If you’re feeling like your current coverage isn't the right fit, you aren't necessarily stuck. While the standard Medicare Advantage Open Enrollment Period (January 1-March 31) is the most common time to make a move, you can change Medicare Advantage plans after this window if you qualify for a Special Enrollment Period (SEP).
Common triggers for a mid-year switch include moving to a new address, losing employer coverage, or qualifying for "Extra Help." Beyond these legal windows, you should consider switching if your primary doctor leaves the network or your prescription costs increase unexpectedly.
Four Signs You Should Consider Switching Plans
Many individuals can feel locked into a plan that no longer serves them. There are four situations that suggest it’s time to look for a better option.
1. Your Healthcare Needs Have Changed
Life happens. If you’ve received a new diagnosis or have a major surgery on the horizon, a plan that worked last year might not work now. It may be time to find plans with a lower maximum out-of-pocket (MOOP) limit to protect your savings from high medical bills.
2. Your Doctor or Hospital Left the Network
It can be frustrating to find out your trusted physician is no longer in-network. Because Medicare Advantage plans use specific provider networks, a change in their contracts can leave you paying higher out-of-network rates. If your provider leaves, it’s a clear signal to re-evaluate your coverage.
3. Your Prescription Drug Costs Have Spiked
Plan formularies—the list of covered drugs—can change. A medication that was a tier 2 preferred drug last year might jump to tier 4 this year, significantly increasing your copay. If your pharmacy costs have spiked mid-year, it’s a good idea to compare plan formularies to find a more affordable alternative.
4. You Aren’t Using Your "Extras"
Many plans offer dental, vision, or gym memberships. However, if you aren't using these perks but are paying higher copays for your actual doctor visits, the trade-off might not be worth it. You can find a plan that prioritizes the care you actually use.
Can you change Medicare plans after Open Enrollment?
Many people worry about the "lock-in” rule. This is a real term used by to describe the period outside of open enrollment when you generally must stay in your chosen plan. However, this "lock" has several keys.
Understanding the Enrollment Deadlines
The Medicare Annual Enrollment Period (October 15-December 7) is when anyone can make a change. Then, from January 1 to March 31, the Medicare Advantage Open Enrollment Period allows for a one-time switch. If you miss these, you'll need a specific reason to make a change.
The Special Enrollment Period (SEP)
A Special Enrollment Period isn't a loophole so much as a safety net. Life events allow for mid-year changes, so you aren't left without accessible care. It’s important to note that SEPs require a "qualifying life event" and aren't guaranteed for everyone at all times.
Qualifying Life Events: Your Ticket to a Mid-Year Switch
If you experience one of the following events, you usually have a 60-day window to make a change. We have a detailed guide on qualifying life events if you want to dive deeper into the specifics.
Moving Your Primary Residence
You typically qualify for an SEP if you move to a new ZIP code that isn't in your current plan’s service area, or if you move to an area with new plan options that weren't available before.
Changes in Eligibility
If you suddenly qualify for Medicaid or "Extra Help" (also known as the low-income subsidy), or if you lose that eligibility, you can change your plan. These programs help pay for Medicare costs, and a change in status means your coverage needs to be updated.
Institutional Changes
Moving into or out of a skilled nursing facility or long-term care hospital triggers an enrollment window. This ensures your coverage follows you to the level of care you need.
The 5-Star Plan Exception
Medicare rates plans every year. If a 5-star-rated plan is available in your area, Medicare allows you to switch into that plan once per year between December 8 and November 30.
The Medigap Trial Right
If you recently joined a Medicare Advantage plan for the first time and find yourself missing the flexibility of Original Medicare, you might have "buyer's remorse." There's a 12-month trial window. If you've been in a Medicare Advantage plan for less than a year, you may be able to switch back to Original Medicare and buy a Medicare Supplement (Medigap) policy without being subject to medical underwriting. This is a vital protection for those who want to return to a broader network of doctors.
How to Switch: A 3-Step Checklist
Switching plans doesn't have to be a headache. Our licensed agents use proprietary technology to make this process quick and efficient.
Step 1: Confirm Your SEP Eligibility. Don't cancel your current plan yet. First, ensure you have a qualifying event to avoid a coverage gap.
Step 2: Compare Formularies and Networks. Use an advocate (like SelectQuote) to verify that the new plan fully covers your "must-have" doctors and medications.
Step 3: Notify Your Current Carrier (Or Don’t). In most cases, once you enroll in a new Medicare Advantage plan, you're automatically disenrolled from your old one. However, if you're returning to Original Medicare, you may need to take specific action to notify your carrier.
Frequently Asked Questions
Can I switch plans just because my doctor left the network?
Generally, no. A doctor leaving a network isn't a qualifying life event for an SEP. However, you can switch during the Annual Enrollment Period (Oct 15-Dec 7) or the Medicare Advantage Open Enrollment Period (Jan 1-March 31).
What happens if I miss all the enrollment deadlines?
Unless you qualify for a Special Enrollment Period due to a life event like moving or losing other coverage, you'll likely have to wait until the next Annual Enrollment Period in October.
Does changing plans mid-year reset my 2026 deductible?
Yes. If you switch to a new plan mid-year, any money you've already paid toward your deductible or maximum out-of-pocket limit usually does not carry over to the new plan.
Explore Your Medicare Advantage Plan Options with SelectQuote
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