Stuck with a Medicare Advantage plan that doesn’t meet your needs? You might think you have to wait until fall to make changes, but there are actually three different windows throughout the year when you can switch plans or return to Original Medicare.
Key Takeaways
- Medicare Advantage plan members have three main enrollment periods to change plans: Annual Enrollment (October 15-December 7), Medicare Advantage Open Enrollment (January 1-March 31), and Special Enrollment Periods triggered by qualifying life events
- The Medicare Advantage Open Enrollment Period (January 1 to March 31) is exclusively for those already enrolled in a Medicare Advantage plan as of January 1st. Individuals in Original Medicare cannot use this period to join a Medicare Advantage plan
- Special Enrollment Periods (SEPs) are triggered by specific life events that allow you to change your Medicare Advantage plan outside the standard enrollment periods. Examples include moving outside your plan’s service area or changes in your Medicaid eligibility
- New Medicare beneficiaries who enroll in a Medicare Advantage plan when first eligible for Medicare at age 65 or those who dropped a Medigap policy to join a Medicare Advantage plan for the first time get a 12-month trial period to switch back to Original Medicare with guaranteed Medigap access
- When switching from a Medicare Advantage plan (which often includes Part D coverage) to Original Medicare, it’s vital to enroll in a standalone Part D plan within 63 days to avoid a late enrollment penalty. This penalty is calculated based on the number of months without creditable prescription drug coverage and is added to your monthly Part D premium for as long as you have Medicare drug coverage
Medicare Advantage plans offer an alternative to Original Medicare, but circumstances change. Whether you’re dealing with network restrictions, coverage gaps, or simply want different benefits, understanding when you can make changes prevents being stuck with inadequate coverage for an entire year.
Three Key Windows to Change Your Medicare Advantage Plan
Medicare Advantage plan changes aren’t allowed year-round. Three distinct enrollment periods provide opportunities to switch plans or return to Original Medicare, each with specific rules and timing requirements.
The most predictable windows occur annually, giving plan members regular opportunities to reassess their coverage needs. However, life events can create additional chances to make changes outside these standard periods. Understanding these timing restrictions helps ensure you don’t miss opportunities to improve your healthcare coverage.
For detailed information about Medicare enrollment periods and plan options, Medicare.org provides guidance on navigating these complex decisions.
Annual Enrollment Period: Your Primary Opportunity Every Fall
The Annual Enrollment Period runs from October 15 through December 7 each year, serving as the primary window for Medicare plan changes. During this time, all Medicare beneficiaries can switch between different Medicare Advantage plans, move from Medicare Advantage to Original Medicare, or make changes to prescription drug coverage.
October 15 – December 7 Annual Changes
This seven-week period offers the most flexibility for Medicare plan changes. Current Medicare Advantage members can switch to any available plan in their area, regardless of their current health status or coverage satisfaction. The enrollment process is straightforward – simply enroll in a new plan, and you’ll automatically be disenrolled from your current coverage.
Coverage changes made during this period take effect January 1st of the following year. This timing allows for seamless transition between plans without coverage gaps, ensuring continuous healthcare protection throughout the year.
Switch Between Original Medicare and Medicare Advantage
The Annual Enrollment Period allows movement in both directions between Original Medicare and Medicare Advantage plans. Those currently in Medicare Advantage can return to Original Medicare Parts A and B, while Original Medicare beneficiaries can join Medicare Advantage plans for the first time or after previous enrollment.
When switching from Medicare Advantage to Original Medicare, beneficiaries should consider Medigap supplemental insurance to cover out-of-pocket costs. However, guaranteed issue rights for Medigap policies may be limited if more than six months have passed since initial Medicare Part B enrollment.
Add or Drop Part D Coverage Options
Prescription drug coverage changes are also permitted during the Annual Enrollment Period. Original Medicare beneficiaries can add, drop, or switch Part D standalone prescription drug plans. Medicare Advantage members can choose plans with or without integrated prescription drug coverage, depending on their medication needs and preferences.
This flexibility allows beneficiaries to align their prescription coverage with changing medication requirements, potentially saving money on premiums and out-of-pocket drug costs throughout the year.
Find Plans in your area with your ZIP Code
Medicare Advantage Open Enrollment Period: January Through March for Current Members
The Medicare Advantage Open Enrollment Period provides a second opportunity for plan changes, but with important restrictions. This period runs from January 1 through March 31 and offers additional flexibility specifically for current Medicare Advantage members.
Only Available If Already Enrolled January 1
This enrollment period is exclusively available to individuals already enrolled in a Medicare Advantage plan as of January 1st. Those in Original Medicare cannot use this period to join Medicare Advantage plans – they must wait for the Annual Enrollment Period or qualify for a Special Enrollment Period.
The restriction ensures that this period serves its intended purpose: providing Medicare Advantage members with additional time to reassess their plan choice after experiencing coverage for several months. This is particularly valuable for identifying network issues, coverage gaps, or service problems that weren’t apparent during the initial selection process.
