Medicare Advantage (MA) plans, also known as Medicare Part C, provide an alternative way to receive Medicare coverage through private insurance companies. These plans combine Part A (Hospital Insurance) and Part B (Medical Insurance), often including Part D (Prescription Drug Coverage) and additional benefits. Once enrolled in a Medicare Advantage plan, changes or disenrollment are generally restricted to specific, defined timeframes or when a qualifying life event occurs. Understanding these periods is essential for managing your healthcare coverage and avoiding unexpected gaps or costs.
The Annual Enrollment Period (AEP)
The Annual Enrollment Period (AEP) is the primary window each year when any Medicare beneficiary can make changes to their coverage. This period runs yearly from October 15 through December 7. During this time, you can switch from one Medicare Advantage plan to another, or you can disenroll from your Medicare Advantage plan and return to Original Medicare (Parts A and B). If you choose to return to Original Medicare, you can also select a stand-alone Part D prescription drug plan during the AEP. Any changes made and finalized during this seven-week window take effect on January 1st of the following calendar year.
The Medicare Advantage Open Enrollment Period (MA OEP)
A second guaranteed opportunity for those already in a Medicare Advantage plan is the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1 through March 31 annually. This period is specifically designed for people who are currently enrolled in an MA plan and wish to make a change. During the MA OEP, you have a one-time opportunity to either switch to a different Medicare Advantage plan or disenroll from your MA plan entirely and return to Original Medicare. If you use the MA OEP to return to Original Medicare, you are also granted a concurrent chance to enroll in a Part D prescription drug plan. A change made during this period typically becomes effective on the first day of the month following the month the plan receives your request.
Special Enrollment Periods Based on Qualifying Events
Disenrollment outside of the standard AEP and MA OEP is possible through a Special Enrollment Period (SEP), which is triggered by specific changes in your life circumstances. SEPs are exceptions that allow you to modify your coverage when you experience a qualifying event. A common trigger is moving to a new address that is outside of your current Medicare Advantage plan’s service area. Other qualifying events include an involuntary change in your assistance status, such as qualifying for or losing Medicaid or qualifying for the Low-Income Subsidy, also known as Extra Help. You may also qualify for an SEP if your plan ends its contract with Medicare or if you move into or out of an institutional setting. The timeline for using most SEPs is limited, often providing a window of one or two months after the qualifying event occurs.
Specific Disenrollment Rights for New MA Enrollees
A distinct type of Special Enrollment Period, sometimes called a “Trial Period” right, is available to certain new Medicare Advantage enrollees. This right applies if you enrolled in a Medicare Advantage plan when you first became eligible for Medicare at age 65. It also applies if you switched from Original Medicare to a Medicare Advantage plan for the first time. If you are within this specific first 12-month period of your initial enrollment, you have a one-time right to disenroll from the Medicare Advantage plan and switch back to Original Medicare. Utilizing this trial right also grants guaranteed issue rights to purchase a Medicare Supplement Insurance (Medigap) policy in many circumstances.