8 Life Changes That Allow You to Change Medicare Plans Outside of Open Enrollment
Each year, the Medicare Open Enrollment period runs from October 15 to December 7. Anyone who qualifies for Medicare can make changes to their coverage during this time, and they will go into effect on January 1 of the following year. But life can sometimes throw unexpected obstacles your way, and you may find yourself in a position where your health plan no longer suits your needs.
Insurance jargon is confusing, and with the added pressure of being locked into a health plan for an entire year, choosing the right Medicare coverage can feel overwhelming. Maybe you realized after the Open Enrollment period that you haven't signed up for a prescription drug plan (part D plan), or you might've discovered that your primary healthcare provider is not in your plan's network. If you are in a similar position and feel stuck, don't let it dishearten you. Qualifying participants are eligible to change their Medicare plans outside the Open Enrollment period.
When can you change your Medicare coverage after Open Enrollment?
Participants have two opportunities to reevaluate their coverage options. We'll discuss both options, what dates they take place, and who is eligible to apply. The two plans are:
Medicare Advantage Open Enrollment period
The Medicare Advantage Open Enrollment Period is between January 1 and March 31 of each year. You must already be enrolled in the Advantage plan to participate in the enrollment period. If you are enrolled, you can choose to either switch to another Medicare Advantage plan, revert to the original Medicare plan, or choose a prescription drug Part D plan.
Special Open Enrollment Period for qualifying life events (QLE)
If you aren't qualified to adjust your health plan during the Medicare Advantage Open Enrollment period, don't fret just yet! Certain life events qualify you to change your Medicare plan during the Medicare Special Enrollment Period, which lasts for 60 days from the date of your qualifying life event. So, if you apply for the Special Open Enrollment Period and get approved on January 1, you'll have until March 1 to make changes to your health plan.
If you are eligible for a Special Enrollment Period, you can either switch to a Medicare Advantage plan, join the Original Medicare plan, or enroll in a Part D plan.
What are the eight qualifying life events (QLE)?
The following events will qualify you for a Special Enrollment period.
1. There are changes in your household
If you, or anyone in your household, is getting married or divorced, is giving birth to or adopting a child, or there was a death in the family, you may be eligible to change your medicare plan outside of Annual Open Enrollment.
2. Loss of health coverage in your household
If you, or anyone in your household, lost health insurance coverage either in the last 60 days or expects to lose coverage in the next 60 days, you may qualify for a Special Enrollment Period. Loss of health insurance coverage includes:
• Turning 26 and becoming too old to be eligible as your parent's beneficiary
• Suddenly losing eligibility for Medicare, Medicaid, or Children's Health Insurance Program (CHIP)
• Losing your job insurance, individual insurance, or student insurance
3. Your employer offers to cover the cost of your insurance
If your employer offers you, or anyone in your household, the following coverages, you may be eligible.
• Individual coverage health reimbursement arrangement (HRA), or ICHRA
• Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)
4. Change of location
The following scenarios may qualify you for a Special Enrollment Period:
• You move to either a different ZIP code or county
• You're a student moving to or from the area you attend school
• You're a seasonal worker moving to or from the area you work or live
• You move to or from a shelter or other temporary emergency housing
5. Your income changes
If a sudden increase or decrease in your income affects your current Medicare health plan eligibility, you could qualify for a Special Enrollment Period.
6. You've become a U.S. Citizen
If you have just become a U.S. citizen and qualify for Medicare, you'll have the opportunity to review your coverage options and find a Medicare plan that best suits you.
7. You've been released from prison
Prisoners who are preparing for their release date and who are eligible for Medicare may be qualified for a Special Enrollment Period.
8. Other qualifying events
• Starting or ending your volunteer service as an AmeriCorps, VISTA, or NCCC member
• Becoming a member of a federally recognized tribe
• Becoming a shareholder in the Alaska Native Claims Settlement Act (ANCSA) Corporation
Selecting the most suitable healthcare plan can be a stressful situation, but knowing the eight factors above will help you make an informative decision.
Sources: Medicare.gov
