When to Consider Changing Medicare Plans

Medicare open enrollment: Oct 15 - Dec 7

You might find it liberating just knowing you can change the Medicare plan you have. Knowing when and why you might want to change your plan helps you decide whether changing is worthwhile. (Choosing and applying for a new plan, then updating all your health providers with your new member information can be a hassle.) Look through the lists below to see if YOU have a good reason to be looking at a different Medicare plan. Check out our Medicare In Depth blog if you want a refresher on Medicare: Medicare In Depth.

When Can Medicare Plans Be Changed?

Medigap for Original Medicare:

Apply any month for a start day of the 1st of the next month.
Health history required with application unless you have a Special Enrollment Period (SEP).
If you have a Medicare Advantage plan and wish to return to Original Medicare, you can apply during the Medicare Advantage enrollment change periods listed below.

Medicare Advantage (usually include prescription drugs).

Apply during the Annual Enrollment Period (October 15th – December 7th) for a start day of the 1st day of the new year.
If you have a Medicare Advantage plan already, you can change to another Advantage plan or return to Original Medicare and a standalone Prescription Drug Plan. Start date is the 1st day of the month after you apply.

Standalone Prescription Drug Plans.

Generally speaking, prescription drug plans can be changed during the same periods as Advantage plans.
That means if you return to Original Medicare after having an Advantage plan, you can select a drug plan at the same time.

You Are Eligible for a Special Enrollment Period (SEP) if:

your Medicare plan is no longer available in your area.
you move to an area where your plan is not available or you have new options that weren’t available where you used to live.
you gain or lose Medicaid assistance and/or Extra Help prescription assistance.
you are living in a care facility or are leaving a care facility. (These SEPs vary with the exact circumstances.)
you want to change to a 5-star rated Advantage plan.

NOTE: There are other more rarely used reasons for an SEP not mentioned here.

Need more Medicare information? Check out our other Medicare posts here or get help from an expert.

Why do people change Medicare plans?

If you're already enrolled in Medicare, you've probably been inundated with ads touting alternative plans. In reality, ads promising more benefits or lower premiums may or may not apply to your own situation.

Not enrolled in Medicare yet, or just need a quick Medicare refresher? Check out our blog post What Is Medicare, and How Does It Work? for more details.

Find out more about when and whether to consider a change based on your plan type by checking our lists below.

Reasons to consider changing your Medigap plan:

Premium costs no longer fit your budget.
Your Medicare plan is no longer offered in your area.
You’d prefer the pay-as-you-go model offered by Advantage plans.

NOTE: If you have a Medigap plan you cannot have an Advantage plan at the same time.

Reasons to consider changing your Advantage plan:

Your favorite physician(s) or care provider left the plan.
Your Advantage plan includes prescriptions and yours are no longer covered or are becoming too expensive.
Your Advantage plan does NOT include prescriptions and you wish it did.
You move out of the plan area or your insurance plan is no longer offered in your area.
Your health is still good and

you want more of your share of medical costs covered.
you want more choice in medical providers.

You’ve been diagnosed with one or more chronic illnesses and want to look at Chronic Illness Special Needs Plans (C-SNPs). These Advantage plans offer increased care coordination benefits.
You’ve qualified for Medicaid and wonder about Dual Eligible Special Needs Plans (D-SNPs). These plans are designed to work efficiently with Medicaid.
You’ve moved to a care facility and now qualify for an Institutional Special Needs Plan (I-SNPs).

NOTE: If you have an Advantage plan you cannot have a Medigap plan at the same time. Be aware that unless you have a Special Enrollment Period for Medigap plans you will have to go through medical underwriting and may be declined or charged a higher premium.

Reasons to consider changing your prescription drug plan:

Your plan no longer covers your prescription.
You have new prescriptions that you take regularly (if they are generic or preferred brand on your current plan you’re probably not going to see much if any change with a new plan).
Your plan has increased the premium and you’d like a better deal.
You move out of the plan area or your insurance plan is no longer offered in your area.

NOTE: If you have an Advantage plan, even if it does not have a prescription drug plan included, you cannot purchase a standalone prescription drug plan. Purchasing an Advantage plan, even if it does NOT include a drug plan, will kick you off of your standalone prescription drug plan. Purchasing a prescription drug plan will kick you off your Advantage plan.

Next Steps:

If you did find one or more reason you probably would benefit from changing plans, we’re here to guide you. We can help you eliminate the options that won’t meet your needs and focus on the plans that do.