Changing Your Medicare Advantage Plan Outside of Open Enrollment

If you’re enrolled in a Medicare Advantage plan, then you are likely familiar with the Open Enrollment Period (also known as the Annual Enrollment Period) that happens each year from Oct. 15 to Dec. 7.

This is when you can sign up for Medicare Advantage (if you didn’t do so during your Initial Enrollment Period), change from Medicare Advantage back to Original Medicare, or switch to a different Medicare Advantage plan. You may also add, drop, or switch standalone Part D prescription drug plans, if applicable.

But what about the other 10 months of the year? Can you make any changes to your Medicare Advantage coverage at any other time outside of the Open Enrollment Period?

Senior couple researching in a library

Fortunately, you can. If you missed the fall enrollment deadline of Dec. 7, you have another window of opportunity in the new year. The Medicare Advantage Disenrollment Period runs each year from Jan. 1 to Feb. 14. During this time, you may only drop your Medicare Advantage plan and switch back to Original Medicare.

But the fall Annual Enrollment Period is the only time of the year that you may change from one Medicare Advantage plan to another without being granted a Special Enrollment Period.

Some situations in which a Special Enrollment Period may be granted to make changes to a Medicare Advantage plan:

  1. Losing creditable drug coverage through no fault of your own
  2. Joining or dropping employer or union health or drug coverage
  3. Being institutionalized
  4. Enrollment in or eligibility loss of a State Pharmaceutical Assistance Program
  5. Enrollment in Medicaid, a Medicare Savings Program or Extra Help
  6. Disenrollment from your first Medicare Advantage plan
  7. Enrollment in or disenrollment from PACE (Program of All-Inclusive Care for the Elderly)
  8. Change of address
  9. Retroactive enrollment in Medicare
  10. Eligibility or loss of eligibility for a Special Needs Plan
  11. Contract violations or enrollment errors
  12. A Medicare Advantage plan that chooses not to renew its service
  13. Qualification for a new Initial Enrollment Period
  14. Wanting to enroll in a five-star Medicare Advantage plan
  15. Enrollment in a poor-performing plan
  16. A Medicare Advantage plan that surrenders contracts with providers 

Special Enrollment Periods

Below is a brief summary of each type of Special Enrollment Period that can be used to drop, change or add Medicare Advantage coverage.  

Losing creditable drug coverage through no fault of your own

If you had a Medicare Advantage plan with prescription drug coverage which met Medicare’s standards of “creditable” coverage and you were to lose that coverage through no fault of your own, you may enroll in a new Medicare Advantage plan with creditable drug coverage beginning the month you received notice of your coverage change and lasting for two months after the loss  of coverage (or two months after receiving the notice, whichever is later).

Additionally, if you wish to disenroll from a Medicare Advantage plan with drug coverage and enroll in another form of creditable coverage such as VA, TRICARE or a state pharmaceutical assistance program, you may do so whenever you become eligible for enrollment in the new coverage. 

Joining or dropping employer or union health or drug coverage

If you wish to disenroll from employer or union-sponsored coverage (including a group-sponsored Medicare Advantage plan) in order to enroll in Medicare Advantage, or you wish to disenroll from Medicare Advantage in order to join an employer or union-sponsored plan, you may do so for up to two months following the end of your previous coverage.  

Being institutionalized

If you move into, out of, or currently reside in a facility of special care such as a skilled nursing home or long-term care hospital, you may enroll in, disenroll from, or change a Medicare Advantage plan one time per month. Once you move out from the facility, you will be given two months to do the same.

Enrollment in a State Pharmaceutical Assistance Program

If you are enrolled in a State Pharmaceutical Assistance Program (SPAP), you may join or switch Medicare Advantage plans once per year at a time of your choosing.

Enrollment in Medicaid, a Medicare Savings Program or Extra Help

If you are enrolled in Medicaid, a Medicare Savings Program (MSP) or Extra Help, you may join, disenroll from or switch Medicare Advantage plans beginning the month you first become eligible for Medicaid or MSP and may continue to switch plans once a month thereafter.

