Missing Medicare's Open Enrollment (which runs from October 15 to December 7 each year) doesn't necessarily mean you're locked into your current Medicare plan until next year. While Open Enrollment (also called the Annual Enrollment Period) is the main time when anyone with Medicare can change plans, there are several other opportunities throughout the year when you may be able to switch Medicare Advantage plans, change Part D prescription drug coverage, or modify your Medicare benefits.
Understanding when and how you can change Medicare plans outside of Open Enrollment can help you get better coverage if your circumstances change, your health needs evolve, or you're simply unhappy with your current plan.
When Can You Change Medicare Plans?
While Open Enrollment (October 15th-December 7th) is the most flexible time to make changes, you have three additional opportunities to modify your Medicare coverage during the year:
- Medicare Advantage Open Enrollment Period (January 1st-March 31st): Available only if you're currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (Year-Round): Available when you experience qualifying life events like moving, losing other coverage, being diagnosed with certain chronic conditions, or becoming eligible for Extra Help.
- Five-Star Special Enrollment Period (December 8th-November 30th): Available if a five-star rated plan serves your area.
This article walks through each of these options in detail so you know exactly when you can make changes to your Medicare coverage.
Medicare Advantage Open Enrollment Period: Your Second Chance
The Medicare Advantage Open Enrollment Period (MA OEP) runs from January 1st through March 31st each year and provides a second opportunity to adjust your coverage.
Who Can Use MA OEP
This enrollment period is only for people currently enrolled in a Medicare Advantage plan. If you have Original Medicare with a standalone Part D plan, you cannot use this period to make changes.
What You Can Do During MA OEP
If you're enrolled in a Medicare Advantage plan, you can make one change during this period:
- Switch to a different Medicare Advantage plan (with or without prescription drug coverage).
- Drop your Medicare Advantage plan and return to Original Medicare; if you do this, you can also join a standalone Medicare Part D prescription drug plan.
What You Cannot Do During MA OEP
- Switch from Original Medicare to a Medicare Advantage plan (you'll need to wait for the next Open Enrollment starting in October).
- Make changes if you only have Original Medicare with Part D.
- Make multiple changes; you get one change per MA OEP.
When Changes Take Effect
Your coverage starts the first day of the month after your plan receives your enrollment request. For example, if you enroll in a new plan on February 10th, your new coverage begins March 1st.
Important Note About Medigap
If you decide to leave Medicare Advantage and return to Original Medicare, you may want Medicare Supplement (Medigap) insurance to help cover out-of-pocket costs. However, you don't have guaranteed issue rights to buy a Medigap policy during MA OEP unless you meet specific conditions.
Depending on your state, insurance companies can reject your Medigap application or charge higher premiums based on your health status if you're outside your Medigap Open Enrollment Period (the six months after you first enroll in Part B). Consider this carefully before switching from Medicare Advantage back to Original Medicare.
Can You Change Medicare Plans Anytime During the Year?
Generally, no; you cannot change Medicare plans whenever you want. You must wait for a designated enrollment period unless you qualify for a Special Enrollment Period (SEP) due to a qualifying life event.
However, there are several situations that trigger Special Enrollment Periods throughout the year, giving you the opportunity to change plans outside the standard enrollment windows.
Common Special Enrollment Periods
Moving To A New Location
If you move outside your current plan's service area:
- You can switch to a new Medicare Advantage plan or Part D plan that serves your new area.
- You can return to Original Medicare (if you’re leaving Medicare Advantage).
- Your SEP begins the month before you move (if you notify your plan in advance) or when you move, and lasts for two full months after you relocate.
Even if you move within your plan's service area but have new plan options available at your new address, you still qualify for a SEP.
Losing Other Health or Drug Coverage
If you lose creditable coverage through no fault of your own:
- Employer or union coverage ends (including COBRA)
- Retiree coverage is discontinued
- You lose Medicaid eligibility
- Your plan leaves Medicare or stops serving your area
Your SEP typically lasts two full months from when you lose coverage or receive notification, whichever is later.
Gaining Medicaid or Extra Help
If you become eligible for Medicaid or the Medicare Low-Income Subsidy (Extra Help) program:
- You can switch between standalone Part D plans once per month.
- You can move from Medicare Advantage with drug coverage to Original Medicare plus Part D.
- You can enroll in Dual-Eligible Special Needs Plans (D-SNPs).
- Full-benefit dual eligibles (those with both Medicare and full Medicaid) can join or switch to an “integrated” D-SNP once per month.
