What should I do if I miss the Medicare Open Enrollment period, and I want to change my plan?
Answered by 19 licensed agents
If you have a Medicare Advantage plan and you have missed your opportunity to make a change in the Open Enrollment Period, then perhaps you might have the ability to make a change using one of the several Special Enrollment Periods (SEP) that are allowed by Medicare.
Some of the SEP's include things like the following:
1) Have you moved to another county or state? Have you recently moved back to the United States after living abroad? Have you moved into or out of a skilled nursing facility?
2) Have you lost Medicaid? Or lost the Extra Help for prescription drugs? Did you lose the PACE program?
3) Have you recently been granted Medicaid or Extra Help with prescriptions? Do you have a Chronic condition like diabetes or heart disease?
4) You could join a 5-star rated plan
5) Were you affected by a FEMA disaster?
There are many other SEP's that you might possibly qualify for. So, talk to a local Medicare Insurance Broker to know all your options.
Medicare supplement plans can be applied for and changed anytime of year you wish. Part C AKA known as Medicare Advantage plans, if you’re on one, can be changed up until March 31st. After that the next time (Unless a person is just gaining Medicare Part B) is the Annual Enrollment Period that starts on Oct 10 to Dec 7.
Other enrollment periods called Special Election Periods (SEP’S) come into play or allows a person to change plans such as moving from one service area to another, or a plan pulls out, or a person is released from incarceration. There are a lot more more SEP”s than I just mentioned.
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If a person misses the Open Enrollment time frame that runs January 1st through March 31, then depending on where the member lives, they may be able to use a disaster SEP to change plans, if they are a veteran, they may be able to use the Veterans SEP; If they move, they can use the Move SEP and finally can call Medicare directly.
You may utilize a Special Election Period which includes:
Moving to a new plan area.
Enrollment in a 5 star plan.
Losing health insurance.
Weather related disasters.
Annual enrollment. Is October 15th through December 7th. If you miss that enrollment period and you are a current Medicare Advantage member, You have 1 more opportunity to change plans January 1st through March 31st.
So from April 1st through December 31st you are locked into your plan unless you meet a special election period requirement.
There are times that you can make a change on your plan. Open Enrollment which is from January 1st through March 31st. This gives you the chance to switch to a plan that is equal to the plan you have (medicare adv to medicare adv -Medigap to Medigap) or return to Original medicare. You also can make a change during a Special Enrollment Period. If you have experienced a life changing event (moved to where your current coverage is not, loss of qualifying coverage, enrolled in medicaid) or if your governor declares a state of emergency in your county and state. Unfortunately if you think you made a mistake with the coverage you chose and it is outside of these specific periods, you will have to wait until Annual Enrollment which starts Oct 15th.
If you've missed the Medicare Open Enrollment period (October 15 to December 7) and wish to change your plan, you may still have options through Special Enrollment Periods (SEPs).
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Special Enrollment Periods (SEPs): SEPs allow you to make changes to your Medicare Advantage or Part D prescription drug coverage outside the standard enrollment periods if you experience certain life events. Qualifying events include:
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Moving out of your plan's service area.
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Losing other credible health coverage.
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Gaining or losing eligibility for Medicaid or Extra Help.
Once OEP ends, (January 1st to March 31st) you can no longer change plans. (MA TO MAPD, MAPD TO MAPD) If you have a chronic condition , diabetes, heart condition, you may be able to switch to a chronic plan. You can do so once per year. If you do not qualify for a Chronic Plan, then you would have to wait for the Annual Enrollment Period beginning in October.
Consult with a licensed agent or call Medicare to review possible options. There are multiple election periods annually. You may qualify for a Special Election Period depending on “why” you missed your Open Enrollment Period.
The best thing to do is check with a trusted local agent to see if there are any "Special Enrollment Periods" available. Medigap plans do not necessarily need an enrollment period.
You should always reach out to your local agent. Even if you think you missed an enrollment period, a good agent can educate you on your options. It's our job to stay updated on all the tricks of the trade.
That really depends on what type of "plan" you have. If you have a Medicare Supplement Plan or MediGap plan, you can change it any time of the year, but you must go through an underwriting process most times. If you have a Medicare Advantage Plan, you have two separate Open Enrollment times, October 15th thru December 7th is the Annual Enrollment Period, and then you have the actual Open Enrollment Period from January 1st thru March 31st. Both of these times you can change your Advantage Plan.
Unless there is an SEP (Special Enrollment Period) in your area due to a disaster related issue that you qualify for, or you qualify for a chronic plan, or you have full Medicaid, you will have to wait until the Annual Enrollment Period, Oct 15 to Dec 7, to change your plan to next year's plan. Just remember that you can always change your PCP.
AEP is in the fall Oct 15 - Dec 7 for a 1/1/26 effective date. If you are on a dis-Advantage plan it is possible to get back to a Supplement Plan G = Good if you are very healthy and can answer 25 - 30 health questions to pass medical underwriting. Did the Advantage rep warn you of that when they signed you up? Ellen Diehl 770-712-9990 call if you need to discuss
It is important to discuss your situation with a licensed Medicare broker to see if you qualify for a special enrollment period and to evaluate what all of your options are.
If the enrollment period was missed because of a state of emergency during that time (Natural Disaster), contact a licensed agent immediately to determine if you are eligible for a Special Election enrollment. If it was missed outside of that, the next opportunity will start on October 15 at the beginning of Annual Enrollment.