Missed Medicare Open Enrollment? Here Are You Options

If you missed Medicare open enrollment, breathe. Yes, December 7 was the deadline, but all is not lost. Depending on your coverage or why you missed the deadline, you may still have the opportunity to make changes that will impact your 2025 Medicare and Medicare Advantage medical coverage. If you moved or were caught in a natural disaster during the enrollment period, Medicare may grant you some wiggle room.

Open enrollment for Medicare runs every year from October 15 through December 7. If you fail to make or change an election by the deadline, you are mostly stuck with that election for the year. There are only limited opportunities for Original Medicare beneficiaries to make coverage changes after that period ends. It will typically depend on circumstances and if you qualify for the special enrollment period. Medicare Advantage beneficiaries who want to make changes are in a better position and have a second chance to review and alter their selections in 2025.

The annual open enrollment period and other opportunities to switch coverage are distinct from the initial enrollment period for people who are newly enrolling in Medicare. That initial enrollment period begins three months before a person’s 65th birthday and ends three months after it. This article will not address the impact and penalties associated with missing the initial enrollment period.

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If you missed Medicare open enrollment and you have Original Medicare

Medicare Open Enrollment, also known as the Annual Election Period (AEP), is the time for those with Original Medicare to either make changes to their Medicare Part D prescription drug coverage or switch to Medicare Advantage.

If you missed the Medicare open enrollment, which runs from October 15 to December 7 each year, you will be automatically re-enrolled in your current plan for the following year. Still, you may not be able to change your coverage unless you qualify for a Special Enrollment Period (SEP).

If you qualify for the SEP, you can only change your Part D coverage. You are not able to switch to a Medicare Advantage during a SEP. The Medicare site offers a Q&A on how to qualify for the special enrollment period to explain qualifying circumstances.

What is the Special Enrollment Period (SEP)? 

A Special Enrollment Period (SEP) is a time outside of the regular enrollment periods during which Medicare beneficiaries have an opportunity to enroll in or make changes to their Medicare coverage. SEPs are available to individuals who experience certain qualifying life events or meet specific criteria. You can make changes to your Medicare Advantage or Part D prescription drug coverage when certain events happen in your life, such as moving or losing other insurance coverage.

Qualifying life events for special enrollment include:

• You change where you live: You can switch to a new Medicare Advantage Plan or to Original Medicare and Part D drug plan if you move outside your plan’s service area. This rule also applies if you move to a new address in your plan's service area but have new plan options in your new location. 
• Loss of your current coverage: This refers to events such as losing Medicaid or employer-provided coverage, your existing coverage no longer qualifying as 'credible coverage or you if you enroll in a PACE plan.
• You have a chance to get other coverage: You opt to join a plan provided by your employer or union, enroll in other drug coverage as good as Medicare drug coverage (like TRICARE or VA coverage) or you enroll in a PACE plan
• Your plan changes its contract with Medicare: Your Medicare Advantage Plan or Medicare Part D drug plan is sanctioned or not renewed by Medicare
• Moving out of your plan’s service area: If you move out of your current Medicare Advantage (Part C) plan’s service area, you qualify for an SEP to enroll in a new Medicare Advantage plan or return to Original Medicare.
• Exceptional situations for a SEP. You may be eligible if you miss an enrollment period because of certain exceptional circumstances, like being impacted by a natural disaster or an emergency, incarceration, employer or health plan error, losing Medicaid coverage, or other circumstances outside of your control that Medicare determines to be exceptional

Special Enrollment Period for Medicare recipients affected by hurricane and wildfire damage. The SEP is available if you live in one of the listed FEMA-designated disaster areas. This type of extension is not automatic. You can apply for extra time using the Exceptional Circumstances SEP. You must attest to residing in — or moving from — areas affected by a disaster event.

Disaster impact on caregivers: If you rely on a caregiver, family member, or friend who lives in a disaster-affected area to help you make healthcare decisions, and they are unable to assist you, you can use the SEP to update your Medicare coverage.

The Medicare Advantage Open Enrollment Period (MAOPE)- January 1 to March 31

If you are currently enrolled in a Medicare Advantage plan and would like to switch to traditional Medicare or switch to another Medicare Advantage plan, you have a second chance to make changes to your 2025 Medicare elections..

The Medicare Advantage Open Enrollment period (MAOPE), which runs from January 1 through March 31, allows Medicare Advantage enrollees to switch between Advantage plans. During this period, you may also switch to or back to Original Medicare and enroll in a Part D prescription drug plan.

Bottom line

Your ability to make any changes after the December 7 deadline depends on whether you are currently have Original Medicare or Medicare Advantage and if there are extenuating circumstances that caused you to miss the cutoff.

Don't worry about seeing a doctor or filling a prescription, your Medicare coverage will continue uninterrupted despite missing the deadline. Your current insurance elections will be renewed automatically and there will be no gaps in your coverage.

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