Open enrollment, your opportunity to choose a Part D prescription or Medicare Advantage plan for the coming year, is Oct. 15 to Dec. 7. If you miss this annual open enrollment period, you’ll be reenrolled automatically in your current plan as long as it’s offered in your area.
But coverage and costs can vary from year to year, and your current plan may no longer be your best choice. Or you may change your mind and want original Medicare rather than Medicare Advantage. After open enrollment ends, you may qualify to switch your coverage.
What can I do about Part D if I miss open enrollment?
If you discover that another Part D plan has better coverage for your medications, or if your doctor prescribes a new drug that isn’t covered in your plan’s formulary, you could have opportunities to change plans after Dec. 7 if you:
- Have a five-star plan in your area. If a locally available Part D plan has an overall five-star rating for quality from the federal government, you can switch to that plan once any time of the year. Coverage begins the first day of the month after the plan receives your enrollment request. You can search for plans with a five-star rating using the Medicare Plan Finder, where you also can see how the plans cover your medications.
- Move outside your current plan’s service area. When you relocate, you usually have two months to get a new Part D or Medicare Advantage plan.
- Qualify for a special enrollment period. You can change plans midyear in other situations, such as discovering that a federal employee made a mistake when processing your enrollment, learning that your current Part D plan terminated its contract with Medicare, or moving into or out of a nursing home or other long-term care facility.
What if I miss open enrollment for Medicare Advantage?
You may want to make Medicare Advantage changes at midyear if you’re prescribed a new medication not in your present plan’s formulary or want to see a doctor not in its provider network. You have several opportunities to switch Medicare Advantage plans or leave Medicare Advantage after open enrollment is over:
- Jan. 1 to March 31. Anyone in a Medicare Advantage plan can choose another Advantage plan during this time, also known as the Medicare Advantage open enrollment period. Or you can leave Medicare Advantage for original Medicare and join a Part D plan. Your new coverage begins the first day of the month after you switch. You can’t get a Medicare Advantage plan during this time if you don’t already have one.
Be aware: If you leave Medicare Advantage for original Medicare and want a Medigap policy to help cover Medicare’s deductibles and copayments, this supplemental coverage may not be guaranteed. Medigap insurers can charge more or reject you because of preexisting conditions unless you buy a Medigap policy during certain times.
- During your first year of Medicare Advantage. You can change to original Medicare any time during this one-year trial. You also can sign up for a Part D prescription drug plan and qualify for a special enrollment period to get Medigap coverage regardless of preexisting conditions.
- If a five-star plan is available. If a Medicare Advantage plan in your area has an overall five-star quality rating, you can switch to that plan any time of the year. Like Part D, coverage begins the first day of the month after the plan receives your enrollment request. You can search for Medicare Advantage plans with a five-star rating using the Medicare Plan Finder.
- If you move to a new address outside of your plan’s service area. Usually, you have up to two months to find a new Medicare Advantage plan or leave Medicare Advantage for original Medicare and get a Part D plan.
- If you qualify for a special enrollment period. You can change Medicare Advantage plans midyear for other reasons, such as finding out a federal employee made a mistake when processing your enrollment; learning your plan terminated its contract with Medicare; moving into or out of a long-term care facility; or qualifying to join a Medicare chronic care special needs plan, a type of Medicare Advantage plan that provides specialized benefits for people with specific ailments.
Keep in mind
If you don’t already have a Part D or Medicare Advantage plan, sometimes you can sign up outside of open enrollment, such as:
- During your seven-month initial enrollment period for Medicare, the three months before the month you turn 65 until three months after your birthday month.
- Within two months of losing medical insurance from your employer or union.
- Within two months of losing drug coverage considered at least as good as Part D, called “creditable coverage.” This creditable coverage may be from an employer, a retiree plan, Tricare or another source.
If you don’t sign up for prescription drug coverage from a Part D or Medicare Advantage plan within these time frames and don’t have other creditable drug coverage, there’s a chance you may have to pay a Part D late-enrollment penalty when you eventually enroll.
One last thing to note: Part D and Medicare Advantage deadlines are different from deadlines for enrolling in original Medicare. You still have to sign up for Medicare Part A and Part B during your initial enrollment period at age 65 unless you or your spouse is still working and you have health insurance from a current employer. You have up to eight months after losing employer health insurance to enroll in Medicare without a Part B late enrollment penalty.
Published December 6, 2022