Additional Special Enrollment Periods
Some Medicare special enrollment periods apply on a one-time basis and are triggered by specific events, while others apply year-round for specific populations. Some apply to Medigap, while others apply to Medicare Advantage and Part D Prescription Drug Plans.
For Medicare beneficiaries who qualify for a Low-Income Subsidy , and for those who are in a nursing home or other institutional facility, enrollment in Medicare Advantage plans and Part D prescription drug coverage is not limited to the annual open enrollment period. Enrollees who qualify for Extra Help can make changes to their Medicare Advantage or Part D coverage up to once per calendar quarter. And enrollees who are institutionalized can make changes to their Medicare Advantage or Part coverage year-round, with coverage effective the first of the month following their enrollment.
. Visit this page to review our guides to Medicaid benefits available to Medicare enrollees in each state.)
Medicare beneficiaries who qualify for a State Pharmaceutical Assistance Program also have the option to join a Medicare Advantage or Part D plan at any point during the year, but only once per year.
Frequently Asked Questions About Medicare Advantage
Medicare Open Enrollment is also known as the Annual Enrollment Period or AEP. During the enrollment period, newly eligible and existing Medicare patients can review Medicare coverage options and:
- Switch from Original Medicare to Medicare Advantage, or vice versa
- Change from one Medicare Advantage plan to another
- Add or change Medicare prescription drug plans
- Make no changes to current Medicare coverage
- Use Medicare’s Plan Finder.
- Visit the plan’s website to see if you can join online.
- Fill out a paper enrollment form. Contact the plan to get an enrollment form, fill it out, and return it to the plan. All plans must offer this option.
- Call the plan you want to join. Get your plan’s contact information.
When you join a Medicare Advantage Plan, you’ll have to give this information:
- Your Medicare number
This information is on your Medicare card.
Can You Change Medicare Supplement Plans Anytime
Suppose you have a Medicare Supplement insurance plan, and you want to switch plans outside the OEP described above. In most cases the insurance company can review your medical records and consider your health condition. They can charge you a higher premium or even refuse to accept you as a member.
Certain situations might give you guaranteed-issue rights to change Medicare Supplement insurance plans. There are several situations when you might have guaranteed-issue rights. Here are a few of them:
- You signed up for a Medicare Advantage plan for the first time, and decided you want to drop the plan and buy a Medicare Supplement insurance plan instead.
- You have a Medicare SELECT plan, and youâre moving out of the planâs service area. Medicare SELECT plans are generally the only Medicare Supplement insurance plans that have provider networks that you might have to use. You can either change to a standardized Medicare Supplement insurance plan with the same or fewer basic benefits than your current plan, or buy any Medicare Supplement Plan A, B, C*, F*, K, or L.
- Youâve had your current Medicare Supplement insurance plan for less than six months. If the insurance company agrees to sell you a new policy with the same basic benefits, it canât add conditions related to pre-existing health problems. However, you might have to wait up to six months before the plan covers your pre-existing condition.
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Why Might I Want To Change Medicare Supplement Plans
You might be happy with your current Medicare Supplement insurance plan. But there are some situations where you might want to change plans. Here are a few examples:
- You found a Medicare Supplement insurance plan for a lower premium. Maybe you even found the same plan for less money, offered by a different insurance company.
Every standardized Medicare Supplement insurance plan with the same lettered name has the same basic benefits no matter where you buy the plan. For example, every Medicare Supplement Plan A includes the same basic benefits. So, if you have Medicare Supplement Plan A , and you see a plan of the same name being sold by a different insurance company, the basic benefits will be the same. Please note that Massachusetts, Minnesota, and Wisconsin have differently standardized plans.
- Youâve found that you need more benefits than your Medicare Supplement plan offers, and youâd like to switch to a plan with more benefits.
- Youâve found that you donât need or want all the benefits than your Medicare Supplement insurance plan offers, and youâd like to switch to a plan with fewer basic benefits and possibly a lower premium.
- Youâd like to buy your plan from a different insurance company.
If You Lose Your Medicaid Eligibility:
If youre covered by both Medicare and Medicaid and then you lose eligibility for Medicaid, you can switch from Medicare Advantage to Original Medicare up to three months from the date you lose Medicaid eligibility, or the date youre notified, whichever is later.
- If youre told in advance that youll lose your Medicaid coverage for the following year, you can switch to Original Medicare between January 1March 31.
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When Can You Disenroll From A Medicare Advantage Plan
Like switching Medicare Advantage Plans, you can only disenroll from a Medicare Advantage Plan during certain times of the year.
