Understanding when you can make changes to your health coverage is a frequent concern for Medicare beneficiaries. The Medicare program, which includes Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage), operates under government-mandated timeframes. Unlike standard commercial insurance, modifying a Medicare plan is strictly limited to designated periods. These specific windows ensure administrative stability, meaning beneficiaries cannot arbitrarily switch or enroll in a plan outside of these set opportunities.
The Annual Enrollment Period
The most widely known opportunity for beneficiaries to review and change their coverage is the Annual Enrollment Period (AEP). This window opens every year on October 15th and closes on December 7th. Any change selected during this time takes effect on the following January 1st, allowing for continuous coverage into the new year.
The AEP is the primary time when beneficiaries can switch between coverage types. An individual with Original Medicare (Parts A and B) can enroll in a Medicare Advantage (Part C) plan. Conversely, a person enrolled in a Medicare Advantage plan can disenroll and return to Original Medicare.
The AEP also allows for changes within the Part C and Part D structures. A beneficiary can switch from one Medicare Advantage plan to another, or switch between standalone Medicare Part D prescription drug plans. These options allow people to adjust coverage based on changes in health status, prescription needs, or a new plan’s network and costs for the upcoming year.
The Medicare Advantage Open Enrollment Period
The Medicare Advantage Open Enrollment Period (MA OEP) runs from January 1st through March 31st, exclusively for those already enrolled in a Medicare Advantage plan. This period offers a second chance for individuals who are dissatisfied with the plan they chose during the AEP.
During the MA OEP, an individual can make a single, one-time change to their coverage. This allows them to switch from their current Medicare Advantage plan to another Medicare Advantage plan. Alternatively, they may drop their Medicare Advantage plan entirely and return to Original Medicare (Parts A and B). If returning to Original Medicare, they can simultaneously enroll in a standalone Part D prescription drug plan.
The MA OEP cannot be used by beneficiaries with only Original Medicare to enroll in a Medicare Advantage plan for the first time. Furthermore, it does not permit changes between standalone Part D plans unless that change is a direct result of disenrollment from a Medicare Advantage plan. New coverage begins on the first day of the month following the enrollment request.
Special Enrollment Periods for Qualifying Life Events
When a beneficiary experiences a significant life change, they may qualify for a Special Enrollment Period (SEP). SEPs allow changes to a Medicare plan outside of the standard AEP and MA OEP windows. These periods are triggered by specific events and provide a temporary window, often 60 days from the date of the event, to enroll in or switch plans.
Changes in Residence
Movement out of a current plan’s service area is a common trigger for an SEP, allowing the beneficiary to switch to a plan available in their new location. If a person moves into or out of a qualified institutional facility, such as a skilled nursing facility or long-term care hospital, they also qualify for an SEP to change coverage. The period to act on a move generally begins the month the move occurs and lasts for two full months after that.
Loss of Other Coverage
Losing existing health insurance coverage can also create an SEP, particularly if that coverage was considered creditable by Medicare, such as employer-sponsored group health coverage. If employment ends or the employer coverage ceases, a person has a two-month SEP to enroll in a Medicare Advantage or Part D plan, ensuring they do not incur a lapse in coverage. However, coverage from COBRA or retiree health plans does not qualify for this specific SEP when it ends.
Financial Assistance Eligibility
Certain financial or assistance-related changes also trigger an SEP, offering continuous opportunities for those with limited resources. Individuals who are eligible for Medicaid or who qualify for the Part D Low-Income Subsidy, commonly called Extra Help, have a continuous SEP. This allows them to switch their Medicare Advantage or Part D plan once per calendar quarter for the first three quarters of the year, providing greater flexibility to manage their healthcare costs.
Plan or Provider Actions
An SEP is also available if a beneficiary is affected by actions taken by their current insurance provider. This occurs when their Medicare Advantage plan decides to stop participating in Medicare or discontinues service in the area where the beneficiary resides. In these situations, the beneficiary is notified and is granted an SEP to select a new plan before their coverage ends.
Other Specific Circumstances
Finally, specific circumstances related to legal status or government declarations can trigger an SEP.
- If a person is released from incarceration, they are granted an SEP to sign up for Medicare Part A and/or Part B.
- If a person missed an enrollment period due to a declared natural disaster or other emergency, they may be granted an SEP to make their necessary plan changes.
In all SEP instances, documentation proving the qualifying event is required to complete the enrollment or change.