Maybe, depending on your situation.  Most people cannot change their stand-alone Medicare Part D plan coverage after the December 7th annual Open Enrollment Period (AEP) deadline.  And Medicare Advantage plan members usually cannot change their Medicare plans after the March 31 close of the Medicare Advantage Open Enrollment Period (MAOEP).  However, if you qualify for a Special Enrollment Period (SEP), you will be allowed to change your Medicare Part D or Medicare Advantage plan during the plan year - even when outside of the AEP or MAOEP.

You may qualify for a Special Enrollment Period for a number of reasons, some common examples include:

• SEP if you are eligible for Extra-Help or the Medicare Part D Low-Income Subsidy or Medicaid eligible.
  If you are dual Medicare/Medicaid or eligible for the Medicare Part D low-income subsidy (LIS) or Extra-Help program, you can change your Medicare Part D prescription drug coverage once per quarter during the first nine months of the year (January through September).
  
  Important:  Extra Help qualification limits change each year (usually increasing), so you may now qualify for the Extra Help program - even if you did not qualify last year or even at the beginning of the year.  Please click here for more information about the 2024 Federal Poverty Level (FPL) guidelines and Extra Help qualifications.
  
  
• SEP if you are currently enrolled in a consistently low-performing Medicare plan.
  If you are enrolled in a consistently low-performing Medicare Part D or Medicare Advantage plan (a plan with consistently low quality ratings), you may qualify for an SEP and be able to change plans once, at any time during the plan year.   The number of low-performing Medicare plans changes each year and often there are no consistently low-performing plans in a given year.
  
  
• SEP if you wish to enroll into a 5-Star Medicare plan.
  You have the once-a-year opportunity to join a Medicare plan with a “5-Star” quality rating at any time during the year - even if you are already enrolled in a 5-Star Medicare plan.  Unfortunately, 5-Star rated Medicare plans are not available in all areas across the country - you will need to check for availability.  As a reminder, you are allowed to use the 5-Star SEP even if you are already enrolled in a 5-Start Medicare plan and wish to move to another 5-Star plan.
  
  Important: If you switch to a "5-Star" Medicare Part D prescription drug plan (a plan that only provides drug coverage – PDP) from your current Medicare Advantage plan with prescription drug coverage (health and drug benefits – MAPD), you would be automatically dis-enrolled from your Medicare Advantage plan and would return back to your Original Medicare Part A and B coverage along with your new “5-Star” prescription drug plan.
  
  You can click here to read more about using the 5-star Special Enrollment Period.
  
  
• SEP if you are moving out of your plan's Service Area.
  If you move out of your Medicare plan’s Service Area - you will be granted an SEP to join a Medicare plan in your new Service Area.  (Your Medicare Part D plan's Service Area is a State or multi-State area - your Medicare Advantage plan's Service Area is a county, partial-county, or ZIP Code area).  For example, if you live in California and move to Florida, you would be granted an SEP to join a Medicare plan (Medicare Part D or Medicare Advantage plan) that is available in your county or ZIP Code region.  If you are enrolled in a Medicare Advantage plan while living in Saint Johns County, Florida and you move to Lake County, Florida - you will be allowed to join a Medicare Advantage plan that is available in Lake County.  But if you are enrolled in a Medicare Part D plan and you move to another Florida county, you will not qualify for an SEP since you still live within your Medicare plan's Service Area (the state of Florida).
  

Question:  If my Medicare Advantage plan changes my healthcare provider network, will I be granted a Special Enrollment Period to change to a health plan that includes my doctor?

Maybe.  Your Medicare Advantage plan can change their healthcare provider network throughout the plan year.  However, your Medicare Advantage plan should make an effort to contact you if one of your doctors is no longer included in the plan’s network and help you find an alternative provider.  If you are outside of the MAOEP, and your Medicare Advantage plan makes “significant” changes to their provider network, Medicare may provide you with a Special Enrollment Period to change your plan.  However, this SEP is not automatically granted when a single provider leaves a Medicare Advantage plan network.


Question:  Am I granted a Special Enrollment Period to change plans if my Part D plan dropped my only brand name drug and substituted coverage for a generic drug?

No.  Medicare Part D plans are allowed to make changes to the plan’s formulary throughout the plan year – both adding and removing medications.  Typically, Medicare Part D plans must continue covering a medication that is dropped from the plan’s formulary until the end of the plan year for anyone who is already receiving benefits for that particular medication.  However, replacing a brand-name medication with a generic equivalent is one of the few Medicare allowable reasons for dropping a medication mid-year and there is no SEP specifically for drugs being dropped from your formulary.