As of 2022, statistics showed that 48 percent of all eligible Medicare beneficiaries (over 28 million individuals) were getting their health care coverage from a Medicare Advantage (Part C) plan.
Medicare Advantage plans are sold by private insurance companies as an alternative to Original Medicare Parts A and B. They provide at least the same coverage as Parts A and B. Today, most Medicare Advantage plans also include prescription drug (Part D) coverage as well as extra benefits like dental, hearing, and vision care.
When you’re eligible for Medicare, you have the option of enrolling in Original Medicare or in a Medicare Advantage (Part C) plan to get your health care coverage. And, fortunately, Medicare also provides annual opportunities to change from one plan to another if you need to, so here’s a look at when you can do that.
When can you switch Medicare Advantage plans?
If you’re enrolled in a Medicare Advantage plan and you’d like to make changes to your coverage, you can do so during the following Medicare enrollment periods:
- The Open Enrollment Period (OEP) runs from October 15 to December 7 every year. During this period, you can join, drop, or switch to a different Medicare Advantage plan, add or drop drug coverage, or switch from Original Medicare to a Medicare Advantage plan. Any changes you make during this period take effect on January 1st.
- The Medicare Advantage Open Enrollment Period (MA-OEP) which runs from January 1 to March 31 annually. During the MA-OEP, you can switch from one Medicare Advantage plan to another (with or without drug coverage), drop your Medicare Advantage plan and return to Original Medicare, and join a stand-alone Medicare prescription drug (Part D) plan if you go back to Original Medicare. Any coverage changes made during this enrollment period go into effect on the first of the month after enrollment.
- Special Enrollment Periods may be available when certain situations arise, such as moving to a new service area, losing your current coverage, or becoming eligible for Medicaid or Extra Help programs. In most instances, Medicare allows you to join a Medicare Advantage plan or switch from one Part C plan to another. Your new coverage typically takes effect on the first of the month after enrollment, but this may depend on your circumstances.
If you enroll in a Medicare Advantage plan during your Initial Enrollment Period with Medicare, you have the right to switch to a different Medicare Advantage plan (with or without prescription drug coverage) within the first three months if you have Original Medicare Parts A and B.
What are some common reasons for switching Medicare Advantage plans?
Medicare Advantage plans are required by federal law to provide at a minimum all the benefits that Original Medicare Parts A (hospital insurance) and B (medical insurance) provide. Most Part C plans available today also include prescription drug coverage. Depending on the type of Medicare Advantage plan you enroll in, you might find that you need different coverage options later.
Some of the most common reasons you might have for changing plans include the following:
- Your preferred health care providers aren’t in the plan’s network.
- You need prescription drug coverage and don’t have it, your current plan doesn’t include your drugs in its formulary, or your medications have gotten too expensive.
- You find a more economical alternative.
- Your medical needs have changed, and you need a plan with more suitable coverage.
- You want more options regarding health care providers and medical facilities.
- Your maximum out-of-pocket costs are too high.
- Your life situation has changed.
If you are considering changing your Medicare Advantage plan, you should explore all options available in your area before the enrollment period begins, so you get the right coverage for your health care needs.