How to Make Plan Changes Outside of Open Enrollment
How to Make Plan Changes Outside of Open Enrollment
Feeling Stuck in Your Medicare Plan? You Might Have More Options Than You Think.
Have you ever felt like you're locked into your Medicare plan? You've wondered if there’s a way out but assumed it’s too late because we’re not in the middle of the fall open enrollment? You’re not alone.
But here’s the truth: For a lot of people, there are options to make a switch.
There's a special enrollment period you may not have heard of: The Medicare Advantage Open Enrollment Period. Let’s talk about what that means, and what other opportunities there might be for you to switch plans any time of the year. Even outside the fall Open Enrollment (AEP).
What Is the Medicare Advantage Open Enrollment Period?
This period runs from January 1st through March 31st and is only for those who already have a Medicare Advantage Plan. During this time, you’re allowed to:
- Switch to a different Medicare Advantage plan.
- Or drop your Advantage plan and return to Original Medicare (possibly adding a Medigap plan).
This window is more like a safety net, not a free-for-all like the fall enrollment season, which is why you don’t see a ton of ads about it.
This can be helpful if:
- A provider you need is suddenly out of network.
- Your prescription drug is no longer covered.
- Benefits like dental or vision were dropped, and you didn’t realize it.
If any of that sounds like you, there’s still time to make a change before March 31. But if you’re considering switching to a Medigap plan, you’ll want to start the process earlier (preferably by the second week of March) to allow time for the underwriting approval.
Want a Medigap Plan Instead?
Medigap plans work with Original Medicare and give you more freedom. you don’t have to stick to a doctor network or get referrals to see specialists.
A lot of of people like the simplicity.
The most common reason people switch their Medigap plan to a different Medigap plan mid year:
To save money. Rates go up over time, and it’s worth checking to see if there’s a better deal out there.
Here’s the important part:
Medigap plans aren’t tied to the fall open enrollment. You can apply any time of year.
After your first 6 months on Medicare, you usually have to go through medical underwriting, which means answering health questions to get approved. But don’t let that scare you off! A lot of people do qualify, even with some health issues. It just depends on the situation.
Before we ever apply, I help you review those questions first. If we need to, I’ll even call the insurance company directly and ask about how they handle certain health conditions, so you know exactly what to expect.
Some States Make It Even Easier to Switch Medigap Plans
Depending on where you live, you may have extra flexibility:
- Always Open Enrollment (no health questions): NY, VT, CT, MA
- Year-Round Switching: WA & ME (if you already have a Medigap plan)
- Birthday Rule States (switch around your birthday): OR, CA, NV, ID, IL, OK, KY, LA, MD
- Anniversary Rule: MO (same idea, just based on your plan anniversary)
What If You Have a Medicare Advantage Plan?
There are still a few ways you might be able to switch during the year, even outside the current January–March window:
1. The 5-Star Rule
If your ZIP code has a 5-star Medicare Advantage plan (based on Medicare's quality ratings), you can switch to it once per year at any time.
2. Chronic Special Needs Plans (C-SNPs)
These are special plans for people with certain chronic conditions (like diabetes, COPD, or heart disease). If there’s one in your area and it matches your condition, you can join anytime.
3. Dual Eligible (Medicare + Medicaid)
You can switch your plan every single month.
4. Extra Help with Drug Costs
Same thing, you can make monthly changes to your Advantage Plan or drug plan if you qualify for Extra Help.
Moved Recently?
If you moved (or will be moving) out of your Medicare Advantage Plan’s service area, you qualify for a special enrollment to pick a new one or even to go back to Original Medicare and get a Medigap plan without health questions.
That’s a big opportunity, especially if you’ve had trouble qualifying for Medigap before.
But if you already have a Medigap plan and move, you can’t switch companies just because you moved. You’d still need to qualify with health questions (unless you’re in one of the special states mentioned above).
What If None of These Apply to You?
If you don’t qualify for any special enrollment right now, your next opportunity will be the Fall Open Enrollment, which runs from October 15 to December 7. Any changes you make at that time will take effect January 1.
This is your time to:
- Switch from one Advantage Plan to another.
- Drop your Advantage Plan and go back to Original Medicare.
- Change your standalone drug plan.
But just a heads-up: this fall period won’t help you switch Medigap plans, you can do that anytime, but you’ll likely have to go through health underwriting.
And if you’re trying an Advantage Plan for the first time and it doesn’t work out? You may qualify for a trial right that lets you switch back to Medigap within 12 months. I’ll help you figure that out too.
Let’s Make Medicare Feel Easier On You
If all this feels a little overwhelming, you’re not alone and that’s exactly why I do what I do. I help make sense of it all, in plain language, and walk you through the process step by step. My help is always 100% free, and I work with many companies so we can find the plan that actually fits you, not what the agent wants you to buy.
Whether you’re brand new to Medicare or just want to make sure your current coverage still makes sense, I’m here to help take the stress out of the process.
Ready to see what your options are? Book your free consultation today.
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