insurance

How to Change Your Medicare Advantage Plan Outside of Open Enrollment

If you end up unhappy with the Medicare Advantage plan you signed up for, you may be able to switch before next year's open enrollment.

Question: If I sign up for a Medicare Advantage plan during open enrollment now and then decide it isn't the best plan for me, can I switch plans before open enrollment next year?

Answer: Once open enrollment is over (it runs from October 15 to December 7 for coverage to begin on January 1), you generally need to wait until next year's open enrollment to switch Medicare Advantage plans. But there are a few exceptions.

If there's a Medicare Advantage plan with a 5-star quality rating in your area, you can enroll in that plan anytime during the year, even after open enrollment is over (you can make this switch once per year). However, there are only 16 5-star Medicare Advantage plans in the U.S., and many areas don't have one available. To see if one is available in your area, type your zip code into the Medicare Plan Finder, and after you type in your drugs and preferred pharmacy, click on "Medicare health plans" and look for plans with the 5-star icon (you can also sort results by overall star rating). For 2018 coverage, 5-star plans are available in some counties in California, Colorado, Florida, Georgia, Hawaii, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, New Hampshire, New York (only an employer group health plan version), Oregon, Texas, Virginia, Washington and Wisconsin, as well as the District of Columbia. See 5-Star Special Enrollment Period for more information.

If you want to switch to a 5-star plan after open enrollment, it's generally a good idea to call the company or visit its website to apply, according to Kaiser Permanente, which has 5-star plans in several states.

You may also qualify for a "special enrollment period" if you meet certain criteria—for example, if you move out of your plan's service area or relocate to a new area that has additional options. See Special Circumstances at Medicare.gov for more about this special enrollment period.

From January 1 through February 14, you also have the option to switch from Medicare Advantage back to traditional Medicare and get a Medicare Part D prescription-drug plan. (You won't be able to switch to another Medicare Advantage plan during this time.) This "Medicare Advantage disenrollment period," however, doesn't guarantee that you will qualify for a Medicare supplement (medigap) plan to cover Medicare's deductibles, co-payments and other out-of-pocket costs. You can get a medigap policy within six months of first enrolling in Medicare Part B (whether you're covered under traditional Medicare or Medicare Advantage), but after that insurers may be allowed to reject you or charge more for medigap coverage because of preexisting conditions. See the Medicare Rights Center's Protected Times to Buy a Medigap factsheet for more information.

Because of the limited options for switching plans midyear, it's important to shop for a Medicare Advantage plan carefully during open enrollment. Go to the Medicare Plan Finder to find out about the coverage and costs for all of the plans available in your area. Type in your drugs and dosages to see how much you'll pay out of pocket for your medications under each plan, and look at the coverage details for the types of care you typically need. You can also compare the estimated out-of-pocket costs for the plans based on poor, good or excellent health (click on "change health status" in "refine my search").

Contact the plan to make sure the doctors and hospitals that you want to use are covered and to find out what happens if you go outside the plan's network. Some plans charge higher co-payments for out-of-network doctors, and others don't provide coverage outside the network except for emergencies. You can also compare estimated costs for excellent, good and poor health at MedicareNewsWatch.com, a research firm that analyzes out-of-pocket costs and chooses a senior choice gold award plan in 70 cities.

For more information about choosing a Medicare Advantage or Part D prescription-drug plan during open enrollment this year, see 8 Steps for Picking Medicare Plans During Open Enrollment.

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