Medicare Advantage beneficiaries may have opportunities to change their healthcare coverage during the year, but they cannot switch plans whenever they want. Medicare establishes specific enrollment periods that determine when individuals can make changes to their existing coverage. These opportunities include the Medicare Advantage Open Enrollment Period and certain Special Enrollment Periods.
Understanding when you can change a Medicare Advantage plan is important because your healthcare needs, financial circumstances, and available coverage options may change over time. Medicare also provides specific rules for beneficiaries who move, lose qualifying coverage, become eligible for Medicaid, or experience other qualifying circumstances.
This guide explains when you can switch Medicare Advantage plans during the year, which situations may qualify for a Special Enrollment Period, and what to consider before making a coverage change.
Can You Change Medicare Advantage Plans During the Year?
Yes, you can change Medicare Advantage plans during the year, but only during specific enrollment periods or when you qualify for an applicable exception.
Medicare generally restricts plan changes to designated enrollment windows. However, certain life events can provide additional opportunities to switch coverage outside the regular Annual Enrollment Period.
Here are the main opportunities to change Medicare Advantage coverage:
- Annual Enrollment Period: October 15 through December 7.
- Medicare Advantage Open Enrollment Period: January 1 through March 31.
- Special Enrollment Period: Available when specific qualifying circumstances occur.
- Initial Enrollment Period: Available when you first become eligible for Medicare, subject to applicable enrollment rules.
Each enrollment period has different eligibility requirements, deadlines, and coverage effective dates.
According to Medicare, Special Enrollment Periods allow eligible beneficiaries to change coverage after certain qualifying life events. Official Medicare Special Enrollment Period guidelines.
Understanding the Medicare Advantage Open Enrollment Period
The Medicare Advantage Open Enrollment Period provides an opportunity for people already enrolled in a Medicare Advantage plan to make a coverage change.
This enrollment window runs from January 1 through March 31 every year.
During this period, eligible beneficiaries can generally make one of the following changes:
- Switch from their current Medicare Advantage plan to another Medicare Advantage plan.
- Leave Medicare Advantage and return to Original Medicare.
- Join a standalone Medicare Part D prescription drug plan when returning to Original Medicare.
However, this enrollment period has important restrictions.
You cannot use the Medicare Advantage Open Enrollment Period to switch from Original Medicare to Medicare Advantage. You also cannot use it to switch between standalone Medicare Part D plans if you have Original Medicare.
Any permitted coverage change generally becomes effective on the first day of the month after the new plan receives your enrollment request.
Beneficiaries should review their current coverage before making a decision because this enrollment opportunity is generally limited to one plan change.
For additional information about Medicare enrollment timelines, read Enrollment Periods for Medicare Advantage Plans.
What Is a Medicare Special Enrollment Period?
A Medicare Special Enrollment Period (SEP) is a specific timeframe that allows eligible beneficiaries to join, switch, or leave certain Medicare health or prescription drug plans outside the regular enrollment periods.
Special Enrollment Periods are generally triggered by qualifying changes in an individual’s circumstances.
Unlike the Annual Enrollment Period, which follows the same dates every year, Special Enrollment Periods depend on the specific event and the beneficiary’s eligibility.
The available coverage changes and enrollment deadlines vary according to the qualifying situation.
Some Special Enrollment Periods last two full months, while others may last three months or remain available for as long as a qualifying condition continues.
Beneficiaries should confirm their eligibility and applicable deadlines before submitting a plan change request.
Qualifying Circumstances That Allow You to Change Medicare Advantage Plans
Several circumstances may allow beneficiaries to change their Medicare Advantage coverage outside the standard enrollment periods.
Understanding these situations can help you determine whether you qualify for an additional enrollment opportunity.
1. Moving Outside Your Medicare Advantage Plan’s Service Area
Moving to a different location can affect your Medicare Advantage coverage because plans generally serve specific geographic areas.
If you move outside your existing plan’s service area, you may qualify for a Special Enrollment Period to select another available Medicare Advantage plan.
You may also choose to return to Original Medicare.
Generally, your opportunity to switch begins when you move and continues for two full months after the month of your move.
If you notify your current plan before relocating, your Special Enrollment Period can begin during the month before the move and continue for two full months afterward.
Beneficiaries should check which Medicare Advantage plans are available at their new address before selecting replacement coverage.
2. Losing Medicaid Eligibility
Individuals who receive both Medicare and Medicaid may have additional enrollment opportunities.
If you are no longer eligible for Medicaid, you may qualify for a Special Enrollment Period to make certain Medicare coverage changes.
Depending on your circumstances, you may be able to:
- Join a Medicare Advantage plan that includes prescription drug coverage.
- Switch to another qualifying Medicare Advantage plan.