You can disenroll from your plan during the annual election period, special election periods or during the annual Medicare Advantage Open Enrollment Period, Dworetsky says. Medicare will automatically disenroll you from your old plan if you switch to a different Medicare Advantage plan during any of these periods.
Consider Medicare Advantage Including Prescription Drug Coverage
Many Medicare Advantage plans include Part D prescription drug coverage. If you are already enrolled in Medicare Part A and Part B, you may qualify for Medicare Advantage.5
Some Medicare Advantage plans may offer other benefits beyond Original Medicare. See to find one that may work for you and see if youre eligible to enroll.
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I Am Currently Enrolled In A Medicare Advantage Plan Can I Switch To Original Medicare If I Switch To Original Medicare Will I Be Able To Enroll In A Medicare Supplement Plan
You cannot purchase a Medicare supplement plan if you are enrolled in Medicare Advantage. If you are enrolled in a Medicare Advantage plan you may have a right under Maine law to enroll in a Medicare supplement plan if you switch back to original Medicare, but only under certain limited circumstances.
- You may be entitled to guaranteed issue of a Medicare Supplement policy if your Medicare Advantage plan is involuntarily terminated .
- If you enroll in Medicare Advantage during your six-month open enrollment period, beginning when you first enroll in Medicare Part B, and then switch to Original Medicare Part A and Part B within 36 months:
- You have the right to buy any Medicare supplement plan as long as you buy it within 90 days after your Medicare Advantage coverage ends. This arrangement is intended to provide you with a one time trial period to determine if a Medicare Advantage plan meets your needs. NOTE: If you enrolled in a Medicare Advantage plan mid-year, you will need to switch back to original Medicare sooner than 36 months because federal law only allows you to go back to original Medicare at certain times. Also, the 36 month trial period is specific to Maine, so you may not have the same rights if you move to another state.
Medicare Supplement Open Enrollment Period
Medicare Supplements have a slightly different enrollment period. This enrollment period starts the first month that you are age 65 and lasts for 6 months. This is an important enrollment period because it is the time period in which you have guarantee issue rights for a Medicare Supplement.
If you miss your open enrollment period for Medicare Supplements, you can apply anytime. The only negative to this is that you are not guaranteed to be accepted.
The plan will require medical underwriting and could deny your coverage, or charge you a higher premium based on your health history.
So, if you are leaning toward a Medicare Supplement over a Medicare Advantage plan, your time for guaranteed lower rates is during Medicare Supplement Open Enrollment.
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Notes On Part D Changes
- If youre enrolled in a Medicare Advantage plan that includes prescription drug coverage, you can simply enroll in a stand-alone Part D Prescription Drug Plan, which will automatically disenroll you from your Medicare Advantage plan .
- If your Medicare Advantage plan does not include prescription drug coverage and youre planning to switch to Original Medicare plus a Part D plan, youll need to actively disenroll from the Medicare Advantage plan and then enroll in a Part D Prescription Drug Plan. Its recommended that you complete both actions within the same month if you disenroll from a Medicare Advantage plan in January but dont enroll in a Part D prescription plan until February, your Original Medicare coverage would take effect in February, but your drug coverage wouldnt kick in until March.
- Youll also have the option to apply for a Medigap plan when you switch to Original Medicare, albeit with medical underwriting in most cases .
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.
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In Most Instances Your Medigap Plan Will Not Change
Another type of plan that likely will not change when you move to another state is your Medigap plan. This is because Medigap plans are standardized, meaning that while they are sold by different companies at different premium rates, the benefits offered by Medigap policies remain the same.
The only instance in which youd need to change your Medigap plan after a move would be if you relocate to any of the following three states:
While Medigap plans offered in these states are still standardized, the benefits differ from those of Medigap plans offered throughout the rest of the United States.
How To Change Medicare Insurance Plans
It is one of the most frustrating situations in the world when you want to get something done, get out of a deal, make a change, or get away from an association or affiliation you dont want.
Its even more frustrating when it has to do with your money and your health.
When it comes to Medicare insurance plans, first of all, it can just be downright confusing. On top of that, there are so many myths and misconceptions about how it all works. And if you make the wrong decision, you could be stuck with it. In many cases, it might be difficult to undo what youve just put into motion or replicate what you had before.
These decisions could affect how you approach going to the doctor, pharmacy, and urgent or emergency care. Wouldnt it help to know all of your options instead of hoping you find one sometime?
We could talk about myriad topics related to this sometimes frustrating and confusing subject, but in this snippet, were going to focus on how to change your Medicare plans.
