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Senior woman reviewing her Medicare documents at home - changing plans during Medicare open enrollment period.

3 Life Changes That Allow You to Change Medicare Plans Outside of Open Enrollment

Changing one’s Medicare Advantage plan or Prescription Drug Plan is possible but only under special circumstances, otherwise known as Qualifying Life Events (QLE), which triggers a Special Enrollment Period (SEP). 

These SEPs last for 30 days up to 8 months depending on the situation. For example, you have 63 days to make a change if you are moving out of a service area, whether you have a Medicare Advantage plan or a Drug Plan.

During this period, you can select a new plan. Various circumstances can call for one to change their Medicare Advantage. Read through to understand what a Medicare Open Enrollment Period is and what life changes can lead to a change in Medicare plans.

What is the Medicare Open Enrollment Period?

Formally known as the “Annual Election Period” or “AEP,” the Medicare Open Enrollment Period is a period that lasts between October 15 through December 7 each year and allows Medicare beneficiaries to change their Medicare Advantage plans and Prescription Drug plans. These changes always take effect on January 1 of the following year. 

As such, the Open Enrollment Period is primarily meant for individuals who already have Medicare coverage. For new applicants, you need to sign up during the Initial Enrollment Period (IEP). This IEP starts three months before you turn 65 and ends three months after the month when you turn 65. However, you can sign up for Medicare Advantage plans during open enrollment if you miss this period.

Special Enrollment Period

It is important to note that you can only change your coverage plans outside the Open Enrollment Period if you qualify for the Special Enrollment period. As mentioned, this is a period where beneficiaries of Medicare make changes to their coverage plans as necessitated by circumstances otherwise known as Qualifying Life Events. However, note that if you qualify for the SEP and want to change the plans, you may:

  • Need to choose a new plan within the same category as your current plan
  • Have a limited option of health plans to choose from
  • Be allowed to change plan categories under special circumstances

Here are some of the changes you can make to your Medicare Advantage Plans:

  • Adding or dropping prescription drug coverage
  • Going back to original Medicare with or without a drug plan
  • Switching to a different Medicare Advantage Plan

The 3 Life Changes that Allow a Change of Medicare Plans Outside Open Enrollment

Couple at home reviewing documents on their Medicare coverage.
Couple at home reviewing documents on their Medicare coverage.

In case of a major life event, your health plan should not be the cause of your worrying. Read on to learn more about instances in which you may be able to change your plans outside the Open Enrollment Period.

  1. Loss of Health Coverage

The loss of coverage is one of the QLEs that can make you eligible for the Special Enrollment Period. There are three ways in which you can lose coverage:

  • if you are a dependant on your parents’ plan when you turn 26
  • losing existing coverage, such as those offered through an employer, student program, or independent market policy
  • losing eligibility for Medicare, CHIP, or Medicaid

Most commonly for Medicare beneficiaries, the loss of health coverage from an employer group health insurance plan is a common SEP that allows the enrollment into a Medicare plan. 

  1. Changes in Residence

Medicare Advantage and Drug plans are only available in select “Service Areas,” so moving out of the service area is an approved reason to switch plans at any time of the year. If you recently returned from abroad or are moving to a different ZIP Code, you will automatically qualify for a Special Enrollment Period. These situations allow you to change your health plans to suit your new coverage needs. 

Additionally, you will qualify for the Special Enrollment Period if you are a seasonal worker and have to move to or from the place you work and live. This QLE also applies to you if you are moving from or to a new residential area.

  1. Qualifying for Extra Help or Medicaid

Qualifying for Extra Help or Medicaid are two events that also allow changes to Medicare outside of the Open Enrollment Period. 

Extra Help is low-income assistance that helps with the cost of prescription drugs on Medicare Part D. If you qualify for Extra Help with your prescription drug costs, you may be able to enroll in a Medicare prescription drug plan at any time.

Medicaid is a federal and state program to help cover medical costs for some people with limited resources. The eligibility requirements differ by state. If you qualify for Medicaid, your state will pay all or part of your Medicare premiums. You may also be able to get help with other out-of-pocket costs.

Get Help Making Changes

While you cannot change your Medicare plans at will, it is important to note that you can make such changes outside the Open Enrollment Period. You only need to qualify for a Special Enrollment Period, as discussed above, to effect the changes. Contact us today for changes to your Medicare plans.

Sylvia Gordon, aka Medicare Mama, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family as well as a member of the Forbes Finance Council. Sylvia has served on the advisory boards of major insurance companies like United Healthcare, Cigna, Anthem, Globe Life, and Aetna Senior Supplemental Benefits. 

In her free time, she can be found taking care of her many animals (dogs, goats, peacocks, chickens) and reading a good book. Follow her on TikTok and YouTube.

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