Written by Ari Parker — Updated: Friday, September 1, 2023
There are many reasons why you may want to change your Medicare coverage. Maybe you’re unhappy with your Medicare plan. Or maybe your healthcare needs have changed, so you need a higher level of coverage. Regardless of your reason, it’s important to know when you are able to change your Medicare coverage, and what kinds of issues you may run into.
Like with all types of healthcare insurance, you cannot change your Medicare plan whenever you want. This is because insurance plans must maintain a balanced pool of beneficiaries. If we could change our insurance coverage whenever we wanted, we’d only sign up for high-cost coverage when we needed it. This would then force insurance companies to raise the prices for these plans even more to be able to pay for its beneficiaries' high level of healthcare needs—ultimately eliminating the purpose of insurance.
While you cannot change your Medicare coverage whenever you want, there are set times at which you can switch between plans or from Medicare Advantage to allow for freedom of choice.
Medicare Advantage beneficiaries have more flexibility when it comes to changing plans. As a Medicare Advantage planholder, you can change your plan at least once a year, during the annual Open Enrollment Period. There are also a couple of other standard enrollment periods that help beneficiaries who may have ended up on a bad Medicare Advantage plan.
Even if you’re happy with your Medicare Advantage plan, we still recommend beneficiaries shop around because:
Medicare’s Open Enrollment Period can sometimes feel hectic for Medicare beneficiaries. You’ll receive countless communications from Medicare professionals and see a series of commercials highlighting exciting benefits.
Because of aggressive sales and marketing tactics, you may be hit with “buyers remorse” at the beginning of the year when you realize the plan you ended up choosing doesn’t fit all of your needs. Note: When you work with one of our licensed Advisors, this won’t happen. We’re careful to be sure all of your prescriptions are covered by your plan, you can continue seeing your preferred doctors, and the monthly premium for your plan works for your financial situation.
If you do find yourself on a Medicare Advantage plan you don’t want, you have an opportunity from January 1 - March 31 to either change to another Medicare Advantage plan or switch back to Original Medicare. This is called the Medicare Advantage Open Enrollment Period.
Some special circumstances allow Medicare Advantage enrollees to change their plans outside of standard enrollment periods. Special Enrollment Periods occur when:
Within one year of either of the following, you can switch from Medicare Advantage to Original Medicare + Medigap with a guaranteed issue right:
If a Medicare Advantage, prescription drug, or Medicare Cost Plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period to change from your current plan to the 5-star plan. This is a one-time enrollment period available to Medicare beneficiaries between December 8th and November 30th. Give us a call at (855) 900-2427 to see if there’s a 5-Star plan in your area.
You may recall that when you first enrolled in Medicare, you were able to enroll in any Medigap plan without answering any questions about your health history. This was because for six months after your Part B effective date, you have a one-time guaranteed issue period. Outside of this time and a handful of other guaranteed issue periods, insurance companies may ask you questions about your health history and deny your Medigap application.
Medigap guaranteed issue periods allow you to enroll in any Medigap plan, regardless of your age and health history. During these periods, insurance legally cannot ask you questions about your health history, and they cannot deny you a Medigap plan.
The first Medigap guaranteed issue period is your Medigap Open Enrollment Period. This is a six-month window following your Part B effective date, and it’s the most common time for Medicare beneficiaries to enroll in a Medigap plan.
If you’re confused by the different Medicare options, you’re not alone. For this reason, Medicare offers a Medicare Advantage trial period, which provides you with a guaranteed issue right within one year of either:
If your Medicare Advantage plan withdraws from your area or you move to a new area where your plan is not available, you’re eligible for a guaranteed issue right for Medigap.
If you’re on employer-sponsored supplemental (retiree) coverage that gets canceled by your employer, you are eligible for a guaranteed Medigap issue right.
If your Medigap plan’s insurance carrier goes bankrupt or no longer offers Medigap coverage, you’re eligible for a guaranteed issue right.
Some states offer more flexibility around Medigap enrollment.
The following states have continuous or annual guaranteed issue protections, meaning that you have at least a once-a-year opportunity to enroll in a Medigap policy with a guaranteed issue right:
The following states have a Medigap birthday rule, which allows you to switch from one Medigap plan to another during a period of time surrounding your birthday. Each state’s birthday rule period varies, and generally you will only skip underwriting if you enroll in a Medigap plan with equal or lesser coverage than the one you’re currently enrolled in.
Missouri has a Medigap anniversary rule, which is similar to the birthday rule. Using the anniversary rule, you can switch to the same type of plan from a different carrier 30 days before and 30 days after your policy’s annual anniversary date. This encourages Medigap insurance carriers to maintain competitive pricing.
Technically, as long as you’re not enrolled in a Medicare Advantage plan, you can enroll in a Medigap plan at any time. The catch is that, if you’re outside of a guaranteed issue period, insurance companies can ask you about your health history and may deny your application. This is why the majority of those on Medigap plans enroll as soon as they can, during their Medigap Open Enrollment Period.
The main reasons you may want to change your Medicare prescription drug plan are:
Like with all types of healthcare insurance, you cannot switch at any time, but you’re able to change your prescription drug coverage at least once a year, during Medicare’s Open Enrollment Period.
During Medicare’s Open Enrollment Period (October 15 - December 7), you can change:
You can enroll in any Part D plan available to you to ensure your healthcare needs for the next year are met, and you’re getting the best prices for your prescriptions.
If you choose to switch from a Medicare Advantage plan back to Original Medicare during the Medicare Advantage Open Enrollment Period, you may also enroll in a Medicare Part D plan.
Like Medicare Advantage, there are Special Enrollment Periods for Part D coverage. Special Enrollment Periods occur when:
If you qualify for Extra Help, you may be able to change your coverage once during the first three quarters of the year.
If a prescription drug plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period to change from your current plan to the 5-star plan. This is a one-time enrollment period available to Medicare beneficiaries between December 8th and November 30th.