Selecting a Medicare plan is a big step, and there’s a lot of information to digest and understand. If you’ve picked a plan but now you’re not satisfied with it, you might want to change plans. The good news is that you can change plans, and you might find a better option.
It doesn’t matter if you have Original Medicare, Medicare Advantage, or a Medigap plan; you can make a switch if you believe your coverage is insufficient. You can even change from one Medicare Advantage plan to another since they offer different programs.
If you qualify for a special enrollment period by experiencing a qualifying life event, you can change your plan anytime. If you don’t have a qualifying event but want to change your insurance, you will have to wait for the open enrollment periods of Original Medicare or Medicare Advantage.
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Can You Still Make Changes to Your Medicare Coverage for 2023?
If you currently have a Medicare Advantage plan, you can make changes to your coverage during the Medicare Advantage Open Enrollment Period, which runs from January 1 until March 31. However, if you have an Original Medicare plan, you must wait until the Annual Enrollment Period, which begins October 15 and lasts through December 7.
An exception to this is if you have an original Medicare plan and have experienced a qualifying life event, such as a marriage, loss of employer coverage, newly extended dependent, or a change in residence. In this case, you may qualify for a Special Enrollment Period and can make changes then.
Changing Medicare Plans
During Medicare annual enrollment, anyone who has a Medicare plan can make a change to their coverage. The Medicare Advantage Annual Enrollment Period is a chance for people with a Medicare Advantage program to change back to Original Medicare or switch to a different Medicare Advantage plan.
Adding Part D Drug Coverage
They can also add Medicare Part D (prescription drug plan) to their coverage at this time if they switch back to Original Medicare or enroll in a Medicare Advantage plan that does not offer Part D drug coverage, such as a Medicare Medical Savings Account plan or some Private Fee-for-Service plans. However, if you enroll in a Medicare Advantage PPO or HMO plan, you cannot enroll in a separate Part D plan.
Medicare Options at a Glance
|Original Medicare||Medicare Advantage||Medigap|
|Part A: Hospital Coverage||Yes||Yes||Supplements Part A benefits|
|Part B: Medical Coverage||Yes||Yes||Supplements Part B benefits|
|Part D: Drug Coverage dependent on insurer and plan||No||Dependent on insurer and plan||No|
|Out-of-network Coverage||No||Dependent on plan||No|
|Premiums||Part A is commonly premium-free; separate premium for Part B||One premium||Separate premium in addition to Original Medicare|
|Deductibles||Separate deductible for Parts A and B||Dependent on insurer and plan||Helps pay Original Medicare deductibles; excludes Part B deductibles for those who became eligible for Medicare after January 1, 2020|
|Copays||None||Dependent on insurer and plan||None|
|Coinsurance||20%||Dependent on insurer and plan||Helps pay Original Medicare coinsurance|
|Out-of-pocket Costs||No annual limit on costs||Annual limit, after which you don’t pay||Helps pay Original Medicare out-of-pocket costs|
|Coverage||Covers most medically necessary services||Covers all medically necessary services of Original Medicare and may include more such as dental, vision, and hearing||Can fill some coverage gaps in Original Medicare plans|
When Can You Change to a New Medicare Advantage Plan?
If you’d like to change from Original Medicare to a Medicare Advantage Plan or want to change from one Medicare Advantage plan to another, you can do so during Medicare annual enrollment.
If you already have a Medicare Advantage plan, you can also make changes during Medicare Advantage open enrollment.
Open Enrollment Period
- When: January 1 to March 31 annually (currently open)
- What you can do: Change from one Medicare Advantage plan to another.
The Medicare Open Enrollment Period is specifically for Medicare Advantage beneficiaries. This enrollment period allows beneficiaries to change from one Medicare Advantage plan to another. During this time, anyone with Medicare Advantage can also change to Original Medicare and join a separate drug plan (Medicare Part D) as it is not a part of Original Medicare.
There can only be one change during this time period, so if you decide to change in early January, then change your mind in mid-March, you will need to wait until the Medicare Annual Enrollment Period on October.
Changing from one Medicare Advantage plan to another Medicare Advantage plan doesn’t require you to unenroll in your previous plan. This will automatically happen when you enroll in your new plan. However, if you’re canceling a Medicare Advantage plan and changing to Original Medicare, you’ll need to send a written notification to the insurer notifying them of this change.
Annual Enrollment Period
- When: October 15 to December 7 annually
- What you can do: Change from one Medicare Advantage plan to another; change from Original Medicare to Medicare Advantage; change from Medicare Advantage to Original Medicare.
This broad enrollment window applies to all Medicare beneficiaries, Original or Advantage. Your new plan will be effective beginning January 1 of the following year as long as your request to change is received by December 7 of the preceding year.
If you have a stand-alone prescription drug plan and are switching to a Medicare Advantage all-in-one plan, you’ll need to disenroll from your old plan so your new coverage can begin on January 1.
Why Change to Medicare Advantage?
Medicare Advantage plans are offered through private insurers rather than the government. They must follow the rules established by Medicare to qualify and must provide beneficiaries with Part A coverage and Part B coverage.
