What to do if you miss Open Enrollment

Medicare’s annual open enrollment period runs from October 15 to December 7 every year. During this time, you can freely switch from Original Medicare to Medicare Advantage, or from Medicare Advantage to Original Medicare. You can also change your Medicare Advantage or Prescription Drug plan. Additionally, you can enroll in a Part D Prescription Drug plan if you didn’t when you became eligible, although late enrollment penalties can apply.

Open enrollment is a great time to change to a Medicare plan that better meets your needs. But what happens if you miss open enrollment for health insurance? Don’t worry. We’re here to help.

Act During The Medicare Advantage Disenrollment Period

Depending on what you wanted to do during open enrollment, you may still be able to achieve it during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14. During this period, you can:

  • Change from a Medicare Advantage plan to the Original Medicare plan
  • Enroll in a standalone Prescription Drug Plan

Just note that you will lose some benefits by unenrolling from Medicare Advantage. For example, you may no longer have a cap on out-of-pocket expenses for Medicare-approved health care costs.

Investigate Medigap Plan Open Enrollment Periods

People commonly switch from Original Medicare to Medicare Advantage during the open enrollment period for better coverage. While this option is off the table outside the open enrollment period, you might be able to find a Medigap plan that provides the coverage you really need in the interim.

Medigap has its own open enrollment periods, which vary from state to state. Some periods also depend on certain circumstances. For example, in California you can get a Medigap plan without underwriting within six months of losing Medi-Cal benefits, getting fired, retiring, losing your military health coverage, or moving outside your Medigap Benefits area. Consult your local State Health Insurance Assistance Program to see whether you could enroll in a Medigap plan or change your existing one.

See Whether You Qualify For A Special Needs Plan

People typically want to change health care plans to get a plan that better meets their medical needs. You might be able to do this at any time if you qualify for a Special Needs Plan.

Special Needs Plans are Medicare Advantage plans that cater to people with certain health conditions. These include:

  • Chronic alcohol or drug dependence
  • An autoimmune disorder, such as lupus
  • Chronic heart failure
  • Diabetes mellitus
  • End-stage renal disease needing dialysis
  • HIV or AIDS

Call 1-800-MEDICARE (1-877-486-2048) or your local State Health Insurance Assistance Program to learn whether you could qualify for a Special Needs Plan.

You can enroll in a Special Needs Plan by mailing a paper application to the plan or via the Medicare website or hotline. Some plans also have online enrollment.

Speak With Your Doctor About Changing Your Drugs

Many people change plans during the open enrollment period because their current plan doesn’t cover the drugs they take. If you can’t change your plan, consider changing your drugs.

You should never make this decision without medical advice. But the Medicare Modernization Act requires every plan with prescription drug coverage to cover at least two drugs in any drug class and category. This means that there’s probably something that could treat your condition just as well as your existing medication at less cost to you. Speak to your doctor about alternatives and make the switch under his or her care.

Do you have friends or family members who missed open enrollment? Share this article with them so they can get their own Medicare plans sorted.