- Return to Original Medicare.
- Enroll in a standalone Medicare Part D prescription drug plan.
The opportunity generally lasts three full months from either the date you are no longer eligible for Medicaid or the date you receive notification of the loss of eligibility, whichever is later.
Beneficiaries should review their updated eligibility information and confirm which enrollment options are available.
3. Losing Employer or Union Health Coverage
Losing qualifying employer or union health coverage may provide an opportunity to enroll in Medicare coverage outside the regular enrollment periods.
If your employer or union coverage ends, you may qualify for a Special Enrollment Period to join a Medicare Advantage plan or Medicare prescription drug plan.
For certain qualifying coverage losses, the opportunity to enroll generally lasts two full months after the month your coverage ends.
However, the rules depend on the type of coverage and the circumstances surrounding its termination.
It is important to distinguish between active employer coverage, COBRA, and retiree coverage because they do not necessarily provide the same Medicare enrollment protections.
Review your existing coverage and confirm your Medicare enrollment rights before making changes.
4. Moving Into or Out of a Nursing Home or Other Institution
Beneficiaries who move into or out of certain institutions may qualify for additional Medicare enrollment opportunities.
Eligible institutions can include nursing homes and rehabilitation hospitals.
Depending on the circumstances, beneficiaries may be able to:
- Join a Medicare Advantage plan.
- Switch from one Medicare Advantage plan to another.
- Return to Original Medicare.
- Make certain changes to prescription drug coverage.
This Special Enrollment Period generally remains available while you live in the qualifying institution and for two full months after the month you move out.
The applicable rules depend on the institution and the individual’s circumstances.
5. Becoming Eligible for Medicaid or Extra Help
Qualifying for Medicaid or Extra Help can provide additional opportunities to change Medicare coverage.
Extra Help is a federal program that assists eligible individuals with Medicare Part D prescription drug costs.
Beneficiaries who qualify may be able to make certain changes to their Medicare drug coverage.
People who receive Medicaid or Extra Help can generally change their coverage once per calendar month under the applicable Special Enrollment Period rules.
Individuals who qualify for full Medicaid benefits may also have an opportunity to join or switch to an eligible integrated Dual Eligible Special Needs Plan (D-SNP), when available.
These enrollment opportunities are subject to specific eligibility requirements and restrictions.
6. Your Medicare Advantage Plan Ends or Changes Its Contract
Changes involving your Medicare Advantage plan’s contract with Medicare may also create a Special Enrollment Period.
If Medicare terminates a plan’s contract, or the insurance company decides not to renew its contract, affected beneficiaries may receive an opportunity to select alternative coverage.
The enrollment window depends on the specific contract situation.
When a plan is not renewed, beneficiaries generally have an opportunity to select another plan between December 8 and the last day of February of the following year.
If you do not select another Medicare Advantage plan within the applicable timeframe, you may be returned to Original Medicare when your existing plan ends.
Review official notices from Medicare and your insurance company to understand your available options.
7. Qualifying for a Five-Star Medicare Advantage Plan
Medicare uses a Star Rating System to evaluate the quality and performance of Medicare Advantage and prescription drug plans.
If a Medicare Advantage or Medicare drug plan with an overall five-star rating is available in your area, you may qualify for a one-time Special Enrollment Period to join that plan.
This opportunity is generally available once between December 8 of the year before the plan year and November 30 of the plan year.
The enrollment rules and available options depend on the type of plan and your eligibility.
Before switching, review the five-star plan’s provider network, prescription drug coverage, premiums, and other benefits.
What Should You Consider Before Switching Medicare Advantage Plans?
Qualifying for an enrollment opportunity does not automatically mean that changing plans is the best decision.
Before submitting a request, carefully compare your existing coverage with the available alternatives.
Here are some important factors to review:
Monthly Premiums and Other Costs
Compare the monthly premiums, deductibles, copayments, and coinsurance amounts associated with each plan.
A plan with a lower monthly premium may have different out-of-pocket expenses for medical services.
Understanding the complete cost structure can help you evaluate your potential healthcare expenses.
Annual Out-of-Pocket Maximum
Medicare Advantage plans have an annual out-of-pocket maximum for covered Medicare Part A and Part B services.
Review this limit when comparing available plans.
Prescription drug expenses and monthly premiums generally do not count toward this medical out-of-pocket maximum.
Doctor and Hospital Networks
Medicare Advantage plans may use provider networks that determine where beneficiaries can receive covered healthcare services.
Check whether your preferred doctors, specialists, hospitals, and healthcare facilities participate in the new plan.
Network restrictions can affect your access to healthcare services.
Prescription Drug Coverage
Review the plan’s prescription drug formulary to determine whether your medications are covered.
