How to Change Your Medicare Plan

Medicare helps keep healthcare affordable for millions of Americans, but your needs change over time, and you need to know if and when you can change Medicare plans. This guide will review all the rules for switching plans.

How Can You Change from Original Medicare?

If you're enrolled only in Original Medicare, you have three options for switching plans:

1. Add a prescription drug plan (Part D)
2. Add a Medicare Supplement insurance plan
3. Switch to a Medicare Advantage plan

You may be able to add a Medicare Supplement insurance plan, also called a Medigap plan, at any time during the year. However, Medigap plans may require underwriting, and your coverage could be denied unless you have a right to Guaranteed Issue. If your application is approved, you can enroll in Medigap at any time.

To add a prescription drug plan or Medicare Advantage plan, you must be in a valid enrollment period. Every person on Medicare has the right to make changes to their coverage during the Annual Enrollment Period (AEP).

AEP is from October 15 to December 7. Any changes you make during AEP are effective January 1. This is the time to add coverage to Original Medicare or switch to Medicare Advantage.

When Can You Change Medicare Advantage Plans?

To switch Medicare Advantage plans, or to return to Original Medicare, you have two enrollment windows:

1. Annual Enrollment Period (AEP)
2. Medicare Advantage Open Enrollment Period (OEP)

Medicare Advantage AEP

No matter what type of plan you have, you can make these changes during AEP:

• Switch Medicare Advantage plans

• Drop Medicare Advantage and return to Original Medicare

• Drop Medicare Advantage, return to Original Medicare, and enroll in a standalone prescription drug plan

• Drop Medicare Advantage, return to Original Medicare, and enroll in a Medigap plan (assuming your coverage is approved, see below regarding applying for Medigap)

Medicare Advantage OEP

The Medicare Advantage Open Enrollment Period is from January 1 to March 31 each year. This enrollment period only applies if you have a Medicare Advantage plan. During OEP, you can:

• Change Medicare Advantage plans

• Drop Medicare Advantage and return to Original Medicare

If you return to Original Medicare during OEP, you can add a standalone Part D prescription drug plan at the same time.

How to Change Medicare Part D Plans

If you already have a Part D drug plan, you can make changes during the Annual Enrollment Period each year. During AEP, you can change from one Part D plan to another or enroll in a Medicare Advantage plan that offers drug coverage (MAPD plan).

During AEP you can also drop your Part D coverage entirely if you want to. In this case, you'd be enrolled in Original Medicare and have no drug coverage.

Special Enrollment Periods

After your initial enrollment and plan selection, you can generally only make changes to your coverage during AEP or OEP. However, there are several times that you may qualify for a Special Enrollment Period (SEP). Some examples are when you:

• Permanently move out of your plan's service area

• Become eligible for Medicaid

• Lose Medicaid eligibility

• Move into or out of institutional care (e.g., an assisted living or nursing home)

There are many other reasons for Special Enrollment Periods, but they can be fairly complicated. If you think you may qualify, visit medicare.gov or contact a licensed health insurance professional.

During an SEP, you can make any of these changes:

• Switch Medicare Advantage plans

• Switch Part D drug plans

• Drop Medicare Advantage and/or Part D drug plans

When Can You Change Your Medicare Supplement Plan?

Since Medicare Supplement insurance plans don't replace Original Medicare, you can theoretically enroll in them at any time. However, two circumstances make this impractical.

First, you can't be enrolled in both Medicare Advantage and Medigap at the same time. To drop Medicare Advantage, you must be in a valid enrollment period. As discussed earlier, this would include:

• Annual Enrollment Period (October 15 to December 7)

• Open Enrollment Period (January 1 to March 31)

• Special Enrollment Period (if you meet the requirements)

The second difficulty with changing from a Medicare Advantage plan to a Medicare Supplement plan is that you may not qualify for the Medigap plan. Unless you enroll during a Guaranteed Issue window, you'll have to answer health-related questions on your Medigap application, and you can be declined.

On the other hand, you may have a Guaranteed Issue right in these circumstances:

• During your Medigap Open Enrollment Period — the six months after you turn 65 and are enrolled in Part B

• You move out of your Medicare Advantage plan's service area

• You have been on your first Medicare Advantage plan for less than 12 months (called a Trial Right)

• Your Medicare Advantage plan fails to renew its contract with CMS

As with Special Enrollment Periods, there are a number of other ways you might have a Guaranteed Issue right. They can be complicated, so you should check with Medicare or your agent if you think you qualify.

Changing Medicare Plans

Now that you know when you can change Medicare plans, you'll want to consider whether you should. As the yearly enrollment periods draw near, be sure to take time to review your current plan and research other plans in your area.

If the thought of doing the work yourself exhausts you, consider working with an independent agent. By working with a professional, you can see which plans your doctors accept and compare quotes to get the best deal.

Joseph Arroyo is a licensed Medicare insurance agent who lives in Hilton Head, South Carolina. Arroyo is certified to sell Medicare products including Medicare Supplement insurance, Medicare Advantage, and prescription drug plans.