Most people make changes to their Medicare plan coverage at some point. These are usually not lifelong plans that you buy at age 65 and then keep forever.
There are all kinds of reasons why you might change plans: your health changes, you move, your premium cost goes up, your doctor leaves your plan’s network, your medications change, or you just don’t like your plan anymore.
In this video, we’ll walk through how to change your Medicare Supplement, Medicare Advantage, and Medicare Part D plan.
Because Medicare Part D, Medicare Advantage, and Medicare Supplements have different enrollment rules, we’ll talk about each one separately.
If you’re only interested in learning about how to change one type of plan, check the chapters in the description to skip to the type of plan that interests you most.
Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To…
Medicare Part D
AEP
The most common time to switch Medicare Part D coverage is during the Annual Enrollment Period between October 15 and December 7 each year. This is when you should look at your Part D coverage options because plans can and do change every year.
If you make a change during the AEP, your new coverage will begin January 1. For a complete explanation of what changes you can and can’t make during the AEP, please see the video linked here: https://youtu.be/8biLJsPuepY
Medicare Advantage Open Enrollment Period
There’s also the Medicare Advantage Open Enrollment Period. This is only an option for people who are enrolled in Medicare Advantage plans.
If you are in a Medicare Advantage plan, you can make one change between January 1 and March 31.
You can either enroll in a different Medicare Advantage plan or you can return to Original Medicare and purchase a standalone Part D plan. If you make a change during this Open Enrollment Period, your new coverage will begin the first day of the month following your request to change plans.
By the way, insurance companies are not allowed to advertise this Open Enrollment Period, so no one should be suggesting you make any plan changes between January 1 and March 31.
All changes during this time are required to be initiated by the Medicare beneficiary.
Change of Address
If you move to a new address, either moving outside your current plan’s service area or moving within your plan’s service area but to a new address that has plan options that weren’t available at your old address, you will have a Special Enrollment Period to change your Part D coverage, either by enrolling in a different Medicare Advantage plan that includes Part D coverage or enrolling in a different standalone Part D plan.
It’s a good idea to tell your plan that you’ll be moving. That triggers a Special Enrollment Period that starts the month before you move and continues through two months after you move.
Loss of Other Coverage
If you lose your current drug coverage, you will have a Special Enrollment Period to enroll in Part D drug coverage. This can include no longer being eligible for Medicaid, losing employer group coverage, losing any other type of creditable drug coverage, leaving a Medicare Cost plan, or leaving a PACE plan.
In most of these circumstances, you have two months to enroll in a Medicare Advantage plan with drug coverage or a standalone Part D plan.
The opposite is also true. If you become eligible to enroll in an employer prescription drug plan, Medicaid, a PACE plan, or another type of creditable drug coverage, like the VA, you can leave your current Part D coverage anytime to enroll in other drug coverage.
Plan Sanctioned by Medicare
If your Medicare Part D plan is sanctioned by Medicare or its contract is not renewed, you will be able to change your Part D coverage.
For an exhaustive list of Part D changes you can make, please follow this link:
https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances-special-enrollment-periods
Medicare Advantage Plans
Laws and regulations that govern changing Medicare Advantage plans are very similar to those for Medicare Part D plans.
AEP
The most common time to make Medicare Advantage plan changes is during the Annual Enrollment Period between October 15 and December 7. Any plan changes you make during this time will be effective January 1.
For a complete explanation of what changes you can and can’t make during the AEP, please see the video linked here: https://youtu.be/8biLJsPuepY
Your Medicare Advantage plan will send you an Annual Notice of Change document before the AEP that will let you know what plan changes are coming in the new year.
Knowing what’s changing with your plan and comparing that to the other available plans in your zip code for the new year will help you decide whether to stay with your current plan or make a plan change.
Because Medicare Advantage plans have provider networks, one of the most important things to check during every AEP is whether your doctors, hospitals, and other providers will be remaining in your plan’s network for the upcoming year.
Medicare Advantage Open Enrollment Period
Your next option to make a plan change is during the Medicare Advantage Open Enrollment Period between January 1 and March 31. You can make one plan change during this period.
You can either enroll in a different Medicare Advantage plan, or you can return to Original Medicare and purchase a standalone Part D plan. If you make a change during this Open Enrollment Period, your new coverage will begin the first day of the month following your request to change plans.
There are a couple things to be aware of with the Medicare Advantage Open Enrollment Period.
First, insurance companies are not allowed to advertise this open enrollment period. No one should be trying to market plans to you during this time of year. This is only for people who are not happy with their current Medicare Advantage plan.
Second, if you choose to leave a Medicare Advantage plan and return to Original Medicare, you can enroll in a standalone Part D plan, but you may not be able to purchase a Medicare Supplement plan for your health coverage. More on that in the Medicare Supplement section below.
Change of Address
If you move to a new address that is either outside your plan’s service area or still inside its service area but your new home has Medicare Advantage options that weren’t available at your old address, you will have a Special Enrollment Period to change Medicare Advantage plans that is generally three months long.
