Medicare special enrollment periods
Medicare special enrollment periods are available due to various circumstances, with differing rules for Medicare Part B (and premium Part A) versus Medicare Advantage and Medicare Part D.
If you experience one of the qualifying life events that triggers a special enrollment period, you may be able to enroll in Medicare without a late enrollment penalty and without having to wait until the next General Enrollment Period. Or if you already have private Medicare coverage, you may find that you have an opportunity to make a plan change due to the qualifying event.
If you’re unsure of your eligibility for a special enrollment period, you can call 1-800-MEDICARE to discuss the issue with a Medicare representative.
What is the 5-star special enrollment period?
If there’s a Medicare Advantage or Medicare Part D plan in your area that has earned the government’s 5-star (excellent) rating, you’re allowed to switch onto that plan anytime between December 8 and November 30. This is called the 5-star special enrollment period, and you’re allowed to utilize it one time during that period.
For 2024, there are a total of 36 Medicare contracts nationwide that received a 5-star rating. Three are Medicare cost plans and 31 are Medicare Advantage plans with integrated Part D prescription coverage (MA-PDs). The other two are employer group Part D plans that can’t be purchased by individuals (see Tables A1, A2, and A3 here for details about the plans that received 5-star ratings for 2024).
If I am a dual eligible, when can I make changes to my Medicare coverage?
If you’re covered by both Medicare and Medicaid, you can switch plans up to once per quarter during the first three quarters of the year, and you also have access to the regular Open Enrollment Period in the fourth quarter of the year. This applies to Medicare Advantage as well as Medicare Part D.
Note that there are SNPs designed for people who are dual-eligible for Medicaid and Medicare, and there are also SNPs for people who are institutionalized.
When can I enroll in a Medigap plan?
You can apply for a Medicare supplemental insurance (Medigap) plan at any time during the year. If you’re within the six-month open enrollment window that begins as soon as you’re at least 65 and enrolled in Medicare Part B, the coverage is guaranteed issue. That is also the case if you’re in a special enrollment period triggered by a qualifying event. (Be aware that not all of the special enrollment periods for Medicare Advantage or Medicare Part D apply to Medigap plans).
You can still apply for a Medigap plan outside of open/special enrollment periods; just be aware that in most states, the carrier will use medical underwriting to determine whether to accept your application, and how much to charge you.
Some states have created annual windows during which enrollees can switch to a different Medigap plan without medical underwriting, but this is the exception rather than the rule; federal law does not grant any sort of annual open enrollment period for Medigap plans (you can click on your state on this map to see how Medigap plans are regulated).
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
Footnotes
Tags: disenrollment, dual-eligibility, five-star rating, Medicare Part C, Medicare Part D, plan changes, special enrollment period
