Medicare has fixed dates for enrolling in its plans. From initial enrollment to policy changes, there are periods throughout the year during which a person can make changes to their current Medicare plan.
A person may move out of an area and find that the healthcare services in their new region fall outside their existing network of doctors. Or they may want to adjust the medications their plan covers or move to a policy that better suits their healthcare and lifestyle needs.
This article explores the enrollment periods for each part of Medicare.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Advantage is a bundled, privately administered plan that includes Part A and Part B. Some Advantage policies offer other benefits, such as prescription medication coverage.
A person who wants to switch from Medicare Advantage to Original Medicare or vice versa can do so during the following periods:
General enrollment period: January 1 through March 31
This is the Medicare Advantage general enrollment period. During this time, a person can switch from Medicare to Medicare Advantage, but they cannot switch the other way around.
If a person signs up for traditional Medicare during the general enrollment period, coverage will start on July 1.
Open enrollment period: October 15 through December 7
During the open enrollment period for Medicare, a person can change from Medicare Advantage to Original Medicare and vice versa. They can also switch to a different Medicare Advantage plan.
Additionally, a person can join a Medicare Part D plan at this time to continue receiving drug coverage.
Special enrollment periods
Medicare outlines certain circumstances that trigger special enrollment periods (SEPs). During these windows, a person can switch between Medicare Advantage plans or return to Original Medicare.
An SEP may occur if a person moves to a new address outside of their Advantage plan’s service area or loses coverage because Medicare did not renew its contract with their private insurer.
A person has two options for notifying their current plan provider: contacting the provider or calling Medicare directly.
If a person contacts their plan provider, the administrators will ask them to submit disenrollment paperwork. The insurer will notify Medicare that a person wishes to leave their plan.
Alternatively, a person can call Medicare at 1-800-MEDICARE (1-800-633-4227) to notify Medicare that they wish to return to an Original Medicare plan.
Medicare should confirm in writing that a person has switched back to Original Medicare and when the new coverage should start.
Medigap plans are standardized policies that can help reduce the out-of-pocket costs of Medicare.
Private insurers administer these plans, though each must offer the same benefits. There are several to choose from, ranging from A to N. However, insurers can no longer sell plans C and F.
People can have Medigap only alongside Original Medicare. They cannot enroll in a Medigap plan if they have Medicare Advantage.
It is possible to switch between Medigap plans at any time, though a person may have to pay a higher premium. A person can also switch during a one-time open enrollment period.
One-time open enrollment period for Medigap
A person can switch Medigap plans during a one-time 6-month open enrollment period for Medigap that starts when they are 65 years old and have a Medicare Part B plan.
Some states have additional open enrollment periods, which may also be available to people under 65 years of age.
This is generally the most cost effective time to switch between Medigap plans. During the open enrollment period for Medigap, an insurance company cannot deny coverage or charge more due to any preexisting health conditions.
At any time
Outside of the open enrollment period, there are no specific dates during which a person can switch Medigap plans. They may do so at any time.
However, an insurance company has the right to deny a person’s application or charge a higher premium based on preexisting conditions once a person is outside the 6-month open enrollment period.
Therefore, Medigap policies could be more expensive if a person switches outside of the open enrollment window.
Guaranteed issue rights
A person may qualify for guaranteed issue rights or Medigap protections.
This means an insurance company must sell a person a Medigap policy without considering any present or past health concerns.
A person usually has guaranteed issue rights if they move away from their previous policy’s service area. For example, this will apply to those who relocate and lose coverage from their Medicare Advantage plan.
To switch Medigap policies, a person should apply directly with the private insurer that provides the new plan. If the insurance company accepts a person’s application, the person should then notify their current insurance company that they wish to switch.
The new company will provide guidance on submitting a request to end the previous coverage.
When a person gets a new Medigap policy, Medicare entitles them to a “free look period.” This is a 30-day window during which a person can decide whether they want to keep their new policy and close their previous one.
A person should not cancel their first Medigap policy until they are sure that the new one is better for them.
If a person has a Medigap policy and a Medicare Part D policy through the same insurer, they may need to make separate payments for each policy.
A person will generally change to Medicare Part B if they previously had private insurance through an employer’s plan but are no longer working, if they have lost coverage for their spouse, or for another related reason.
In these circumstances, a person is often eligible for an SEP. This means they can sign up for Medicare Part B at any time due to a change in their insurance status.
To switch to Medicare Part B, a person can call 1-800-MEDICARE (1-800-633-4227) and notify Medicare of a change in coverage.
Otherwise, a person can enroll in Medicare Part B during the general enrollment period, which runs from January 1 through March 31.
Medicare Part D provides prescription drug coverage for those who qualify for Medicare. A person may want to switch to Part D drug coverage in certain circumstances, such as the following:
If they lose coverage from an employer-based health plan or Medicare Advantage
If a person loses their prescription drug coverage, they will probably qualify for a SEP. During this time, they can sign up for a new Part D plan.
A person should not go more than 63 days without creditable prescription drug coverage. If they do, they may have to pay a penalty.
If they want to switch to a different Part D plan
If this is the case, a person can sign up during the open enrollment period from October 15 through December 7.
If they switch from Medicare Advantage to Original Medicare
A person can sign up for Medicare Part D during their open enrollment period for prescription drug coverage, which runs from October 15 through December 7.
Medicare requires that people have creditable prescription drug coverage. If a person has Original Medicare, signing up for Medicare Part D is one way to accomplish this.
People can enroll in Medicare Part D by:
- finding a plan on Medicare’s Plan Finder
- calling a health insurance company that provides a suitable plan
- calling Medicare at 1-800-MEDICARE (1-800-633-4227)
If a person has a previous Medicare drug plan, they do not usually have to cancel the old one. The previous coverage will end when a person’s new drug plan begins.
Medicare has different enrollment periods during which insured people can change their plans.
As a general rule, if circumstances cause a person to lose their insurance, they may qualify for an SEP outside of the fixed enrollment periods.
Calling Medicare is usually the best approach, as a Medicare agent can explain the different criteria and answer a person’s questions about their individual circumstances.
