Question: I signed up for a Medicare Advantage plan and started to use it, but I discovered that some of my doctors aren't included. Can I switch to another Medicare Advantage plan or switch back to traditional Medicare?
Answer: You generally can’t switch to another Medicare Advantage plan until open enrollment in the fall, which runs from October 15 to December 7, 2017, for 2018 coverage. There are a few exceptions, however. You can switch plans if you qualify for a Special Enrollment Period, such as if you move to an address that isn’t in your plan’s service area. See Special Circumstances at Medicare.gov for more information.
You can also switch to a Medicare Advantage plan with a 5-star quality rating anytime during the year. But there are only 17 5-star Medicare Advantage plans in the U.S. in 2017, including just 14 with prescription-drug coverage, so you may not have a 5-star plan in your area. You can check by looking up “Medicare health plans” for your zip code using the Medicare Plan Finder. You can also see a list of 5-star plans at the Centers for Medicare and Medicaid Services’ website.
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You do have from January 1 through February 14 to switch from Medicare Advantage back to traditional Medicare and can get a Part D prescription-drug plan. This “Medicare Advantage disenrollment period,” however, does not guarantee that you will be able to get a medigap policy to help cover Medicare’s deductibles, co-payments and other gaps in coverage. You can get any medigap policy within six months of first enrolling in Medicare Part B (whether you had coverage through traditional Medicare or Medicare Advantage), but after that insurers can generally reject you or charge more because of preexisting conditions.
However, there is another special rule that could help you qualify for a medigap policy: If you joined a Medicare Advantage Plan when you first became eligible for Medicare and disenroll within 12 months, you can buy a medigap policy within 63 days of making this change, says Mitchell Clark, of the Medicare Rights Center. For more information, see the Medicare Rights Center’s Protected Times to Buy a Medigap factsheet.
Your state may have other opportunities to sign up for a medigap policy regardless of any preexisting conditions. New York and Connecticut, for example, let you enroll in a medigap plan at any time regardless of your health. Contact your State Health Insurance Assistance Program to learn more about the options in your area.
For more information about Medicare rules, see our Guide to Getting the Most Out of Medicare. Also see What Retirees Must Know About Medicare Advantage plans.