All Medicare patients are eligible to change their Medicare Advantage or Medicare Prescription Drug Plan during Open Enrollment (October 15th - December 7th). But, what if they want to switch their plan outside of Open Enrollment? Can they do that? In most cases, the answer will be no, however, there are special circumstances ("Special Enrollment Periods") in which patients are eligible to switch their plan outside of Open Enrollment.
Their living situation has changed:
- They moved to a new address that isn't in their current plan's service area or the new location has additional plan options.
- They moved back to the U.S. after living outside the country.
- They just moved into, currently live in, or just moved out of an institution (i.e. long term care facility*). If they are moving into or already live in a long term care facility, patients are eligible to enroll, switch, or dis-enroll every month while in the facility, as well as up to two months after leaving the facility. *A long term care (LTC) facility provides care for residents who require some form of medical care. These include a skilled nursing facility (SNF), a nursing facility (NF), an intermediate care facility for the mentally retarded (ICF/MR), a psychiatric hospital, a long-term care hospital, and a swing-bed hospital.
They lose their current coverage:
- They are no longer eligible for Medicaid.
- They left or dropped creditable coverage from an employer, union, Medicare Cost Plan, or Program of All-Inclusive Care for the Elderly (PACE) plan.
- They are informed their current drug coverage through an employer or union has changed and is no longer considered creditable.
- They involuntarily lose other creditable drug coverage.
Their plan changes its contract with Medicare:
- Their plan is sanctioned by Medicare because of a problem with the plan.
- Medicare terminates their plan's contract or their contract isn't renewed.
Other special situations:
- They are eligible for both Medicaid and Medicare ("Dual Eligible").
- They qualify for Extra Help paying for Medicare prescription drug coverage.
- They enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility.
- They have a severe or disabling condition, and there's a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with their condition.
- They are enrolled in a SNP (Special Needs Plan) and no longer has the chronic condition that qualifies as a special need that the plan serves.
5-Star Special Enrollment Period
- There is a 5-star Medicare Prescription Drug Plan, Medicare Advantage Plan, or Medicare Cost Plan available in their service area, and their current plan does not have 5-star rating from CMS. If so, they have a one time opportunity to enroll in a 5-star plan in their service area between December 8–November 30th of each year.
Medicare Advantage Plan Open Enrollment Period
New change for 2019, from January 1st through March 31st of each year, patients on Medicare Advantage plans (MAPDPs and MAs) will have a special Open Enrollment Period to:
- Enroll in a different Medicare advantage plan, with or without drug coverage.
- Disenroll from their Medicare Advantage plan and switch to Original Medicare, along with the option to enroll in a stand-alone Part D plan (PDP).
From 2011-2018, this MA Open Enrollment period did not exist. Instead there was something called the “Annual Medicare Advantage Disenrollment Period.” For these years, patients on advantage plans had from January 1- February 14th to disenroll from their Advantage plan and enroll in a standalone Part D plan with Original Medicare Parts A and B.
The Medicare Advantage OEP previously existed from 2007-2010 and has been brought back under the 21st Century Cures Act of 2016, starting in January 2019.
The Medicare Advantage Open Enrollment Period is not available for those enrolled in Medicare Savings Accounts or other Medicare cost plans, or PACE plans.
Check this article out to learn how to do a plan comparison for patients enrolling in a Medicare Advantage plan!