If You Enroll In Drug Coverage Thats Equivalent To Medicare Part D
If you enroll in TRICARE, VA coverage, or another plan that offers comprehensive prescription drug benefits and you have a Medicare Advantage plan that includes prescription drug coverage then you can leave your Medicare Advantage plan and return to Original Medicare.
- Youll want to check with your prescription drug plan to make sure that it provides you with credible drug coverage.
- You can do this at any time, but your ability to enroll in the alternative creditable drug coverage may be limited by that plans rules.
What Changes Can You Make During Medicare Open Enrollment
During Medicare open enrollment, you can review your existing coverage and make changes to it. Specifically, you can switch from:
- Original Medicare to a Medicare Advantage plan.
- A Medicare Advantage plan to Original Medicare.
- One Medicare Advantage plan to another.
- One Medicare Part D drug plan to another.
You can also do the following during the Medicare open enrollment period in 2022 :
- Join a Part D drug plan.
- Drop your Part D coverage.
The Medicare Advantage Open Enrollment Period
The Medicare Advantage Open Enrollment Period runs from January 1 to March 31 each year. You have to be currently enrolled in a Medicare Advantage plan to be eligible to make changes during this time. Changes you can make include:
- Switch to another Medicare Advantage plan
- Drop a Medicare Advantage plan and go back to Original Medicare
- Join a Part D prescription drug plan if you qualify.
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Types Of Special Enrollment Periods With Limited Plan Category Choices
Enrollees and their dependents who qualify for the most common Special Enrollment Period types like a loss of health insurance, moving to a new home, or a change in household size will only be able to pick a plan from their current plan category.
For example, someone whos already enrolled in a Bronze health plan will only be able to select a new plan from the Bronze category.
Plans That Terminate At Year
If youre enrolled in a plan through the exchange and your coverage terminates at the end of the year because your insurer exits the market in your area, the exchange will pick a new plan for you if you dont select one yourself during open enrollment. If you have an off-exchange plan that terminates at the end of the year, you have to pick a new plan for yourself by December 31 in order to avoid being uninsured on January 1.
But your special enrollment period triggered by loss of coverage also extends for the first 60 days of the new year . So if your plan terminates on December 31, you have the first 60 days of the new year to select a plan other than the one the exchange picked for you .
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Your Plan Changes Its Contract With Medicare
- Medicare takes an official action because of a problem with the plan that affects me.
What can I do?
Switch from your Medicare Advantage Plan or Medicare Prescription Drug Plan to another plan.
Your chance to switch is determined by Medicare on a case-by-case basis.
- Medicare ends my plan’s contract.
What can I do?
Switch from your Medicare Advantage Plan or Medicare Prescription Drug Plan to another plan.
Your chance to switch starts 2 months before and ends 1 full month after the contract ends.
- My Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan’s contract with Medicare isn’t renewed.
What can I do?
Join another Medicare Advantage Plan or Medicare Prescription Drug Plan.
Annual Medicare Advantage Open Enrollment Period
For Medicare Advantage enrollees who are no longer in their trial period, theres an annual Medicare Advantage open enrollment period that became available starting in 2019. It runs from each year, and allows Medicare Advantage enrollees to switch to Original Medicare or to a different Medicare Advantage plan.
The ability to switch plans during the January March enrollment period is limited to one plan change per year. This open enrollment period replaced the Medicare Advantage disenrollment period that was used from 2011 to 2018, and provides more flexibility to Medicare Advantage enrollees .
When Medicare Advantage enrollees switch to Original Medicare during the January-March open enrollment period, theyre also eligible to purchase a Part D Prescription Drug Plan. But a person who has Part D coverage with Original Medicare cannot switch to a different Part D plan during the January March open enrollment period, since this window only applies to Medicare Advantage enrollees.
Alternatively, you can switch to a different Medicare Advantage plan during this period, if the one you have is not meeting your needs.
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Medicare Special Enrollment Period
You only qualify for a Medicare special enrollment period if you missed your IEP because you were still covered by a group health plan through your own or your spouse’s job . You can sign up for Original Medicare coverage within this eight-month window, which starts:
- The month after your employment, or the employment of your spouse or family member, ends.
- The month after the group health plan tied to that job ends.
Can I Change Medicare Advantage Plans Anytime
Updated: September 16, 2021Expert reviewed by: Kelly Blackwell, Certified Senior Advisor®Medicare Advantage Plans, also called Medicare Part C, are an alternative to Original Medicare. They provide the same coverage as Medicare Part A and Part B, and sometimes offer additional benefits not included in Original Medicare, like drug, dental and vision coverage.