Switch Plans or Return to Original Medicare
During this period, Medicare Advantage members can switch to a different Medicare Advantage plan or return to Original Medicare. If switching back to Original Medicare, beneficiaries can also enroll in a standalone Part D prescription drug plan to maintain prescription coverage.
Coverage changes made during this period take effect the first day of the month following enrollment. For example, an application submitted in February would result in coverage beginning March 1st, providing relatively quick resolution to coverage issues.
Special Enrollment Periods: Change Plans Due to Qualifying Life Events
Special Enrollment Periods (SEPs) allow Medicare Advantage plan changes outside standard enrollment windows when specific qualifying events occur. These periods recognize that life circumstances can create urgent needs for different healthcare coverage that shouldn’t wait for annual enrollment opportunities.
1. Moving Outside Your Plan’s Service Area
Geographic moves that take you outside your current Medicare Advantage plan’s service area automatically trigger a Special Enrollment Period. This includes moves to different states, counties, or ZIP codes where your current plan doesn’t provide coverage.
The SEP typically lasts for two months after the move, giving you time to research and select appropriate coverage in your new area. You can choose any Medicare Advantage plan available in your new location or switch to Original Medicare with Part D coverage.
2. Plan Changes or Cancellations by Your Insurer
When your Medicare Advantage plan makes significant changes to coverage, provider networks, or service areas, or if the plan is cancelled entirely, you qualify for a Special Enrollment Period. This protects beneficiaries from being stuck with inadequate coverage due to insurer decisions beyond their control.
Common triggering events include substantial reductions in provider networks, elimination of prescription drug coverage, or changes to plan service areas. The SEP typically begins when you receive notification of the changes and continues for a specified period, allowing time to find alternative coverage.
3. Loss of Medicaid or Premium Assistance
Changes in Medicaid eligibility or state premium assistance programs create Special Enrollment Periods for Medicare plan changes. This includes both losing and gaining these forms of assistance, as they significantly impact healthcare costs and plan affordability.
These SEPs recognize that changes in financial assistance can make current plan choices unaffordable or reveal new options that weren’t previously accessible. The timing and duration of these SEPs vary based on specific circumstances and state programs.
4. Five-Star Plan Enrollment Once Per Year
Medicare Advantage plans receiving five-star ratings from the Centers for Medicare & Medicaid Services can be joined at any time during the year, with one important exception: the first week of December. This special enrollment opportunity is limited to once per calendar year per person.
Five-star ratings represent the highest quality measures for Medicare Advantage plans, including clinical care quality, member satisfaction, and customer service performance. This enrollment flexibility rewards high-performing plans and gives beneficiaries access to superior coverage whenever it becomes available in their area.
First-Year Trial Rights and Medigap Guaranteed Issue
New Medicare beneficiaries and those switching to Medicare Advantage for the first time receive special protections during their first year of coverage. These trial rights provide important safeguards against making irreversible coverage decisions without adequate experience with the chosen plan.
12-Month Trial Period for New Medicare Beneficiaries
Beneficiaries who join a Medicare Advantage plan when first enrolling in Medicare at age 65 get a 12-month trial period. During this time, they can switch back to Original Medicare and purchase a Medigap supplemental policy without medical underwriting, regardless of health conditions or pre-existing medical issues.
This trial right also applies to beneficiaries who dropped a Medigap policy to join their first Medicare Advantage plan. The protection ensures that initial Medicare coverage decisions don’t permanently eliminate access to Medigap supplemental insurance, which many beneficiaries find necessary for managing Original Medicare’s out-of-pocket costs.
60-Day Application Window for Medigap Coverage
When exercising trial rights to return to Original Medicare, beneficiaries have 60 days to apply for a Medigap policy. This application must be submitted within the specified timeframe to maintain guaranteed issue rights, which protect against medical underwriting and coverage denials.
The 60-day window begins either when the Medicare Advantage coverage ends or when the beneficiary receives notice that their coverage will end. Missing this deadline can result in losing guaranteed access to Medigap coverage, potentially leaving significant gaps in supplemental insurance protection.
Avoid Lifetime Part D Penalties When Switching to Original Medicare
Switching from Medicare Advantage to Original Medicare requires careful attention to prescription drug coverage timing to avoid permanent penalties. Most Medicare Advantage plans include integrated Part D prescription drug coverage, but Original Medicare does not automatically include this protection.
Beneficiaries switching to Original Medicare must enroll in a standalone Part D prescription drug plan within 63 days of losing Medicare Advantage coverage. Failing to meet this deadline results in a late enrollment penalty that increases Part D premiums for life, even if prescription drug coverage wasn’t needed immediately after the switch.
The penalty calculation is based on the number of months without creditable prescription drug coverage multiplied by 1% of the national base beneficiary premium. This penalty continues for as long as the beneficiary maintains Part D coverage, making timely enrollment vital for long-term healthcare cost management.
Additionally, beneficiaries should research Part D plan formularies to ensure their current medications are covered under their chosen standalone plan. Unlike Medicare Advantage plans that may offer wide coverage, standalone Part D plans vary significantly in their covered medications and cost-sharing structures.