Medicare Enrollment Guide
Can I change my Medicare plan right now?
Sometimes yes, sometimes no. Medicare only lets you switch health or drug plans during certain windows. This page walks through each one in plain English.
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The short answer
Every year you can change your Medicare Advantage or drug plan from October 15 to December 7. If you are already in a Medicare Advantage plan, you get one more chance from January 1 to March 31. Outside those dates, you need a life event that opens a Special Enrollment Period.
The three regular windows
These happen on a set schedule, so they are the ones to know first.
When you first qualify
Initial enrollment
When you first become eligible, you can pick a Medicare Advantage plan and a drug plan.
January 1 to March 31
Medicare Advantage Open Enrollment
Only for people already in a Medicare Advantage plan.
When you first qualify
Initial enrollment
When you first become eligible, you can pick a Medicare Advantage plan and a drug plan. For most people this window is about seven months long: the three months before you qualify, the month you qualify, and the three months after.
This is the big one. You can switch Medicare Advantage plans, move from Original Medicare to Medicare Advantage or back, and add, drop, or change your drug plan. Changes made now start January 1.
October 15 to December 7
Fall Open Enrollment
January 1 to March 31
Medicare Advantage Open Enrollment
Only for people already in a Medicare Advantage plan. You can switch to a different Medicare Advantage plan, or leave and go back to Original Medicare with a drug plan. You get one change in this window.
When life changes
When life changes: Special Enrollment Periods
Outside the regular windows, more than 20 situations can let you change plans. Each one has its own timing, so the notes below are a starting point. Your plan or Medicare decides whether you qualify. If you qualify for more than one window, you can use whichever suits you best.
Categories
Moving
You moved
If you move out of your plan’s service area, or to a place with new plan choices, you can switch. Tell your plan about the move early. Your window can open the month before you move and run about two months after.
You are in a state drug assistance program
If you are in a qualified State Pharmaceutical Assistance Program, such as New York’s EPIC, you can join or switch plans once a year at any time. You cannot use it to drop drug coverage, and it does not apply if the program enrolled you automatically. If you lose eligibility, you get a window that runs about two months after you are notified.
You moved back to the U.S. or were released from prison
These plans are not available while you live abroad or are incarcerated. When you return or are released, you can join one. Your window can open the month before and run up to two months after.
Work and other coverage
You joined, left, or lost employer or union coverage
Joining or leaving a job-based or retiree plan, including a Medicare Advantage or drug plan offered through it, opens a window. It stays open until two months after the month your employer or union coverage ends.
You are leaving COBRA
Dropping COBRA to join a Medicare Advantage or drug plan opens a window. To join Medicare Advantage you must already have Parts A and B. COBRA does not count as current employer coverage for delaying Part B, so talk to Paul before you drop anything.
You lost drug coverage that was as good as Medicare's
If you lose it through no fault of your own, you can join a drug plan or a Medicare Advantage plan with drug coverage. The window runs two months after your coverage ends or two months after you get notice, whichever is later. It does not apply if you lost coverage for not paying premiums.
You want to use VA, TRICARE, or similar drug coverage
You can leave a Medicare drug plan, or a Medicare Advantage plan with drug coverage, whenever you are able to enroll in other drug coverage that is as good as Medicare’s.
You are in a state drug assistance program
If you are in a qualified State Pharmaceutical Assistance Program, such as New York’s EPIC, you can join or switch plans once a year at any time. You cannot use it to drop drug coverage, and it does not apply if the program enrolled you automatically. If you lose eligibility, you get a window that runs about two months after you are notified.
Medicaid and Extra Help
You have Extra Help, Medicaid, or a Medicare Savings Program
With Extra Help you can join, leave, or switch drug plans once a month. If you are in Medicare Advantage, you can move to Original Medicare with a standalone drug plan. You cannot use this one to join a Medicare Advantage plan. People with full Medicaid can join a matching integrated Dual-eligible Special Needs Plan once a month.
Your Medicaid or Extra Help status changed
If Medicare puts you in a drug plan after finding you qualify for Extra Help, or moves you into a new Dual-eligible Special Needs Plan when your old one ends, you have three months to switch. The time starts after you are notified or the plan begins, whichever is later.
Medicare enrolled you in a plan automatically
If you are in a qualified State Pharmaceutical Assistance Program, such as New York’s EPIC, you can join or switch plans once a year at any time. You cannot use it to drop drug coverage, and it does not apply if the program enrolled you automatically. If you lose eligibility, you get a window that runs about two months after you are notified.
Special Needs Plans, PACE, and care facilities
You qualify for a Special Needs Plan
If you are eligible, you can leave your plan to join one. There are plans for people with Medicaid, people in qualifying facilities, and people with certain chronic conditions. Facility plans can be joined or left at any time. A second chronic condition gives you another window.
