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Can I still make changes to my Medicare coverage for 2021?

Q: Can I still make changes to my Medicare coverage for 2021?

A: For 2021 coverage, open enrollment (also known as the annual election period) for Medicare Advantage and Medicare Part D ended on December 7, 2020.

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Beneficiaries who are enrolled in Medicare Advantage have an additional opportunity to change coverage during the Medicare Advantage open enrollment period – from January 1 to March 31.

As of 2019, this window replaced the Medicare Advantage Disenrollment Period that was available in prior years. It lasts twice as long and provides more flexibility than the disenrollment period did, as it also allows Medicare Advantage enrollees the option to switch to a different Medicare Advantage plan.

In the past, the disenrollment period only allowed people to drop their Medicare Advantage plan and enroll in Original Medicare instead. You can still do that, but picking a different Medicare Advantage plan is now an option during the first quarter of the year.

In addition to those two enrollment windows, some Americans have other opportunities to enroll or make changes to their coverage:

Special enrollment period if you’re in an area affected by certain natural disasters

The federal government allows a special enrollment period, after the end of the general enrollment period, for people who live in (or rely on enrollment help from someone who lives in) an area that’s experienced a FEMA-declared major disaster or emergency. For 2021 coverage, there are several states and several partial states where this special enrollment period is available. Eligible enrollees who make a Medicare Advantage or Part D plan selection during this special enrollment period will have coverage effective January 1, 2021.

Five-star special enrollment

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 2021, there are a total of 28 plans that have a five-star rating. Most are Medicare Advantage plans, but the list includes two stand-alone Part D plans and two Medicare cost plans.

General Medicare enrollment for those who didn’t sign up when first eligible

From January 1 to March 31 each year, people who are eligible for Medicare Parts A and B but not yet enrolled can sign up for coverage. Coverage will take effect on July 1 of that year. If you didn’t sign up for Part B when you were first eligible and you haven’t had creditable coverage from an employer plan in the meantime, you’ll have to pay an additional premium for your Part B plan, as a late enrollment penalty.

If you sign up for Medicare during the general enrollment period, you have three additional months (April – June) during which you can select a Part D plan or a Medicare Advantage plan. And once you’re enrolled in Medicare Part B (and at least 65 years old), you’ll have a one-time enrollment window during which Medigap plans in your area are guaranteed-issue. In most states, Medigap plans will then be medically underwritten if you apply after that six-month window ends.

Special Needs Plans

If you develop a condition that makes you eligible for a Medicare Special Needs Plan (SNP) and an applicable SNP is available in your area, you can join it at any time, but once you join, your special enrollment period ends.

Dual-eligible enrollees

If you’re covered by both Medicare and Medicaid, you can switch plans at any time during 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.

Medigap

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.

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ROCHELLE MEDALIE
8 months ago

My husband and I both have Cigna Medicare Supplement with a significant monthly premium (I’m 68 and he is 71) but were told by Kaiser representative that we could switch to their plan at any time as they are 5 star. I’m not familiar with this as thought we had to wait for open enrollment. There is no monthly premium with Kaiser so we do want to switch. However, our Part D currently is with Humana and I’m thinking we’d have to switch everything at once but not sure. I just want everything to be legal! Please can you advise? Thank you, Rochelle Medalie

Josh Schultz
8 months ago

Hi Rochelle,

It sounds like the agent is encouraging you to enroll in a Medicare Advantage plan, and it is correct that you can enroll in a 5-Star Medicare Advantage plan at this time of year. If you enroll in Medicare Advantage, you would be leaving Original Medicare — and could only see medical providers who participate in that Kaiser plan. This article can help you compare these options: https://www.medicareresources.org/medicare-benefits/how-to-choose-between-medicare-advantage-medigap-and-part-d/

Also note that payments you’ve made toward your Part D (Humana) deductible or out-of-pocket spending limits would start over under the Kaiser plan’s prescription drug benefit.

-Josh

I need to add another drug to my drug plan this ye
6 months ago

I need to add another drug to my drug plan this year is that possible to do or do I have to wait for next year’s plan

Virginia L. Fox
4 months ago

My father’s insurance is not accepted at the hospital his urologist practices at can he change his insurance?

Editor
2 months ago
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