Loss of Other Coverage
If you lose your current coverage, whether that’s a group employer plan, Medicaid, a Medicare Cost plan, PACE program, COBRA, or any creditable drug coverage, you will have a Special Enrollment Period to enroll in a Medicare Advantage plan.
If you are losing creditable drug coverage, you will want to enroll in a Medicare Advantage plan that includes Part D drug coverage.
The opposite is also true. If you become eligible for other coverage through an employer group plan or other health coverage with creditable drug coverage, you can leave your Medicare Advantage plan anytime the new plan will accept you.
Plan Sanctioned by Medicare
Just like Part D plans, if your Medicare Advantage plan is sanctioned by Medicare or its contract is not renewed, you will be able to switch to other coverage.
Five Star Special Enrollment Period
Depending on where you live, you may also have a 5 Star Special Enrollment Period to change Medicare Advantage plans.
In theory, this is also a possibility for standalone Part D plans, but in 2022, there are no 5 star Part D plans that are available to individuals.
The 5 Star Special Enrollment Period runs from December 8 through November 30. For more information, please see the video linked here: https://youtu.be/inLiPQuGKtI
Medicare Advantage Trial Right
For anyone new to a Medicare Advantage plan, during your first twelve months you have a trial right.
If you decide you don’t like your Medicare Advantage plan, you can switch back to Original Medicare and get your Medicare Supplement back without having to pass health underwriting, if you had one before joining the Medicare Advantage plan, or purchase a new Medicare Supplement also without health underwriting.
You can also enroll in a standalone Part D plan. This is an important consumer protection that not a lot of Medicare beneficiaries know about.
Medicare Supplements/Medigap
While the laws that govern Medicare Part D and Medicare Advantage plans are fairly similar, the rules for Medicare Supplements, which are also known as Medigap plans, are completely unique.
Also, Medicare Supplements have more rule variations from state to state than either of the other two types of Medicare plans.
Medicare Supplement Open Enrollment Period
Your first six months on Medicare Part B are your Medicare Supplement Open Enrollment Period. During that time, you can purchase any Medicare Supplement sold in your state from any insurance company without having to answer any health questions or go through underwriting.
In most states, once you are beyond your first six months on Medicare Part B, you usually have to answer a list of health questions and provide a list of your medications on a Medicare Supplement/Medigap application in order to change plans.
Then, that application is sent to an underwriter at the insurance company who determines whether or not you are eligible to purchase a Medicare Supplement.
State Specific Guaranteed Issue Rights
However, many states have expanded guaranteed issue rights to purchase a Medicare Supplement without having to qualify through medical underwriting, so the first thing to do if you’re thinking about switching Medicare Supplements is to find out what your state laws are.
You can do that by calling a knowledgeable broker who is licensed in your state or checking with your state’s department of insurance.
No AEP for Medicare Supplements
Medicare Supplement plans do not fall under the Annual Enrollment Period, so there is no nationwide right to change Medicare Supplements between October 15 and December 7. Medicare Supplements are month to month contracts that, at least in theory, can be changed any time during the year.
Change of Address
If you move to a new address and have a standard Medicare Supplement, you do not have a guaranteed issue right to purchase a new one.
If you have a Medicare Select Medicare Supplement, which is explained in this video (https://youtu.be/aYrOjOZPckM), and move out of your plan’s service area, you do have some guaranteed issue options.
If you have had your Medicare Select policy for more than 6 months, you can purchase a standard policy from the same company with fewer benefits than your current policy without having to answer health questions.
Or you can use your guaranteed issue right to purchase one of a number of Medicare Supplement plans offered by any insurance company in your state.
Loss of Other Coverage
There are also nationwide guaranteed issue rights if you lose other coverage. This can be triggered by losing employer coverage, your Medicare Advantage plan leaving your area, you moving out of your Medicare Advantage plan’s service area, if you have been in a Medicare Advantage plan for less than twelve months and decide to return to Original Medicare, or if your Medicare Supplement company goes bankrupt.
To use a guaranteed issue right, you will need documentation of your eligibility. Save all paperwork proving why and when your current coverage is ending to submit along with your Medicare Supplement application.
Medicare Supplement Underwriting
Although there are quite a few guaranteed issue rights for Medicare Supplements, the most common situation is still that you will have to answer health questions and pass underwriting to be able to switch Medigap policies.
There’s another video linked here (https://youtu.be/br-4S0U912U) that explains that process and what medical conditions and situations are likely to be issues for Medicare Supplement insurance companies.
Questions? We Can Help!
Changing Medicare plans can seem like a daunting task. There are a lot of different national and state rules and laws that come into play, but when the time comes that you need to change Medicare plans, it certainly can be done.
If you have questions about changing your Medicare coverage, please feel free to give our office a call at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation.
We’re here to take the confusion out of Medicare and help you find the best coverage for you!
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