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10 Ways You Can Still Change Your Medicare Advantage Plan After Open Enrollment

By Keith Speights - Apr 16, 2017 at 7:03AM

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You might not have to stick with your current Medicare Advantage plan until next open enrollment.

Open enrollment for Medicare Advantage plans ended on Dec. 7, just like it does every year. Does that mean you have to wait until Oct. 15, the beginning of the next open enrollment period, to change your plan? Not necessarily.

There are some special circumstances where changes can be made outside open enrollment. Here are 10 scenarios where you can still change your Medicare Advantage Plan after Dec. 7 and before Oct. 15.

Retired couple talking with agent

Image source: Getty Images.

1. You move to a new location

There are several ways that changing where you live can allow you to change your Medicare Advantage plan outside of the open enrollment period.

If you relocate to somewhere that isn't in your current plan's service area, you're free to switch plans or convert to original Medicare. If you tell your current plan about your move in advance, you'll have two months after your move to switch plans. If you tell your current plan of your new address after you move, you'll have two months to switch from when you let the plan know.

Even if you move to a new address that's in your current plan's service area, you could potentially still change plans -- but only if there are new plan options in your new location. Note, however, in this situation, you can change Medicare Advantage plans but you can't switch to original Medicare. The time period in which you're allowed to change plans are the same as if you had moved to an address not in your current plan's service area. 

What if you move back to the U.S. after living in another country? You can join a Medicare Advantage plan for two full months after the month you return to the U.S.

If you move into or out of a skilled nursing facility or long-term care hospital, you can also join a new Medicare Advantage plan. You can make changes as long as you live in the institution and for two full months after the month you leave.

If you were in jail and are released, you can join a Medicare Advantage plan. Your window for enrolling extends for two months after the month you're released from jail.

2. You lose your current coverage

If you're no longer eligible for Medicaid, you can change Medicare Advantage plans or enroll in one if you had not already done so. You could also switch to original Medicare. Changes can be made for two months after the month you find out you've lost Medicaid eligibility. If you lose coverage for the next year, you must make any changes between Jan. 1 and March 31.

If you drop coverage from an employer or union plan (including COBRA) or from a Program of All-Inclusive Care for the Elderly (PACE) plan, you have two months after the month your coverage ends to enroll in a Medicare Advantage plan.

If you involuntarily lose other drug coverage that's as good as Medicare drug coverage or your current drug coverage is no longer "creditable" (equivalent to Medicare drug coverage), you can either join a Medicare Advantage plan with drug coverage or enroll in a Medicare Part D prescription drug plan. The window for enrolling is two months after the month you lose your coverage or when you find out your drug coverage is no longer creditable, whichever is later.

3. You have an opportunity to get other coverage

If you have the chance to enroll in coverage from your employer, your union, or PACE, you can drop your current Medicare Advantage plan at any time during the year to go to the new coverage. 

4. Your current plan's status with Medicare changes

If Medicare sanctions your current Medicare Advantage plan or ends the contract with the plan for some reason, you're free to switch to a new Medicare Advantage plan. In situations where your current plan has its contract with Medicare canceled, you can change to a new plan starting two months before the contract ends and one month after it ends. The period allowed for changes varies on a case-by-case basis when Medicare Advantage plans are sanctioned.

Also, if your current Medicare Advantage plan doesn't have its contract renewed, you'll have from Dec. 8 to the last day in February to enroll in a new Medicare Advantage plan.

5. You're dually eligible for Medicare and Medicaid

You can join, switch, or drop your Medicare Advantage Plan at any time during the year if you're eligible for both Medicare and Medicaid.

Medicare enrollment form

Image source: Getty Images.

6. You're either currently enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility

Many (but not all) states help pay drug plan premiums and other drug costs through State Pharmaceutical Assistance Programs (SPAP). If you're either enrolled in SPAP or lose eligibility, you will be able to join a Medicare Advantage plan with drug coverage or a Medicare Part D prescription drug plan. Check with Medicare if this applies to you to find out when you're allowed to enroll in a Medicare Advantage plan.

7. You're in a Special Needs Plan (SNP) but you no longer qualify 

Medicare Special Needs Plans (SNPs) are Medicare Advantage plans that limit membership to individuals with specific diseases or conditions. If you have been enrolled in an SNP but no longer have a disease or condition that qualifies as a special need that the plan serves, you can switch to another Medicare Advantage plan. You can enroll in a new plan starting from the time you lose your special needs status through three months after your SNP's grace period ends.

8. Your decision to join (or not join) a plan resulted from a federal employee's error

If a federal employee made an error that impacted your decision on joining your current Medicare Advantage plan or choosing not to join a plan, you can potentially enroll in a new plan. Medicare will notify you about the error (not the other way around). You'll have two months after the month in which you're notified by Medicare about the error to make a change. 

9. You weren't properly informed that your other private drug coverage wasn't as good as Medicare drug coverage

If either Medicare or your current private plan notifies you that you weren't appropriately told that your current drug coverage wasn't equivalent to Medicare drug coverage, you will have two months after the month you are notified about the error to either join a Medicare Advantage plan with drug coverage or enroll in a Medicare Part D prescription drug plan.

10. You weren't properly informed you were losing private drug coverage that was as good as Medicare drug coverage

If either Medicare or your current private plan notifies you that you weren't appropriately told that you were losing private drug coverage that was as good ad Medicare drug coverage, you will have two months after the month you are notified about the error to to either join a Medicare Advantage plan with drug coverage or enroll in a Medicare Part D prescription drug plan.

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