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My new Medicare Part D coverage is much more expensive than last year. Can I still change to another Medicare Part D prescription drug plan after the AEP closes?



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Question: My new Medicare Part D coverage is much more expensive than last year. Can I still change to another Medicare Part D prescription drug plan after the AEP closes?
Category: Changing Medicare Part D Plans

Answer: Maybe, depending on your situation.  Most people cannot change their Medicare Part D plan coverage after the December 7th Annual Enrollment Period (AEP) deadline.  However, if you qualify for a Special Enrollment Period (SEP), you can change your Medicare Part D or Medicare Advantage plan during the plan year and outside of the AEP.

You may qualify for an SEP for a number of reasons, some common examples include:
  • Moving to another 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).

  • LTC.  If you move into (or out of) a Long-Term Care (LTC) facility.

  • Sanctioned plans.  If you are enrolled in a sanctioned Medicare plan (see SEP for sanctioned plans), you may qualify for an SEP. To learn more and see if you qualify for this particular SEP, you will need to contact Medicare at 1-800-633-4227.

  • No longer incarcerated.  If you were incarcerated, you will be granted a Special Enrollment Period upon your release to join a Medicare plan in your new area of residence.

  • Eligible for Extra-Help.  If you are eligible for the low-income subsidy (LIS) or the Medicare Part D Extra-Help program, you can change your Medicare Part D prescription drug coverage at any time during the plan year.

  • Low-performing plans.  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.

  • 5-Star plans.  You also have the once-a-year opportunity to join a Medicare plan with a “5-Star” quality rating at any time during the year.  (Unfortunately, 5-Star rated Medicare plans are not available in many areas.)  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.

  • False or misleading information.  Depending on your circumstances, you may be granted a Special Enrollment Period if you were provided false or misleading information when enrolling into your plan. To learn more and see if you qualify for this particular SEP, you will need to contact Medicare at 1-800-633-4227.

  • MADP.  Although not an SEP, the Medicare Advantage Disenrollment Period (MADP) is available beginning on January 1st and continued through February 14th of each year. During the MADP you can leave your Medicare Advantage plan and return to Original Medicare Part A and Part B - along with the option to enroll in a stand-alone Medicare Part D prescription drug planUpdate: Please note that the MADP will no longer be available after 2018 and the MADP will be replaced with the Medicare Advantage plan Open Enrollment Period (OEP).

  • OEP.  Starting in 2019, the Medicare Advantage plan Open Enrollment Period (OEP) that will begin January 1st and continue through March 31st.  During the OEP, you will be allowed to change or drop your Medicare Advantage plan (MA/MAPD), return to original Medicare Part A and Part B, and join a stand-alone Medicare Part D plan.



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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.