Compare drug costs, pharmacy networks, coverage restrictions, and applicable deductibles.
If you take regular prescription medications, understanding these details is particularly important.
Additional Benefits
Some Medicare Advantage plans offer additional benefits such as dental, vision, hearing, and wellness-related services.
Compare these benefits carefully and review their limitations.
Do not assume that benefits included in your current plan will automatically be available under another plan.
Can You Switch From Medicare Advantage to Original Medicare?
Yes. You can leave Medicare Advantage and return to Original Medicare during certain enrollment periods, including the Annual Enrollment Period, Medicare Advantage Open Enrollment Period, and applicable Special Enrollment Periods.
Original Medicare includes Part A and Part B coverage.
If you return to Original Medicare, you may also need to enroll in a standalone Medicare Part D prescription drug plan if you want Medicare prescription drug coverage.
You may also consider purchasing a Medicare Supplement Insurance policy, commonly called Medigap.
Medigap can help pay certain out-of-pocket expenses associated with Original Medicare, depending on the policy.
However, leaving Medicare Advantage does not automatically guarantee that you can purchase a Medigap policy without medical underwriting. Federal and state rules provide specific enrollment protections and guaranteed issue rights in certain situations.
Before changing coverage, review Medicare Supplement Plans and understand the applicable eligibility requirements.
You can also learn more about Medigap Guaranteed Issue Rights.
How to Change Your Medicare Advantage Plan
Once you confirm that you qualify for an enrollment period, the next step is to review your available plan options and submit your enrollment request.
Follow these steps to approach the process carefully:
Step 1: Confirm Your Enrollment Eligibility
Determine whether you qualify for the Medicare Advantage Open Enrollment Period, Annual Enrollment Period, or a Special Enrollment Period.
Step 2: Review Available Medicare Advantage Plans
Compare plans available in your service area. Consider premiums, deductibles, provider networks, prescription coverage, and additional benefits.
Step 3: Check the Enrollment Deadline
Special Enrollment Periods have different deadlines depending on the qualifying event. Confirm the final date for submitting your request.
Step 4: Submit Your Enrollment Request
You can generally enroll through Medicare.gov, contact the insurance company directly, or use another permitted enrollment method.
Step 5: Confirm Your New Coverage
Review your enrollment confirmation and verify the effective date of your new coverage. Keep your enrollment records and follow any instructions provided by the new plan.
For official assistance and current enrollment information, visit Medicare.gov or contact Medicare at 1-800-MEDICARE (1-800-633-4227).
Conclusion
You can change Medicare Advantage plans during the year, but your ability to do so depends on your enrollment eligibility and qualifying circumstances.
The Medicare Advantage Open Enrollment Period, which runs from January 1 through March 31, provides an opportunity for existing Medicare Advantage members to switch plans or return to Original Medicare.
Special Enrollment Periods offer additional flexibility when certain circumstances occur, including moving outside a plan’s service area, losing Medicaid or qualifying employer coverage, becoming eligible for Extra Help, or experiencing specific changes involving your existing plan.
Before making a change, carefully compare premiums, out-of-pocket expenses, provider networks, prescription drug coverage, and additional benefits. Understanding enrollment deadlines and coverage requirements can help you avoid unnecessary complications.
For more information about Medicare Advantage and Medicare Supplement options, visit Navigating My Medicare and explore its Medicare education resources.
Frequently Asked Questions (FAQs)
1. Can I change my Medicare Advantage plan at any time?
No. You generally cannot change your Medicare Advantage plan whenever you want. You must qualify for an applicable enrollment period, such as the Annual Enrollment Period, Medicare Advantage Open Enrollment Period, or a Special Enrollment Period.
2. What is the Medicare Advantage Open Enrollment Period?
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 each year. It allows people already enrolled in Medicare Advantage to switch to another Medicare Advantage plan or return to Original Medicare. Generally, only one change is permitted during this period.
3. What qualifies me for a Medicare Special Enrollment Period?
Qualifying circumstances may include moving outside your plan’s service area, losing Medicaid eligibility, losing certain employer or union coverage, moving into or out of a qualifying institution, or experiencing specific changes involving your existing plan. Eligibility depends on the event and Medicare’s rules.
4. How long do I have to change my Medicare Advantage plan after moving?
If you move outside your Medicare Advantage plan’s service area, you generally have a Special Enrollment Period that begins when you move and continues for two full months afterward. If you notify your plan before moving, the opportunity can begin in the month before your move.
5. Can I return to Original Medicare after leaving Medicare Advantage?
Yes. You can generally return to Original Medicare during an applicable enrollment period. You may also enroll in a standalone Medicare Part D plan. If you want Medigap coverage, review your guaranteed issue rights and state-specific enrollment rules because medical underwriting may apply in certain circumstances.