Kelly Blackwell is a Certified Senior Advisor ®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
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Switching Between Original Medicare And Medicare Advantage
People can switch from original Medicare to Medicare Advantage or vice versa. Both Medicare and Medicare Advantage plan providers can arrange for someone to switch plans. Both processes involve speaking to a Medicare Advantage plan provider.
Individuals can switch between original Medicare and Medicare Advantage at any time during the first 3 months of their enrollment. After this time, they must wait for specific enrollment periods to make changes.
People with Medicare Advantage can switch to original Medicare by calling either Medicare at 1-800-MEDICARE or their Medicare Advantage plan provider.
Can I Add Medigap After Leaving A Medicare Advantage Plan
If you are currently enrolled into a Medicare Advantage plan, and it is illegal for insurance companies to sell you a Medigap policy if you have a Medicare Advantage plan.
This does not mean you have missed your chance to ever enroll in a Medicare Supplement insurance plan. Your Medigap Open Enrollment Period begins the first month that you enroll in Medicare Part B not the first month you are eligible for Medicare. So if you delayed your enrollment in Medicare Part B, or if you canceled your automatic enrollment when you first turned age 65, you may still have the guaranteed-issue right to enroll in Medigap when youre ready for Medicare Part B.
If you already had a Medigap plan and then dropped it when you switched to a Medicare Advantage plan, you may be able to get the same plan back if you go back to Original Medicare within one year. This is your trial right to try a Medicare Advantage plan. If your old Medicare Advantage plan is no longer available when switching back, then you can purchase Medigap Plan A, B, C, F, K, or L with guaranteed issue, thats sold by any insurance company in your state.
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Special Enrollment Available For 5
Medicare utilizes a star rating system for Medicare Advantage and Part D Prescription Drug Plans. Each Medicare contract is assigned a rating of one to five stars, with the best contracts receiving five stars. If you live in an area where a 5-star Part D or Advantage plan is available, you can join or switch to the 5-star plan up to once per year, between December 8 and November 30.
In 2021, there are a total of 28 Medicare contracts nationwide that have a 5-star rating. Two are Medicare cost plans, five are stand-alone Part D plans, and the rest are Medicare Advantage plans.
Most plans do not receive five stars, and in most years, most areas of the country do not have 5-star plans available. For 2021, however, theres a UnitedHealthcare contract with a five-star rating, available in most of the US.
The Medicare Annual Enrollment Period
The Medicare Annual Enrollment Period happens every year October 15 to December 7. During this time, anyone with Medicare can make changes to their coverage for the following year.
What can I do during AEP?
During AEP, you can join, switch or drop a plan. For example, you can:
- Enroll in a Medicare Advantage or stand-alone Medicare Part D prescription drug plan
- Switch to a different Medicare Advantage or stand-alone Part D prescription drug plan
- Drop a Medicare Advantage plan and go back to Original Medicare . (If you do this, you may also need to get a Part D prescription drug plan if your former Medicare Advantage plan included drug coverage.
- Replace a Medicare Advantage plan with a stand-alone Part D prescription drug plan
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Change Medicare Plans During Special Election Period
Medicare has certain provisions to help you deal with unexpected happenings. If you go through certain special circumstances, you may be able to change Medicare plans during Special Election Periods. These events may include, but arent limited to:
moving to a new address losing your current coverage qualifying for other coverage such as Medicaid, Employer Group Coverage and State Pharmaceutical Assistance Program becoming qualified for Extra Help to pay for Medicare Part D coverage through the Social Security Administration
The dates and types of changes you can make vary according to the Special Election Period.
Why Would I Want To Change Medicare Advantage Plans
There could be many reasons to change Medicare Advantage plans. For example:
- You are facing an expensive surgery and you want a plan with a lower out of pocket maximum so youll have lower out of pocket costs.
- You are spending a lot on dental services and you want more comprehensive dental benefits.
- You dont use many medical services so you want very basic coverage with the lowest premiums possible.
- Your current Medicare Advantage plan is a PPO and you would prefer an HMO .
- You are taking an expensive prescription drug and you want a plan with lower copayments for prescription drugs.
Do you want to start looking for Medicare Advantage plans in your area today? Just enter your zip code on this page.
Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealths Medicare related content is compliant with CMS regulations, you can rest assured youre getting accurate information so you can make the right decisions for your coverage. Read more to learn about our Compliance Program.
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What Is The 2022 Medicare Advantage Open Enrollment Period
There are two open enrollment periods that allow you to make changes to your Medicare Advantage plan for 2022.
