Can I Change My Medicare Plan Mid-Year? Your Options Explained

Medicare plans are critical for covering healthcare expenses, but sometimes the plan you initially chose may not meet your needs as the year progresses. If you're wondering whether you can switch plans mid-year, the good news is that there are options—though your ability to change plans is subject to certain rules and specific enrollment periods. This guide breaks down when and how you can change your Medicare plan mid-year, the circumstances that allow it, and what you should keep in mind before making the switch.

1. Medicare Annual Enrollment Period (AEP)

The most common time to change your Medicare plan is during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. While this is not technically "mid-year," it's the primary opportunity to review and make changes to your Medicare Advantage or Part D (prescription drug) plans. Any changes you make during AEP will take effect on January 1 of the following year.

2. Medicare Advantage Open Enrollment Period (OEP)

If you have a Medicare Advantage plan and you're looking to make adjustments mid-year, the Medicare Advantage Open Enrollment Period from January 1 to March 31 offers you some flexibility. During this time, you can:

• Switch from one Medicare Advantage plan to another.

• Unenroll from Medicare Advantage and return to Original Medicare (Parts A and B), with the option to enroll in a Part D prescription drug plan.

However, you cannot switch from Original Medicare to a Medicare Advantage plan or change your Part D plan unless you are already in Medicare Advantage.

3. Special Enrollment Periods (SEPs)

Special Enrollment Periods (SEPs) allow for mid-year plan changes when you experience specific life events. These SEPs ensure that you don’t have to wait for the AEP to adjust your coverage if your circumstances change. Some common reasons for qualifying for an SEP include:

• Moving to a new area: If you move out of your plan’s service area, you’ll qualify for an SEP to enroll in a new Medicare Advantage or Part D plan.

• Losing employer coverage: If you lose employer-sponsored health insurance, you’ll have an SEP to enroll in Medicare or change your plan.

• Eligibility for Medicaid: If you qualify for Medicaid or other assistance programs, you may be eligible for an SEP to switch plans.

• Entering or leaving a care facility: This includes moving into or out of a nursing home or rehabilitation facility, which qualifies you for an SEP.

Most SEPs last for 2 months from the date of the qualifying event, but the exact timeframe depends on your situation.

4. 5-Star Special Enrollment Period

Medicare rates Medicare Advantage and Part D plans on a 5-star scale. If you’re currently enrolled in a plan that is rated lower than 5 stars, you can use the 5-star Special Enrollment Period to switch to a top-rated 5-star plan. This can be done once per calendar year, and it’s available any time between December 8 and November 30 of the following year. Switching to a 5-star plan can offer higher quality service and benefits without waiting for the AEP.

5. Medigap Plans

Medigap (Medicare Supplement Insurance) plans have different rules. Unlike Medicare Advantage and Part D plans, there is no annual enrollment period for Medigap. You can apply to switch Medigap plans at any time during the year. However, after your initial Medigap enrollment period (the 6-month window that starts when you turn 65 and enroll in Medicare Part B), insurers can use medical underwriting, meaning they may charge you more or deny coverage based on your health status.

6. What to Consider Before Switching

If you're thinking about switching Medicare plans mid-year, there are a few key considerations:

• Network changes: If you’re in a Medicare Advantage plan, make sure your new plan includes your preferred doctors, hospitals, and specialists in its network.

• Costs: Look at the premiums, deductibles, and out-of-pocket costs for the new plan compared to your current one. Keep in mind that switching plans could lead to changes in your healthcare costs.

• Prescription coverage: If you’re switching Part D or Medicare Advantage plans, ensure that your medications are covered under the new plan's formulary.

• Medical needs: If your health situation has changed, a plan with better coverage for your specific conditions might be a better fit, even if it means higher premiums.

Conclusion

While switching your Medicare plan mid-year isn't always straightforward, you do have options, especially during the Medicare Advantage Open Enrollment Period and if you qualify for a Special Enrollment Period. It’s important to review your plan annually and make changes as necessary to ensure it meets your healthcare needs and budget. By understanding the enrollment periods and knowing your options, you can make the most informed decision about your Medicare coverage throughout the year.