. The duration of this SEP lasts for 12 months after you join the Medicare Advantage Plan for the first time.

Enrollment in Chronic Care Special Needs Plan (SNP)

If you have a severe or disabling condition and there is a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with your condition, you have the opportunity to join that specific SNP. This SEP can be exercised at any time, but once you join, your chance to make changes using this SEP ends.

No longer qualifying for Special Needs Plan (SNP)

If you are enrolled in a Special Needs Plan (SNP) but no longer have a condition that qualifies as a special need, you have the option to switch from the SNP to a Medicare Advantage Plan or Medicare drug plan. This SEP allows you to choose a new plan starting from the time you lose your special needs status, up to three months after your SNP’s grace period ends.

Enrollment error by federal employee

If you joined a plan or chose not to join a plan due to an error made by a federal employee, you have the opportunity to join a Medicare Advantage Plan with drug coverage or a Medicare drug plan, switch from your current plan to another Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan, drop your Medicare Advantage Plan with drug coverage and return to Original Medicare, or drop your Medicare prescription drug coverage. The timing for this SEP lasts for two full months after the month you receive a notice of the error from Medicare.

Inadequate disclosure of non-creditable drug coverage

If you weren’t properly informed that your other private drug coverage was not as good as Medicare drug coverage (non-creditable coverage), you have a two-month Special Enrollment Period to join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan. This SEP begins two full months after the month you receive a notice of the error from Medicare or your plan.

These special situations provide additional opportunities for beneficiaries to make changes to their Medicare Advantage plans outside of the regular enrollment periods. Understanding the eligibility criteria and timing for each SEP can help you make informed decisions about your healthcare coverage.

Taking action: Finding plans and care providers

Now that you are familiar with the different Special Enrollment Periods and when they apply, it’s time to take action and find the right Medicare Advantage plan for your needs. Medicare offers several resources to help you in this process.

Find health & drug plans

Medicare.gov provides a search tool that allows you to find and compare Medicare Advantage plans, Medicare drug plans, and Medigap policies. The tool allows you to enter your location, current coverage, and specific preferences to generate a list of available plans in your area. You can compare the costs, coverage options, and quality ratings of different plans to make an informed decision.

Find care providers

In addition to finding the right plan, it’s important to have access to quality healthcare providers. Medicare.gov’s search tool also allows you to find and compare healthcare providers in your area. You can search for doctors, hospitals, nursing homes, and other healthcare facilities to ensure that your plan includes the providers you prefer.

Find medical equipment & suppliers

If you require medical equipment or supplies, Medicare.gov provides a search tool to find suppliers in your area. You can search for durable medical equipment, prosthetics, orthotics, and other supplies to ensure that you have access to the necessary resources for your healthcare needs.

Find a Medicare Supplement Insurance (Medigap) Policy

If you decide to switch from a Medicare Advantage plan to Original Medicare, you may want to consider purchasing a Medicare Supplement Insurance (Medigap) policy. Medigap policies help cover the out-of-pocket costs associated with Original Medicare, such as deductibles, copayments, and coinsurance. Medicare.gov’s search tool can help you find available Medigap policies in your area.

Find publications

Medicare.gov offers a wealth of publications and resources to help you navigate the Medicare system. You can find informational booklets, guides, and brochures on topics such as Medicare Advantage, Medicare prescription drug coverage, and Medigap policies. These publications provide detailed information to help you make informed decisions about your healthcare coverage.

Talk to someone

If you have questions or need assistance with the enrollment process, Medicare provides various resources for you to seek guidance. You can call 1-800-MEDICARE (1-800-633-4227) to speak with a representative who can provide personalized assistance. TTY users can call 1-877-486-2048. Additionally, licensed insurance agents can provide guidance and support throughout the enrollment process.

Taking advantage of these resources and seeking assistance when needed can help ensure that you find the right Medicare Advantage plan and healthcare providers for your needs.

Additional resources and support

Navigating the world of Medicare Advantage plans and healthcare coverage can be complex, but you don’t have to do it alone. In addition to the resources provided by Medicare, there are various organizations and advocacy groups that can offer additional support and guidance. Here are a few reputable sources worth exploring:

• AARP (aarp.org): A nonprofit organization dedicated to empowering people aged 50 and older with information and resources to make informed decisions about their healthcare and well-being
• State Health Insurance Assistance Programs (SHIPs): These programs provide free, personalized counseling to Medicare beneficiaries and their families. They can help you understand your Medicare options, compare plans, and navigate the enrollment process
• Medicare Rights Center (medicarerights.org): A national nonprofit consumer service organization that works to ensure access to affordable healthcare for older adults and people with disabilities. They provide educational resources and assistance with Medicare-related issues
• Local Area Agencies on Aging (AAA): These agencies offer a range of services and support for older adults and their caregivers, including assistance with Medicare enrollment and understanding coverage options

By utilizing these additional resources, you can gain a deeper understanding of your options and make well-informed decisions about your Medicare Advantage plan.

Conclusion

Changing Medicare Advantage plans is an important decision that can greatly impact your healthcare coverage and overall well-being. Whether you’re considering a plan switch due to a life event or simply want to explore different options, understanding the enrollment periods and eligibility criteria is essential. By taking advantage of the Medicare Open Enrollment Period and Special Enrollment Periods, and leveraging the available resources, you can find the right Medicare Advantage plan that meets your unique needs. Remember to review your options carefully, compare plans, and seek assistance when needed. Your health and peace of mind are worth the effort.

Sources

• How to Change Medicare Plans — and Why You Might Want to – NerdWallet
• Special Enrollment Periods – Medicare