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Can I still change to a different 2024 Medicare Part D or Medicare Advantage plan?

Category: Changing Medicare plans
Published: Apr, 28 2024 03:04:10

In some cases.  Your prescription and healthcare needs or costs can change throughout the year and if you find that your current 2024 Medicare plan is no longer providing the most economical and comprehensive coverage, you may be able to use a Special Enrollment Period (SEP) to change Medicare Part D or Medicare Advantage plans outside of the annual Open Enrollment Period (AEP) or Medicare Advantage Open Enrollment Period (MAOEP).

Example question:  My Medicare plan is costing more than expected, can I change to a 5-star Medicare Advantage MAPD plan?

Yes, if a 5-star, plan is available in your area.  Medicare will provide you with a once-a-year opportunity to switch to any Medicare Part D or Medicare Advantage plan in your area that has achieved a 5-star quality rating.  Although these 5-star plans are not available everywhere, you can use our Medicare Advantage Plan Finder to learn whether there are any 5-star plans in your area – just look for the 5-star icon next to the plan name.

Remember:  Some 2024 Medicare Advantage plans also provide a Part B premium Giveback feature and when using the Medicare Advantage Plan Finder you can choose to see the amounts of 5-star Medicare Advantage Part B Givebacks, when available.

You can click here to read more tips when using the 5-star Special Enrollment Period.

Please note:  Unfortunately, in 2024, there are only employer/union (EGHP) 5-star stand-alone Medicare Part D plans (PDPs) and these plans are not available to the general public.  Please also note, people eligible for EGHP enrollment are provided an EGHP SEP when joining or leaving their EGHP.

Example Question:  If I qualify for both Medicare and Medicaid can I change my Medicare Part D plan at this time?

Yes.  If you are eligible for both Medicare and Medicaid, you are granted a Special Enrollment Period and can change Medicare plans once per quarter (once every 3 months) from January through September with coverage starting on the first day of the month after you enroll in a new plan.

If you are not qualified for full-Medicaid benefits, but still qualify for the Medicare Part D Low-Income Subsidy (LIS) or Extra Help program – you are also granted the same SEP.  You can click here to read more about the LIS or Dual-Eligible SEP.

Important:  Extra Help qualification limits have increased so you may now qualify for the Extra Help program.  Please click here for more information about the 2024 Federal Poverty Level (FPL) guidelines and Extra Help qualifications.

Example Question:  I don’t qualify for Extra Help and I can’t find a 5-star plan in my area, what other Special Enrollment Periods can people use to change Medicare plans during this time of year?

Relocation SEP:  One of the most common Special Enrollment Periods is available to people who move out of their Medicare plan’s “service area” during the year.  The service area for a stand-alone Medicare Part D PDP is a state or multi-state area and the service area for a Medicare Advantage plan (MA or MAPD) is a county, partial-county, or ZIP code area.

For example, if you are enrolled in a New York Medicare Part D plan (PDP) and move to Florida, you will be granted an SEP to join a Medicare Part D or Medicare Advantage plan that is available in your new state.  Likewise, if you are enrolled in a Medicare Advantage plan in Allegheny County, Pennsylvania and move across Pennsylvania to Delaware County, you will be granted a Special Enrollment Period to join a Medicare Part D plan or Medicare Advantage plan found in your new county.

Important:  When you move to another service area, you may not find the same Medicare Part D or Medicare Advantage plans – and even plans with the same name may not provide the same coverage as the plan in your previous location.  Please be sure to carefully evaluate your plan options before enrolling.

Long-term Care SEP:  Another popular Special Enrollment Period is available to people moving into, or out of, a long-term care (LTC) facility.  

For more SEPs:  Please click here for a list of other popular Special Enrollment Periods.

Example Question:  If my Medicare Advantage plan changes my healthcare provider network, will I be granted an SEP to change to a 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.

Example 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.

Example Question:  If I now receive all of my medications through the VA, can I disenroll from my Medicare Part D plan?

Yes.  If you are qualified to receive VA or TRICARE drug benefits, you are granted a Special Enrollment Period and allowed to disenroll from your Medicare Part D plan outside of the annual Open Enrollment Period (AEP).  And since your VA (or TRICARE) prescription drug benefits are considered “creditable” drug coverage, you will not incur a late-enrollment penalty if you decide to someday re-enroll in a Part D plan.  You can click here to read more about disenrollment outside of the AEP when you have creditable drug coverage.

Example Question:  Where can I learn more about other Special Enrollment Periods?

For more information about different SEPs that may be available to you, contact a Medicare representative at 1-800-633-4227 or a local SHIP representative.  If you find an applicable SEP, a Medicare representative can also process your plan change using the Special Enrollment Period over the telephone.

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