Medicare coverage is not necessarily a once-and-done decision. Your health needs, prescriptions, doctors, budget, and the plans available where you live can change from year to year. The important part is knowing when Medicare allows you to make a change—and what choices are available during each enrollment period.

The Annual Enrollment Period

The Medicare Annual Enrollment Period (AEP) runs each year from October 15 through December 7. This is the broadest annual opportunity for people who already have Medicare to review and change their health or prescription drug coverage. Changes made during this period generally take effect on January 1 of the following year.

During the Annual Enrollment Period, you may be able to:

• Switch from one Medicare Advantage plan to another.
• Move from Original Medicare to a Medicare Advantage plan.
• Leave Medicare Advantage and return to Original Medicare.
• Join, switch, or drop a stand-alone Medicare Part D prescription drug plan if you have Original Medicare.
• Change between Medicare Advantage plans with or without drug coverage.

Even if you are satisfied with your current plan, it is wise to review the Annual Notice of Change sent by your plan. Premiums, copayments, formularies, pharmacy networks, provider networks, and extra benefits may change for the next plan year.

The Medicare Advantage Open Enrollment Period

If you are already enrolled in a Medicare Advantage plan, another opportunity runs from January 1 through March 31. During this period, you may make one change:

• Switch to a different Medicare Advantage plan, with or without prescription drug coverage; or
• Leave Medicare Advantage and return to Original Medicare. If you do, you may also join a separate Part D drug plan.

This period is only for people who are already enrolled in Medicare Advantage. It cannot be used to move from Original Medicare into Medicare Advantage, or to switch from one stand-alone Part D plan to another while remaining in Original Medicare. A change generally takes effect on the first day of the month after the new plan receives your request.

Special Enrollment Periods

Certain life events may qualify you for a Special Enrollment Period outside the usual annual windows. The actions you can take and the amount of time you have depend on the event. Examples may include:

• Moving outside your plan’s service area or to a location with new plan choices.
• Losing employer, union, Medicaid, or other qualifying coverage.
• Moving into, living in, or leaving an institution such as a nursing home.
• Your plan ending its Medicare contract or no longer serving your area.
• Qualifying for Extra Help with prescription drug costs.
• Joining a plan based on misleading or incorrect information in certain circumstances.

Special Enrollment Period rules are detailed and time-sensitive. Before making a change, confirm which enrollment opportunity applies to you and when the new coverage will begin.

What About Medicare Supplement Insurance?

Medicare Supplement Insurance, also called Medigap, follows different rules from Medicare Advantage and Part D. Your six-month Medigap Open Enrollment Period generally begins when you are 65 or older and enrolled in Medicare Part B. Outside that period, an insurer may be allowed to use medical underwriting, charge more, or decline an application unless you have a guaranteed-issue right under federal or state law.

If you are considering leaving Medicare Advantage for Original Medicare and want Medigap, check your eligibility before making the change. Do not assume that a Medigap policy will automatically be available after you leave your current plan.

Review More Than the Monthly Premium

Before changing plans, compare the total picture: your doctors and hospitals, prescription formulary and pharmacy network, premiums, deductibles, copayments, coinsurance, prior-authorization rules, maximum out-of-pocket limit, and any additional benefits. A plan with a low premium is not always the lowest-cost option for your particular needs.

For official enrollment details, visit Medicare.gov’s plan-change information and its guide to Special Enrollment Periods.

Need Help Reviewing Your Medicare Options?

I’m available to help you compare plan costs, provider access, prescription coverage, and enrollment timing based on your individual situation.

Joseph V. Lombardo
Independent Insurance Agent
📞 (718) 207-9276
✉️ jvlombardo@jvlombfinancial.com
🌐 jvlombardo.com

There is no obligation to enroll. Plan availability, premiums, benefits, networks, and costs vary by location and plan. This information is for educational purposes and is not a complete description of Medicare coverage. Enrollment rules and eligibility depend on individual circumstances.