From Oct. 15 to Dec. 7, 2021, you can change from:
- Original Medicare to Medicare Advantage.
- Medicare Advantage to Original Medicare.
You can also switch from one Medicare Advantage plan to another during this enrollment window.
If youre in Original Medicare, you can join a Part D plan now, too. Or you can switch from one Part D plan to another.
From Jan. 1 to March 31, 2022, you can switch from:
- One Medicare Advantage plan to another.
- A Medicare Advantage plan back to Original Medicare.
One change you cant make during this open enrollment period is to go from Original Medicare to Medicare Advantage coverage.
General Medicare Enrollment For Those Who Didnt Sign Up When First Eligible
From January 1 to March 31 each year, people who are eligible for Medicare Parts A and B but not yet enrolled can sign up for coverage. Coverage will take effect on July 1 of that year. If you didnt sign up for Part B when you were first eligible and you havent had creditable coverage from an employer plan in the meantime, youll have to pay an additional premium for your Part B plan, as a late enrollment penalty.
If you sign up for Medicare during the general enrollment period, you have three additional months during which you can select a Part D plan or a Medicare Advantage plan. And once youre enrolled in Medicare Part B , youll have a one-time enrollment window during which Medigap plans in your area are guaranteed-issue. In most states, Medigap plans will then be medically underwritten if you apply after that six-month window ends.
Although the fall enrollment window for 2022 coverage is approaching, people who arent enrolled in Part B cannot sign up for it during the fall window. Instead, theyll need to wait until January 1, and enroll in Part B during the general enrollment period.
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Special Enrollment Period For Medicare Advantage Or Part D Members
Current Medicare enrollees may qualify for a unique 2- month Special Enrollment Period to switch to a different Medicare Advantage or Part D prescription drug plan due to a “qualifying life event.”
You may qualify for a 2-month Special Enrollment Period in the following situations:
- You move out of your plan’s service area.
- Your plan closes, stops serving the area where you live, significantly reduces its provider network or your plan consistently receives low Medicare star ratings.
- You want to enroll in a 5-star plan at any time or drop your first Medicare Advantage plan within 12 months of enrolling.
- You move into or out of a qualified institutional facility, like a nursing home.
- You are enrolled in or lose eligibility for a qualified State Pharmaceutical Assistance Program.
- You have Medicare financial assistance such as Medicaid, a Medicare Savings Program or Extra Help, or you gain or lose eligibility for any of these.
- You enroll in or leave the Program of All-Inclusive Care for Elderly .
- You gain or lose eligibility for a Special Needs Plan.
Some situations not listed here may qualify for a Special Enrollment Period as well. If you have questions about your personal situation, call your State Health Insurance Assistance Program for help.
What can I do during this time?
- Switch to a new Medicare Advantage or Part D plan.
- Drop your Medicare Advantage plan and return to Original Medicare.
When Can You Change Part D Plans
You can change from one Part D plan to another during the Medicare open enrollment period, which runs from October 15 to December 7 each year. During this period, you can change plans as many times as you want. Your final choice will take effect on January 1.
If you have a Medicare Advantage plan that doesnt include drug coverage and you also have a Part D plan, you can change it during the Medicare Advantage open enrollment period, which runs from January 1 to March 31 each year. If you choose this route, you must do one of the following:
- Change your Medicare Advantage plan to one that includes drug coverage .
- Switch from Medicare Advantage back to Original Medicare, then purchase a standalone Part D plan.
If youre enrolled in a Medicare Advantage plan that you like and want to change only your Part D plan, it is best to wait until the general enrollment period, in the fall.
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Changing Medicare Advantage Plans: Compare Plans Before You Switch
If you want to change Medicare Advantage plans, you may want to make sure youre choosing the right plan for your needs and not missing out on a plan that might be better for you. For an instant side-by-side look at Medicare Advantage plans in your area, start by entering your zip code in the box on this page.
From the list of plans displayed, you can enter your medications to see if theyre covered, look at specific plan costs, and more. Follow the links below to request an email with customized information, or to set up a phone call with me.
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Can I Change Medicare Advantage Plans Anytime During My Special Enrollment Period
Outside of the Medicare Open Enrollment Period, you may be able to change your Medicare Advantage plan during a Special Enrollment Period . Usually youll be granted a SEP if you move or lose other insurance coverage. Life events that may qualify you for a Special Enrollment Period include:
- You move to an address that is outside your plans service area
- You move to an address that has new plan options
- You move into a skilled nursing facility or long-term care facility
- Medicare terminates your plan