If youre brand new to Medicare, this information still applies to you. When you inevitably want to change something down the road, maybe something else from this will stick with you, as well.
For those of you already on Medicare or youve already made your decision, maybe you just feel like youre stuck. Not true.
Maybe you feel like your plan covers everything, so there couldnt possibly be anything that could ever save you money. Usually not true.
So lets demystify some mysteries of Medicare.
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When Can I Make Changes
First of all, the quick answer is, More often than you would think! Many people have no idea they can make changes throughout the year. Its true that some just simply cannot. However, because of recent changes in laws and rules, it is probably rarer that someone cant enroll in some kind of new plan during the year. Odds are, you may be able to find a reason and ability to change during the year if you just look around and ask someone who knows what theyre doing.
Medicare Supplements
First of all, lets debunk this immediately: If you have a Medicare supplement and you can answer some simple health questions, you can enroll in another Medicare supplementanytime during the year. Period.
So many companies and agents seem to suggest that a supplement cant be changed immediately. Consequently, so many people are shocked to learn they can change their supplements in the middle of the year. If you dont like your Medicare Supplement for whatever reason, feel free to start looking, because you can probably change it. If the rate is jumping up, you dont like the service, you dont like the company, etc., no problem as long as you can qualify.
IEP/ICEP-Your Initial Enrollment
Note:Medicare Advantage plans and Medicare supplement plans require enrollment in both Part A & Part B. Prescription Drug Plans only require either A or B.
AEP
OEP
Not sure if youre on a Medicare Advantage? 40 percent of Medicare-eligible persons are on these plans, and that number continues to grow.
Can I Get My Health Care From Any Doctor Other Health Care Provider Or Hospital
- Original Medicare
-
You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.
In most cases, you don’t need a
referral
to see a specialist.
- Medicare Advantage
-
In many cases, youll need to only use doctors and other providers who are in the plans network . Some plans offer non-emergency coverage out of network, but typically at a higher cost.
You may need to get a
referral
-
You can join a separate Medicare drug plan to get Medicare drug coverage.
- Medicare Advantage
-
Medicare drug coverage is included in most plans. In most types of Medicare Advantage Plans, you cant join a separate Medicare drug plan. You can join a separate Medicare drug plan with certain types of plans that:
- Cant offer drug coverage
- Choose not to offer drug coverage
Youll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:
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Changing Medicare Advantage Plans After Open Enrollment
In certain situations, you may be able to change Medicare Advantage plans after these open enrollment periods.
Your first year in a Medicare Advantage plan. This counts as a trial period in two circumstances. You can drop out of the plan and return to original Medicare with the right to buy Medigap supplemental insurance during the first 12 months 1) if you joined the plan when you enrolled in Medicare at age 65, or 2) if you dropped a Medigap policy to join the Advantage plan and this is the first Advantage plan you have been enrolled in.
If a five-star Medicare Advantage plan is available in your area. If a Medicare Advantage plan that covers your area earned an overall five-star rating from the Centers for Medicare & Medicaid Services, you can join that plan any time of year except the first week in December. You can use this five-star special enrollment period once a year. Coverage begins the first day of the month after the plan receives your enrollment request.
To find out whether a five-star plan is available in your area, visit the Medicare Plan Finder and filter results for your zip code based on star ratings. Plans with a five-star rating have a five-star icon. You can also call 800-MEDICARE or your State Health Insurance Assistance Program to find out if five-star plans are available.
How To Switch Medicare Advantage Plans
- You have several opportunities to switch your Medicare Advantage plan throughout the year.
- You can switch your plan for Medicare Advantage and Medicare prescription drug coverage during the Medicare open enrollment period or the Medicare Advantage open enrollment period.
- You can also switch your Medicare Advantage plan during a special enrollment period thats triggered by a major change in your life.
Medicare Advantage plans are offered by private insurance companies. If you have a Medicare Advantage plan, you can:
- switch to a different Medicare Advantage plan that offers drug coverage
- switch to a different Medicare Advantage plan that doesnt offer drug coverage
- switch to original Medicare plus a Part D plan
- switch to original Medicare without adding a Part D plan
To switch plans, contact the insurance provider of the plan you like and apply for coverage. If youre not sure how to contact the provider, Medicares plan finder tool may be useful. You will be disenrolled from your previous plan as soon as your new plan takes effect.
If you are switching from a Medicare Advantage plan to original Medicare, you can either call your former plan or enroll through Medicare by calling 800-MEDICARE.
The short answer is no. You may switch Medicare Advantage plans during set enrollment periods each year and within a specified period of time following certain life events.
Well discuss these enrollment periods in the next section.
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