What Happens if You Miss Medicare Open Enrollment?
Last Updated : 08/13/20185 min read
The Medicare Open Enrollment Period is also known as the Annual Election Period (AEP) for Medicare health and prescription drug plans. It’s also called the Fall Open Enrollment Period. This time period happens only once a year. If you miss the Medicare Open Enrollment Period, here’s what it means and what you might be able to do.
Medicare Open Enrollment: some background
The Medicare Open Enrollment Period is usually a good time to take a close look at your current Medicare coverage. Does it cover your prescriptions? Can you afford the plan’s costs? Is your favorite Medicare doctor part of the plan’s provider network?
The Medicare Fall Open Enrollment Period is different from most of the enrollment periods for Medicare Part A and Part B. The Medicare Open Enrollment Period lets you add, change, or drop Medicare Advantage plans or stand-alone Medicare Prescription Drug Plans. You can make certain other changes then, too.
It’s important to know that if you’re looking at a Medicare Advantage plan or Medicare prescription drug coverage, you generally can’t enroll, switch plans, or drop plans anytime you want. When you’re first eligible for Medicare, you can usually enroll in a Medicare Advantage plan or a stand-alone Medicare Part D Prescription Drug Plan. But once your Medicare Initial Enrollment Period is over, the Medicare Open Enrollment Period is your main chance to get one of these plans.
When is Medicare Open Enrollment and what changes can you make?
The Medicare Open Enrollment Period runs from October 15 through December 7 every year. This is the time when you can typically make these changes to your Medicare coverage:
- Sign up for a Medicare Advantage plan
- Change from one Medicare Advantage plan to another (whether or not the plans include prescription drug coverage)
- Drop your Medicare Advantage plan and return to Original Medicare, Part A and Part B
- Enroll in a stand-alone Medicare Part D Prescription Drug Plan*
- Change from one stand-alone Medicare Part D Prescription Drug Plan to another
- Drop your stand-alone Medicare Part D Prescription Drug Plan
*You generally can’t enroll in both a stand-alone Medicare Part D Prescription Drug Plan and a Medicare Advantage Prescription Drug plan.
What if you miss the Medicare Open Enrollment
If you miss the Medicare Open Enrollment Period, you might still be able to make Medicare coverage changes without waiting until next year. Here are some examples.
Enroll in a 5-star plan
Medicare rates certain types of plans by assigning one through five stars, based on information it collects from member satisfaction surveys, health-care providers, and the plans themselves. Five stars is the highest rating.
You can typically get a Special Enrollment Period to sign up for (or switch to) a 5-star plan once between December 8 one year and November 30 the next year if one is available in your area. That’s a nearly yearlong window of opportunity every year.
The 5-star Special Enrollment Period applies to Medicare Advantage plans, stand-alone Medicare Part D Prescription Drug Plans, and Medicare Cost Plans.
Qualify for other Special Enrollment Periods
There are several situations where you may be able to make coverage changes outside the Medicare Open Enrollment Period by qualifying for a Special Enrollment Period (SEP). Most of these situations involve losing your health-care coverage in one way or another. Here are a few examples of situations that might make you eligible for a Special Enrollment Period to sign up for a Medicare health or prescription drug plan, or change plans.
- You moved out of your plan’s service area.
- You moved into, out of, or still live in a skilled nursing facility, or another institution such as a long-term care hospital.
- You left your employer-based or union-based health insurance.
- You used to be eligible for Medicaid, but now you’re not.
- You just got out of jail.
- You’re moving back to the United States after living outside the country.
- Your plan is losing or ending its contract with Medicare.
Remember, these are just examples. If you experience any major changes to your plan, your coverage, or even your health, it might be worth checking with Medicare to see if you may qualify for a Special Enrollment Period to change your coverage.
You can reach a Medicare representative at the number shown at the bottom of this page.
Different SEPs may last for different amounts of time. In many cases, you’ll have at least two months to make the change, but it does depend on your circumstances.
Switch from one Medicare Advantage plan to another, or drop your Medicare Advantage plan and return to Original Medicare
You can do this between January 1 and March 31. However, you can generally make a change during this period only once. If you drop your Medicare Advantage plan, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan during this time period.
Get ready for Medicare Open Enrollment! Would you like to see a list of plans in your area right away? Just click the Find Plans or button on this page. You can arrange a phone call with me, or have me send you an email – just follow the links below.