If you lose Medicaid, MSP or Extra Help benefits, you will be granted a one-time opportunity to make changes in your Medicare Advantage enrollment.

Disenrollment from your first Medicare Advantage plan

If you enrolled in a Medicare Advantage plan when you first became eligible for Medicare, you have 12 months to disenroll from the plan and transition back to Original Medicare.

If you dropped a Medicare Supplement Insurance plan to enroll in a Medicare Advantage plan but wish to revert back again, you have 12 months to do so (provided that was the first Medicare Advantage plan you had ever been enrolled in).

Enrollment in or disenrollment from PACE

You may disenroll from a Medicare Advantage plan to enroll in a PACE program at any time.

If you wish to disenroll from PACE in order to join a Medicare Advantage plan, you may do so for up to two months following your PACE disenrollment. 

Change of address

If you permanently move out of your Medicare Advantage plan’s coverage area or move to an area with more available plans, you may switch to another Medicare Advantage plan beginning the month before your move and lasting for two months.

If you moved back to the U.S. after living abroad, you may enroll in a Medicare Advantage plan within the same timeframe.

Retroactive enrollment in Medicare

If you have received a retroactive enrollment in Medicare, you may enroll in a Medicare Advantage plan for the first time beginning the month you receive notice of your Medicare eligibility and continuing for two months thereafter.

Eligibility or loss of eligibility for a Special Needs Plan

If you are eligible to enroll in a Special Needs Plan (SNP), you may leave a Medicare Advantage plan at any time in order to do so.

If you are already enrolled in an SNP but are losing your eligibility, you may join a Medicare Advantage plan beginning the month that you are no longer eligible for the SNP and lasting for three months.

Contract violations or enrollment errors

If you are enrolled in a Medicare Advantage plan that failed to provide benefits in accordance with the plan’s terms or provided misleading information about coverage or other circumstances, you may be given an opportunity to disenroll from or switch to a new Medicare Advantage plan. The timeframe in which you may do so will depend on the situation. 

A Medicare Advantage plan that chooses not to renew its service

If your Medicare Advantage plan fails to renew its service for the next calendar year, you have from Dec. 8 through the last day in February to switch to a different plan.

If the failure to renew becomes effective mid-year, you may switch to a new Medicare Advantage plan beginning two months prior to the end of coverage and lasting a total of three months.

If your Medicare Advantage plan is terminated for other reasons, you may switch to a new plan beginning one month before termination and continuing for two more months thereafter.

Qualification for a new Initial Enrollment Period

If you enrolled in a Medicare Advantage plan prior to turning 65 because of a qualifying disability, you will be granted another enrollment period upon turning 65. During this seven-month period, you may switch Medicare Advantage plans or revert back to Original Medicare.

Wanting to enroll in a five-star Medicare Advantage plan

If you want to enroll in a Medicare Advantage plan that has been awarded a five-star Plan Performance Rating,1 you may do so between Dec. 8 and Nov. 30 of the following year.

Enrollment in a poor-performing plan

If you are enrolled in a Medicare Advantage plan that has received a Plan Performance Rating of three stars or less for three consecutive years,1 you may enroll in a higher rated plan throughout the year.

A Medicare Advantage plan that surrenders contracts with providers

If your Medicare Advantage plan ceases contracts with many of its providers and these terminations are considered substantial, you will be granted a one-time opportunity to switch to a different Medicare Advantage plan. The period given to make the change will begin the month you are notified of the opportunity and will continue for two months thereafter.

Multiple generations of family at a picnic

Exceptional circumstances

If your circumstances do not fit into any of the Special Enrollment Periods described above, you may ask the Centers for Medicare and Medicaid Services (CMS) for your own Special Enrollment Period based on your situation.

Speak to a licensed insurance agent

The circumstances in which you can make changes to a Medicare Advantage plan outside of the Annual Enrollment Period can be complex. And it’s important for everyone to obtain the health care coverage they need. With that said, the best thing you can do if you wish to enroll in, disenroll from or switch Medicare Advantage plans is to contact a licensed insurance agent who can help analyze your situation and provide you with an option that works for you.

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.