Important limitation: You cannot use the monthly SEP to switch to or enroll in new Medicare Advantage plans (that's not an “integrated D-SNP); those changes still require the Annual Enrollment Period or MA OEP.
Moving Into or Out Of A Long-Term Care Facility
If you move into, live in, or move out of an institution like a nursing home:
- You can change Medicare Advantage plans or Part D plans
- Your SEP lasts for two months after you move out
Plan Changes or Issues
You qualify for a SEP if:
- Your Medicare plan ends its contract with Medicare.
- The plan significantly reduces its provider network.
- You joined based on misleading information from a plan representative.
- Your plan receives consistently low quality ratings from Medicare.
Chronic Condition Special Needs Plan Eligibility
If you develop a qualifying chronic condition, you can enroll in a Medicare Advantage Special Needs Plan. Or, if you no longer have a qualifying chronic condition for a Special Needs Plan, you get a SEP to adjust your coverage.
Five-Star Special Enrollment Period
The Five-Star Special Enrollment Period is a unique opportunity to join a highly-rated Medicare plan at almost any time of the year.
How It Works
The Centers for Medicare & Medicaid Services (CMS) rate Medicare Advantage plans and Part D plans on a scale of one to five stars, with five stars being the highest rating. If a plan in your area receives an overall five-star rating, you can:
- Join that five-star Medicare Advantage plan or Part D plan
- Do this one time per calendar year
- Enroll any time from December 8th through November 30th (excluding the first week of December)
Important Details
- Your new coverage starts the first day of the month after the plan receives your enrollment.
- You can only use this SEP once per year to switch to a five-star plan.
- Not all areas have five-star plans available.
- To find out if a five-star plan serves your area, use Medicare's Plan Finder at Medicare.gov/plan-compare or call 1-800-MEDICARE (1-800-633-4227).
The Five-Star SEP recognizes that excellent plans should be accessible to beneficiaries who want to improve their coverage quality.
Is There a Penalty For Switching Medicare Plans?
Typically, no; there is no financial penalty for switching Medicare plans, as long as the switch you’re making falls within any valid enrollment period. You won't pay extra premiums or face enrollment penalties simply for changing plans.
That being said, there are important considerations and potential consequences to be aware of:
No Direct Penalties For:
- Switching Medicare Advantage plans during Annual Enrollment Period or MA OEP.
- Changing Part D plans during Annual Enrollment Period.
- Using a Special Enrollment Period to switch plans due to qualifying events.
- Returning to Original Medicare from Medicare Advantage during valid enrollment periods.
Potential Indirect Consequences:
- Medigap Coverage Issues: If you switch from Medicare Advantage back to Original Medicare outside of your Medigap Open Enrollment Period or guaranteed issue situations, insurance companies can:
- Deny your Medigap application based on health status
- Charge higher premiums due to pre-existing conditions
- Limit which Medigap plans are available to you
- Pre-Existing Condition Waiting Periods: Some types of coverage may impose waiting periods if you haven't had continuous coverage. Make sure you understand your new plan's rules before switching.
- Coverage Gaps: If you don't coordinate your switch properly, you could have gaps in coverage. Always ensure your new coverage begins before you drop your old plan.
- Network & Formulary Changes: Your new plan may:
- Not include your current doctors in its network
- Not cover your prescriptions on its formulary
- Have different cost-sharing structures that increase your out-of-pocket costs
While the above aren't considered "penalties," by Medicare, they can increase your healthcare costs if you don't research carefully before switching.
Late Enrollment Penalties Are Different
The penalties that do exist in Medicare apply to late enrollment, not switching plans:
- Part B Late Enrollment Penalty: If you don't enroll when first eligible and don't have creditable coverage.
- Part D Late Enrollment Penalty: If you go 63+ days without creditable drug coverage after your Initial Enrollment Period.
These are lifetime penalties that increase your premiums, but they're not related to switching plans during valid enrollment periods.
What Are The Biggest Mistakes People Make With Medicare?
Understanding common Medicare mistakes helps you avoid costly errors when changing plans. Here are the most significant mistakes people make:
1. Not Reviewing Coverage Annually
Many people set-it-and-forget-it with Medicare, but plans change every year:
- Premiums, deductibles, and copayments can increase
- Provider networks and pharmacy networks can shrink or expand
- Formularies change, affecting which drugs are covered and at what cost
- New plans may offer better benefits at lower costs
Solution: Review your Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) every fall, and compare plans during Annual Enrollment Period or any SEP you may qualify for.
