What happens if you miss Medicare open enrollment?

If you missed Medicare Open Enrollment – which runs from October 15 to December 7 each year – you might be wondering whether there’s still any way to enroll or change your coverage without waiting another year.

The answer depends on a variety of factors, including the coverage you have, the Medicare plans that are available in your area, and certain life circumstances that you might experience.

Medicare open enrollment – also known as Medicare’s Annual Election Period – allows you to enroll in or drop a stand-alone Medicare Part D prescription drug plan (PDP), switch from one PDP to another, switch from Original Medicare to Medicare Advantage or vice versa, or switch from one Medicare Advantage plan to another. Any changes you make during open enrollment will take effect January 1.

Can I change my Medicare Advantage coverage if I missed Medicare open enrollment?

If you have a Medicare Advantage plan, but missed your opportunity to change your coverage during Medicare open enrollment, you’ve got another chance to make a plan change during the Medicare Advantage Open Enrollment Period (MAOEP), which runs from January 1 through March 31.

During that three-month period, you can make one plan change – either switching to a different Medicare Advantage plan or switching to Original Medicare. (In the latter case, you can also enroll in a PDP, but your eligibility to enroll in a Medicare supplemental insurance (Medigap) plan might depend on factors such as your medical history, where you live and how long you’ve been enrolled in Medicare Advantage.)

Read our overview of the Medicare Advantage Open Enrollment Period

Additionally, if there is a 5-star Medicare Advantage plan available in your area, you can switch to that plan at any time between December 8 and November 30.

Read our overview of Medicare star ratings.

Can I make Medicare Part D plan changes if I missed Medicare open enrollment?

After December 7, your opportunity to make changes to your PDP coverage tends to be quite limited. There is nothing comparable to the MAOEP for people who have Original Medicare plus stand-alone Medicare Part D coverage.

The 5-star special enrollment period applies to PDPs as well as Medicare Advantage plans. However, only two PDPs earned five stars for 2024, and they’re both employer-sponsored group plans that aren’t available to beneficiaries who aren’t affiliated with those groups.

If you’re enrolled in a PDP that is terminating on December 31 (which is the case for some people enrolled in PDPs in 2023), you qualify for a special enrollment period that continues through the last day of February.¹ And if you sign up for a replacement plan by December 31, your new plan will take effect January 1, meaning that you’ll have no gap in coverage.

But if your PDP is renewing for 2024 and you’re not eligible for a special enrollment period (addressed below), you’ll likely have to wait until next fall to switch to a different PDP that takes effect in 2025.

If you’ve realized that your PDP doesn’t adequately cover your medications, Medicare.gov has some tips for reducing your prescription costs, including Pharmaceutical Assistance Programs.

You can also check to see if you’re eligible for Extra Help, a program that caps how much you have to pay to fill prescriptions. If you qualify for Extra Help, you’ll have a quarterly opportunity to switch to a different plan. (Note that this plan change opportunity may not be available for enrollees who are considered at-risk for opioid abuse.) You can apply for Extra Help at any time during the year. And thanks to recent rule changes, more people are eligible for full Extra Help starting in 2024.

Could missing Medicare open enrollment result in a penalty?

Medicare open enrollment is an opportunity to sign up for Medicare Part D prescription drug coverage, so missing the enrollment window could result in a larger Part D late-enrollment penalty, since the penalty depends on the number of months you go without creditable drug coverage.

Since you generally won’t have an opportunity to sign up for Medicare Part D until the next open enrollment period, the number of months used to calculate your late-enrollment penalty will grow by 12 each year that you miss open enrollment. This makes it especially important to not miss the next Medicare open enrollment period.

Read our overview of the Medicare Part D late-enrollment penalty.

What makes you eligible for a special enrollment period for Medicare?

A variety of situations can trigger a special enrollment period for Medicare Advantage and/or PDPs for individuals. They include life changes like moving out of your plan’s coverage area, losing other coverage, or an enrollment decision (including non-enrollment) caused by a federal employee’s error.

If you think you might be eligible for a special enrollment period, you can call 1-800-MEDICARE to discuss the situation with a Medicare representative.

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 Medicare for medicareresources.org since 2013. Her coverage is regularly cited by media who cover the health insurance industry.

1. “CY2021 PDP Enrollment and Disenrollment Guidance” (Page 29) CMS.gov, Aug. 15, 2023 ⤶

Tags: Medicare open enrollment