Making decisions isn't always easy. Although you might have all of the pertinent information about your options, you can still make the wrong choice because what looked good on paper isn't always quite the same in reality.
That's why Medicare offers beneficiaries the opportunity for a do‑over when it comes to choosing a Medicare private health or drug plan. However, such changes can generally only be made during specific enrollment periods, with a few limited exceptions.
Everyone is permitted to change health plans once between January 1 and March 31 each year during the Open Enrollment Period. New health plan coverage typically starts on the first of the month after you make your selection.
If you are comparing other coverage types, see Long Term Care Insurance for additional information about long‑term care options and how they differ from Medicare plan choices.
You are not allowed to add or drop Medicare private plan drug coverage during the January through March enrollment period. The annual enrollment window for drug plans occurs later in the year; exact dates can vary, so confirm current deadlines with official Medicare resources. Be aware that your drug coverage might change as a result of changing your health plan.
Exceptions that allow changes outside enrollment
- Beneficiaries who receive federal assistance to help pay for the Medicare drug benefit, and those who live in qualifying institutional facilities, can change both health and drug plans once a month.
- New members of a Medicare private drug plan who find the plan does not cover a medicine they've been taking can use the plan's transition policy. Drug plans must provide new members with at least a 30‑day supply of any drug they were taking before they joined, as long as the drug is not explicitly excluded by law from Medicare coverage.
To continue receiving a medication during a coverage change, ask your health care provider to request that your plan cover the drug for you through an exception. If a plan denies your exception request, you have the right to appeal that decision.
More special situations
- Members who discover that their Medicare prescription drug plan has changed the drugs it covers can ask for an exception. If you are already taking a medication through the plan, it should continue to be covered until the end of the calendar year, but your doctor must request an exception if you need coverage beyond that time.
- If you were enrolled in a Medicare private health or drug plan by mistake, or were deliberately misled, you can use a Special Enrollment Period to change your plan; call 1‑800‑MEDICARE for assistance.
For more information about changing health and drug plans, drug transition and exception policies, and Special Enrollment Periods, contact the Medicare Rights Center or visit its website. You can also review Difference in Conditions (DIC) Insurance if you are evaluating other policy types, or talk to an agent about how plan changes might affect your coverage.
Frequently Asked Questions
Can I switch Medicare Advantage plans outside the January–March Open Enrollment Period?
Generally no, unless you qualify for a Special Enrollment Period or another exception such as receiving certain types of financial assistance.
What happens to my prescriptions if I change health plans?
Your drug coverage may change when you switch plans; ask your provider about transition policies and request an exception if needed.
If my plan denies an exception for a drug, what can I do?
You have the right to appeal the plan's decision and should follow the plan's appeals process promptly.