Medicare Advantage plans roll Part A and Part B together, which is why they’re sometimes called Part C. Instead of offering the same insurance that Original Medicare offers, each Medicare Advantage plan has some differences. Some companies include Medicare Part D (prescription drugs) in their Advantage plan, providing all-in-one coverage.
Additionally, some Medicare Advantage plans include benefits that Original Medicare doesn’t cover, like fitness programs, vision, hearing, and dental services. Some even offer coverage for transportation to medical visits, over-the-counter drugs, and services that promote health and wellness.
Medicare Advantage plans can offer flexibility that Original Medicare does not, as beneficiaries are able to customize plans to best fit their needs.
When Can You Change Back to Original Medicare?
If you have a Medicare Advantage plan and want to change to Original Medicare, or you’ve switched to an Advantage program and find it does not suit you, you can switch back during either the Annual Enrollment Period or Open Enrollment Period.
General Enrollment Period
- When: January 1 to March 31 annually
- What you can do: Change from one Medicare Advantage to Original Medicare; enroll in Original Medicare after delaying enrollment.
If you’re switching from a Medicare Advantage program to Original Medicare, whether you’re switching back or it’s your first time with Original Medicare, you can change insurance from January 1 to March 31 each year. Your Original Medicare coverage will kick in on the first day of the month following enrollment.
If you’ve delayed enrollment because you were covered under another plan (usually an employer-sponsored insurance plan), you do qualify for a Special Enrollment Period and can switch during that time. If you delayed and it wasn’t an approved delay, you’ll face penalties for the delay and have to go uninsured until general enrollment rolls around.
Annual Enrollment Period
- When: October 15 to December 7 each year
- What you can do: Change from Medicare Advantage to Original Medicare.
If you have Medicare Advantage, in addition to being able to switch to Original Medicare from January 1 to March 31, you also have the option to switch from October 15 to December 7 each year. If you change during the October to December timeframe, your insurance will begin on January 1.
People switching from Medicare Advantage might lose some coverage moving to Original Medicare. You can typically add Medicare Part D and Medigap during this time to make up for lost coverage.
Why Change to Original Medicare?
Original Medicare has some advantages; the most noteworthy one is you can go to any doctor or hospital in the United States that takes Medicare. Medicare Advantage often restricts care to in-network providers. Similarly, with Original Medicare, you don’t need a referral to see a specialist.
When it comes to cost, it’s difficult to compare Original Medicare to Medicare Advantage because the Advantage plans have so many price points and options. One thing to note is that the amount providers can charge for services with Original Medicare is established by the government. Rates for these same services with an Advantage plan may be higher or lower, depending on the negotiated rate between the insurer and the provider.
With Original Medicare, you can purchase a Medigap plan to help supplement costs not covered by Medicare, such as copayments, coinsurance, and deductibles. Medigap is not available for Medicare Advantage beneficiaries. Because Medigap is supplemental insurance, there is an additional cost, but it can greatly reduce your overall expenses.
When Can You Change Medigap Plans?
Medigap is only available to people with Original Medicare and is provided through independent insurers rather than the government. This means that there are different Medigap plans, each with some benefits and drawbacks, which means you may want to change your Medigap plan at some point.
Medigap does not have an Annual Enrollment Period, so you’re not restricted to a timeframe if you want to make a change. You are first eligible for Medigap during the 6-month Medigap Initial Enrollment Period, which begins the first month you are 65 years of age and have Medicare Part B.
This period is the best time to buy Medigap because you can typically get a better rate and cannot be denied any policy due to your health. After this 6-month period, there’s no guarantee that you can get a Medigap policy, and your costs may be significantly higher.
If you’re switching Medigap policies, there is a 30-day “free look” period where you pay the premiums on both your old and new policies, and are able to utilize the benefits of the new policy. If you don’t like it, you can drop it before the 30-day trial period ends. If you like it, you can drop your old plan.
How Special Enrollment Periods Work When Switching Medicare Plans
Several situations qualify for a Special Enrollment Period (SEP), which opens the door to switching Medicare plans outside the predefined enrollment periods. For instance, if you’re still working and covered by your employer’s insurance and then lose your job, you’re eligible for SEP.
Some of the more common SEP situations include:
- Moving to a different state or out-of-plan coverage area
- Losing current coverage
- Qualifying for other coverage (Medicaid, Employer Group Coverage, state assistance programs)
- Release from prison
- Moved into or out of an institution (nursing or long-term care facility)
- No longer eligible for Medicaid
- Current plan’s Medicare contract changes
If you experience a qualifying life event, then you have a two-month Special Enrollment Period in which you can sign up for a new Medicare plan.
What You’ll Need to Change Medicare Plans
You will need to know your Medicare number, and if you have an Advantage plan, you’ll need information on which plan it is. Have your Original Medicare or your Medicare Advantage plan card handy.
When you first enrolled for Original Medicare or Medicare Advantage, you had to provide basic information that included your birth certificate, driver’s license, or proof of U.S. citizenship. You will not need this information again to switch plans.
Often, a Medicare switch can be done online or through your current plan’s helpline. If you’re switching from a Medicare Advantage plan to another Advantage plan, you have to enroll in the new plan, and the old plan will be disenrolled for you. If you’re switching to Original Medicare from an Advantage plan, it’s best to call 1-800-MEDICARE or connect with your current plan to get the documentation you need to switch.