You lost eligibility for your Special Needs Plan
Your plan must keep covering you for at least one month, and up to six if you are likely to qualify again. Your window opens the month you stop qualifying and ends three months after that extra period, or when you join another plan. If a chronic condition plan cannot confirm your condition, you have about two months to switch.
You joined or left PACE
If you are in a qualified State Pharmaceutical Assistance Program, such as New York’s EPIC, you can join or switch plans once a year at any time. You cannot use it to drop drug coverage, and it does not apply if the program enrolled you automatically. If you lose eligibility, you get a window that runs about two months after you are notified.
You live in, or just left, a care facility
While you live in a nursing home or similar facility, you can change plans as often as once a month. The same freedom continues for two months after you move out.
Your plan changed or had problems
Your plan is leaving Medicare at year end
Plans must tell you by October 1. You can switch during Fall Open Enrollment, and then again from December 8 through the end of February
Your plan is closing during the year
Your plan must notify you at least 60 days ahead. Your window opens two months before the change and ends one month after. If Medicare ends a plan’s contract over misconduct, it opens one month before and lasts two months after.
Your plan is rated under 3 stars
If your plan has had fewer than 3 stars for three years in a row, you can move to a plan rated 3 stars or better. You should get a notice in late October. To use this window, call 1-800-MEDICARE.
Your plan dropped many of its doctors or hospitals
If Medicare decides the cuts are substantial, you get a one-time window to join another Medicare Advantage plan or return to Original Medicare. It starts the month you are notified and lasts two more months. This window does not guarantee you can buy a Medigap policy.
Your plan broke its contract or misled you
If Medicare finds your plan failed to provide benefits on time or used misleading marketing to get you to join, you can switch to another plan or go back to Original Medicare. Your window opens once Medicare decides a violation happened.
New to Medicare or changing your Medicare
You just joined your first Medicare Advantage plan
During your first 12 months you can go back to Original Medicare, with or without a drug plan. This applies if you joined at 65, or if you dropped a Medigap policy to join. Your rights to buy a Medigap policy depend on your situation, so check before you leave.
You are leaving Medicare Advantage in January to March
If you leave your plan during the Medicare Advantage Open Enrollment window, you can join a standalone drug plan. Enrolling in the drug plan also ends your Medicare Advantage plan.
You are turning 65 after being on Medicare for a disability
You get a new seven-month window around your 65th birthday. You can leave Medicare Advantage for Original Medicare with a drug plan, or join a Medicare Advantage plan with or without drug coverage. A late drug penalty you were paying ends when this window starts.
Your Medicare was backdated
If you receive retroactive enrollment, you can join a Medicare Advantage or drug plan for the first time. The window begins the month you get notice and runs two more months.
You signed up for Part B from January to March
If you do not have premium-free Part A and sign up for Part B during the General Enrollment Period, you can join a drug plan and a Medicare Advantage plan. Both windows begin when you apply and last about two months after you are enrolled.
You lost Part B and were dropped from your plan
If you still have Part A but lost Part B, your Medicare Advantage plan must drop you. You get a window to join a drug plan that starts when you learn about the loss and lasts two more months.
You joined Part B or paid for Part A under a special exception
This covers disasters, wrong information from an employer, release from incarceration, and Medicaid ending. You can join a Medicare Advantage plan starting when you apply, until two months after you are enrolled in both Parts A and B.
Mistakes and special cases
A 5-star plan is available
If a plan has an overall 5-star rating and you live in its area, you can join it once per year, outside the regular windows.
Medicare made an enrollment mistake
If a federal employee made an error in your drug plan enrollment or disenrollment, you get one window to enroll or disenroll. It starts the month Medicare approves it and lasts two more months.
Your old drug coverage did not warn you
If Medicare finds your earlier drug coverage did not properly tell you it stopped being as good as Medicare’s, or was never as good, you get one window to join or leave a drug plan. Medicare may also waive your late penalty.
Something else happened
Medicare can grant a window for exceptional circumstances, such as a disaster or being misled about a plan. Medicare can also grant one to a whole group of people hit by the same problem. Call 1-800-MEDICARE to ask.
Before you switch
A few things that save people headaches.
Do not cancel first
When you enroll in a new plan, your old one ends automatically. Cancelling first can leave you without coverage.
Check doctors and prescriptions
Make sure your doctors, hospitals, and medications are covered by the new plan before you sign up.
Medigap in New York
New York generally lets you apply for a Medigap policy at any time of year without health questions. Other states are stricter.
Do not skip drug coverage
Going without creditable drug coverage when you are first eligible can add a penalty to your premium for life. Extra Help is one exception.
Misled into a plan?
Medicare can sometimes undo your enrollment back to the day you joined. The plan may take back what it paid, so think it over if you used a lot of care. Leaving going forward is often simpler.
More than one window?
If you qualify for several at once, pick the one that fits your timing best. You do not have to use them all.
Not sure which window fits you?
Tell Paul what is going on and he will look at it with you. There is no cost and no pressure. Many questions take about 15 minutes.
No cost. No pressure.
