If you have a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period gives you a chance to make one coverage change early in the year. This window may be helpful if your current plan is not working as expected, your doctors are no longer in the plan’s network, or your prescription coverage has changed.
This enrollment period is different from the fall Annual Enrollment Period. It also has different rules. Knowing what you can and cannot change may help you avoid a costly or frustrating coverage decision.
What is the Medicare Advantage Open Enrollment Period?
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 each year.
It is available only to people who are already enrolled in a Medicare Advantage plan as of January 1. Medicare Advantage plans are offered by private insurance companies approved to provide Medicare coverage. They generally combine Medicare Part A and Part B coverage, and many plans also include prescription drug coverage and extra benefits.
During this period, you may make one change to your Medicare Advantage coverage. Your new coverage generally begins on the first day of the month after the plan receives your enrollment request.
What changes can you make during this period?
If you are enrolled in a Medicare Advantage plan, you generally have two main options during the Medicare Advantage Open Enrollment Period.
- Switch to another Medicare Advantage plan. For example, you may want a plan that includes your preferred doctor, has a different drug list, or offers benefits that better fit your needs.
- Leave Medicare Advantage and return to Original Medicare. Original Medicare includes Part A for hospital care and Part B for medical care. If you return to Original Medicare, you may also enroll in a separate Medicare Part D prescription drug plan.
If you make a change, you usually cannot make another change during this same enrollment period. That makes it important to review the new plan carefully before enrolling.
Can you add a Medicare Supplement plan after leaving Medicare Advantage?
You may apply for a Medicare Supplement insurance plan, also called Medigap, after you leave Medicare Advantage and return to Original Medicare. A Medicare Supplement plan may help pay some of the out-of-pocket costs left by Original Medicare, such as deductibles, coinsurance, and copayments.
However, getting a Medicare Supplement plan is not always automatic. Outside of certain protected enrollment situations, insurance companies may use medical underwriting. This means they can review your health history and may charge a higher premium or decline your application, depending on the carrier and state rules.
Some people have a special protection called a guaranteed issue right. These rights may apply in certain situations, such as when you first joined a Medicare Advantage plan and leave it within the first 12 months to return to Original Medicare. The details can be complicated, and the available plan choices may vary by state.
Before you leave a Medicare Advantage plan, it is wise to understand whether you can get the Medicare Supplement coverage you want. Do not assume you will qualify for a Medigap plan simply because you are returning to Original Medicare.
Who cannot use Medicare Advantage Open Enrollment?
This period is not open to everyone on Medicare. You generally cannot use it if you are enrolled only in Original Medicare with a standalone Part D drug plan.
For example, if you have Original Medicare, a Medicare Supplement plan, and a Part D plan, you usually cannot switch Part D plans between January 1 and March 31 unless you qualify for a Special Enrollment Period.
You also generally cannot use this period to move from Original Medicare into Medicare Advantage for the first time. That type of change is usually handled during the fall Annual Enrollment Period, which runs from October 15 through December 7, or during another enrollment period for which you qualify.
What should you check before changing plans?
A Medicare Advantage plan can be a good fit for people who are comfortable using a plan network and want coverage that may include services such as dental, vision, hearing, fitness, or transportation benefits. The details vary widely by plan, carrier, county, and state.
Before changing plans, consider reviewing these items:
- Your doctors and hospitals: Confirm whether your preferred providers are in the new plan’s network. Some plans may require referrals or have different rules for seeing specialists.
- Your prescriptions: Check that each medication is on the plan’s drug list, also called a formulary. Review the pharmacy options and coverage rules as well.
- Your expected care: Think about upcoming surgeries, specialist visits, therapy, or travel. A plan’s network and cost-sharing rules may matter more when you expect regular care.
- Your out-of-pocket limit: Medicare Advantage plans have an annual limit on covered medical costs, but the limit and your share of costs may vary from plan to plan.
- Extra benefits: Dental, vision, hearing, over-the-counter allowances, and other extras can be useful, but it is still important to focus first on medical providers, prescription coverage, and out-of-pocket costs.
Is switching to Original Medicare the right choice?
There is no one Medicare choice that fits everyone. Medicare Advantage may offer coordinated coverage and extra benefits in one plan. Original Medicare, often paired with a Medicare Supplement and Part D plan, may offer broader provider access because you can generally see any provider that accepts Medicare.
In exchange, Original Medicare with a Medicare Supplement may involve separate monthly premiums and separate plans to manage. Medicare Supplement benefits, premiums, availability, and underwriting rules can vary by plan, carrier, and state.
The best choice often depends on your health needs, budget, doctors, travel habits, and comfort with provider networks.
Do not wait until the last minute
The March 31 deadline can arrive quickly. Give yourself time to compare your choices, check your doctors and prescriptions, and understand the rules before submitting a change. If you are considering a move from Medicare Advantage to Original Medicare with a Medicare Supplement, it may be especially important to review Medigap eligibility before ending your current coverage.
If you would like help sorting through your options, Eric can provide free, no-pressure guidance on Medicare Supplement plans and how they may fit with Original Medicare. Reach out when you are ready to talk through your situation.