2. Missing Enrollment Deadlines
Missing your Initial Enrollment Period or not enrolling in Part D when first eligible can result in:
- Lifetime late enrollment penalties
- Gaps in coverage
- Higher healthcare costs
Solution: Mark enrollment periods on your calendar and set reminders. If you're working past 65, understand the rules for delaying enrollment.
3. Assuming All Medicare Advantage Plans Are the Same
Medicare Advantage plans vary dramatically:
- Different provider networks
- Different prescription drug formularies
- Different costs and coverage
- Different additional benefits
Solution: Compare multiple plans using a Medicare plan finder and comparison tool like Healthpilot and check that your doctors and prescriptions are covered.
4. Focusing Only on Premium Costs
The lowest premium plan isn't always the cheapest overall:
- Higher deductibles and copayments can cost more in the long run
- If your medications aren't on the formulary, you could pay full price
- Out-of-network costs with some plans can be substantial
Solution: Calculate your total estimated annual costs including premiums, deductibles, copays, and prescription costs.
5. Not Understanding the Difference Between Medicare Advantage & Original Medicare
Many people choose Medicare Advantage without understanding that:
- You must use network providers for lowest costs (except emergencies)
- You may need referrals to see specialists
- You cannot have Medigap with Medicare Advantage
- Switching back to Original Medicare later may make it hard to get Medigap
Solution: Research both options thoroughly and consider your healthcare usage patterns, travel plans, and preference for flexibility vs. lower costs. If you need support with finding a Medicare plan, Healthpilot is here to help.
6. Dropping Coverage Without a Replacement
Never drop your current Medicare coverage until:
- You've been accepted into your new plan
- You know when your new coverage starts
- You understand there are no gaps in coverage
Solution: Coordinate enrollment timing carefully and confirm your new coverage before ending your old plan.
How To Change Your Medicare Plan
If you're in a valid enrollment period and want to change your Medicare coverage, follow these steps:
Step 1: Determine Your Eligibility
Confirm that you're in an enrollment period:
- Annual Enrollment Period (October 15th-December 7th)
- Medicare Advantage Open Enrollment Period (January 1st-March 31st, only for those currently enrolled in Medicare Advantage)
- Special Enrollment Period (if you have a qualifying event)
- Five-Star Special Enrollment Period (if a five-star plan is available)
Step 2: Compare Your Options
Use a trusted Medicare plan finder and comparison tool like Healthpilot. Here’s how our process works:
- Enter your ZIP code
- Add your prescription drugs
- Select your preferred pharmacies
- Compare plans based on estimated annual costs, coverage, and quality ratings
Step 3: Check Provider & Pharmacy Networks
Before enrolling in a new plan:
- Verify your doctors are in the plan's network
- Confirm your prescriptions are on the plan's formulary
- Check that your preferred pharmacy participates in the plan
Pro Tip: Healthpilot will do all of this for you.
Step 4: Enroll In Your New Plan
You can enroll:
- Directly through Healthpilot; we also have a team of advisors to support you if you require assistance
- Online through the Social Security Administration’s website
- By calling 1-800-MEDICARE (1-800-633-4227)
- By requesting a paper application from the plan
Pro Tip: Make sure the plan receives your enrollment before your enrollment period ends.
Step 5: Confirm Your Coverage
Once enrolled:
- You'll receive a confirmation from your new plan
- Your new plan will send you membership materials
- Review your effective date to know when your coverage begins
- Keep your old coverage in place until your new coverage starts
Step 6: Cancel Your Old Coverage (If Applicable)
For Medicare Advantage plans:
- You generally don't need to disenroll from your old plan, as enrolling in a new Medicare Advantage plan automatically disenrolls you from your old one
- Your old plan ends the day before your new coverage begins
For Part D plans:
- Enrolling in a new Part D plan automatically cancels your old one
- The cancellation is effective the day before your new coverage starts
Get Help Choosing The Right Medicare Plan For You
Deciding whether to change Medicare plans and choosing the right coverage for your needs can be overwhelming. Our team of licensed Medicare advisors can help you:
- Understand which enrollment periods apply to your situation
- Compare Medicare Advantage plans and Part D options in your area
- Evaluate whether switching plans makes sense for your health needs and budget
- Avoid common mistakes that could cost you money or coverage gaps
- Navigate the enrollment process smoothly