How to Switch Medicare Plans
Understanding Open Enrollment, Disenrollment, and Special Enrollment Periods
No matter how carefully you weigh your options before signing up for Medicare, you still may end up having to change plans at some point. Your healthcare needs could shift, you could move to a new state, or your income could change dramatically, leaving you with few good options aside from switching plans. Also, your plan itself can change in ways that make it less suitable for you. Medicare has strict rules for when and how you can change plans, so the keys to a successful initial enrollment still apply when you’re changing plans. Know your deadlines and mark your calendar.
You Love Your Coverage, So Why Change?
If you’re happy with your coverage, you don’t have to do anything during the government’s annual open enrollment period. Your plan generally will renew for the next year (assuming it’s not going bankrupt, which does happen occasionally). However, you must read your plan’s Annual Notice of Change (ANOC), which your plan must make sure you receive by September 30. This letter details all of the changes to your plan for the following year. If you haven’t received it by the first week of October, contact your plan immediately and ask them to send you a copy.
Most plans make changes every year. And while it may seem tedious to read through them, doing so can save you a lot of money and frustration. If you don’t read your ANOC, you might show up at the pharmacy expecting your usual $10 copay only to find that it’s gone up to $85. Read your ANOC to avoid surprises and decide whether the changes make switching plans a good idea.
You Love Your Coverage, So Why Change?
Suppose you want to alter your Medicare coverage in some way. In that case, chances are you’ll need to do so during the open enrollment, which takes place each year from October 15 to December 7. During open enrollment, you can:
- Switch from Original Medicare to Medicare Advantage
- Switch between Medicare Advantage plans
- Switch Part D plans
- Sign up for Part D for the first time
- Switch from Medicare Advantage to Original Medicare
Disenrollment
Suppose you’re enrolled in the Medicare Advantage plan but want to switch to Original Medicare. In that case, you can do so during open enrollment. But you can also take advantage of the separate Medicare Advantage disenrollment period. (MADP), which lasts from Jan.1 to February 14 each year. Your new coverage will begin either February 1 or March 1, depending on when you disenroll.
To start the disenrollment process, call either your MA plan or Medicare directly and request to disenroll. If (and only if) the Medicare Advantage plan you’re leaving included Part D coverage, you may use this period to sign up for a Part D plan as well. Since you’re switching to Original Medicare, you can also use this period to sign up for a Medigap policy if you wish to do so. However, because this isn’t your original enrollment period, you may be denied Medigap coverage based on your age or health. Also, the insurance company may charge you a higher premium.
Special Enrollment
In certain circumstances, you may qualify for a special enrollment period (SEP), during which you can change your Medicare coverage outside of open enrollment. A SEP is based on your personal circumstances, so you may need to research to know if your reason for switching care qualifies. It’s a good idea to check with your local State Health Insurance Assistance Program (SHIP) to see if your particular situation gives you the option.
Common situations that qualify for the Special Enrollment Period (SEP) include:
-
Moving Out of Your Plan's Service Area
This situation relates to MA and Part D plans, which only cover certain geographical areas. Keep in mind that the criteria for a SEP only apply to permanent moves, not to snowbirding. -
Entering of Leaving a Long-term Care Facility, Nursing Home, or Other Institutional Facility
In this situation, the SEP ensures you can find a plan that will work with the facility's pharmacy if your current plan doesn't provide coverage. -
Contract Violations Committed by Your Plan
If your plan doesn't make good on its obligations to you as a beneficiary, you're entitled to a SEP. However, you'll have to contact Medicare directly to make your case and apply for a SEP. -
Changes to Your Plan That Affect Your Ability to Get Coverage
You should receive notice from either Medicare or your insurance company if your plan stops serving your area or stops working with Medicare. If this happens, you're entitled to a SEP so you can find a new plan.
While most SEPs last between two and three months, there’s no standard length, and the duration of a SEP can vary based on a variety of factors. It’s essential to make sure you know exactly how long yours will last.
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