Every fall, Medicare’s Annual Enrollment Period gives people who already have Medicare the chance to review and change their coverage for the coming year. It runs from October 15 through December 7. If you miss Medicare AEP, the good news is that nothing dramatic happens: your current coverage generally continues into the new year, and depending on your circumstances, you may still have one or more chances to make a change before next fall. Here is a calm, factual walk through your options after December 7.
This article is educational only. Medicare.gov and 1-800-MEDICARE are the official sources for complete information on all of your Medicare options.
What Actually Happens When You Miss Medicare AEP
Missing the Annual Enrollment Period does not mean losing Medicare. If you have Original Medicare, Parts A and B simply continue. If you are enrolled in a Medicare Advantage plan or a standalone Part D drug plan, it typically renews automatically for the new year, as long as the plan is still offered in your area.
What can change are the details. Each September, plans mail an Annual Notice of Change describing next year’s premiums, copays, drug formulary, and provider network. If you did not read yours before December 7, it is worth reading now, because those changes take effect on January 1 whether or not you reviewed them. Knowing exactly what changed is the first step in deciding whether any of the options below matter for you.
The Medicare Advantage Open Enrollment Period: January 1 to March 31
For many people who miss Medicare AEP, the most common second window is the Medicare Advantage Open Enrollment Period, which runs from January 1 through March 31 each year. It is only available to people who are already enrolled in a Medicare Advantage plan on January 1. If you have Original Medicare, with or without a Medigap policy, this period does not apply to you.
During this window you can make one change. You can switch from your current Medicare Advantage plan to a different Medicare Advantage plan, or you can drop Medicare Advantage and return to Original Medicare, with the option to join a standalone Part D prescription drug plan at the same time. Once you have used your one change, this particular window is closed for you until the following year, so it helps to compare carefully before you move.
The 5-Star Special Enrollment Period
Medicare rates Medicare Advantage and Part D plans on a scale of one to five stars, based on measures like member experience, customer service, and quality of care. If a plan rated five stars is available where you live, you can use a one-time Special Enrollment Period to switch into it at any point between December 8 and November 30 of the following year.
Two caveats apply. First, five-star plans are not offered everywhere; availability varies county by county, and a given area, including parts of Florida, may not have one in a particular year. Second, this Special Enrollment Period can be used only once per year, and switching still affects your drug coverage and provider network, so the same homework applies.
Other Special Enrollment Periods That May Fit Your Situation
Beyond the two windows above, Medicare grants Special Enrollment Periods when certain life events happen. Common examples include:
- Moving. If you move outside your plan’s service area, such as relocating from Fort Lauderdale to another county or state, you get a window to choose a new plan that serves your new address.
- Losing other coverage. If you lose coverage from an employer or union, or through a spouse’s job, a Special Enrollment Period lets you pick up a Medicare plan outside the normal calendar.
- Extra Help or Medicaid. People who qualify for the Extra Help program for prescription drug costs, or who have both Medicare and Medicaid, have additional opportunities during the year to change plans.
- Your plan leaves your area. If your Medicare Advantage or Part D plan is discontinued or stops serving your county, you are given time to enroll in a replacement.
- Other qualifying events. Situations like moving into or out of a skilled nursing facility, or being affected by a federally declared emergency, can also open an enrollment window.
Each Special Enrollment Period has its own timing rules, so it is worth confirming the details for your specific situation before assuming a window is open or closed.
If You Miss Medicare AEP and No Special Enrollment Period Applies
If none of the situations above fit, your current coverage stays in place for the year, and your next scheduled opportunity to change plans is the following Annual Enrollment Period, beginning October 15. That is not a wasted year. It is a good stretch of time to keep notes on how your plan performs: whether your medications stay covered at a predictable cost, whether your doctors remain in network, and how your out-of-pocket spending adds up over the months. Those notes make next fall’s comparison much easier.
It also helps to talk through your situation with someone who works with these rules every day. The Medicare team at Maher Insurance Group can review your circumstances at no cost, confirm whether any Special Enrollment Period currently applies to you, and help you compare options from multiple A-rated carriers when your window does open. Because we are an independent brokerage, we are paid by the insurance carriers, not by our clients.
Frequently Asked Questions
Do I lose my Medicare coverage if I miss the Annual Enrollment Period?
No. Original Medicare continues automatically, and most Medicare Advantage and Part D plans renew for the new year on their own. Missing AEP simply means you kept your current coverage, including any changes the plan described in its Annual Notice of Change.
Who can use the Medicare Advantage Open Enrollment Period?
Only people who are already enrolled in a Medicare Advantage plan on January 1. Between January 1 and March 31, they can make one change: switch to a different Medicare Advantage plan, or return to Original Medicare with the option to add a standalone Part D drug plan.
Can I switch Part D drug plans after December 7 if I have Original Medicare?
Not through the Medicare Advantage Open Enrollment Period, which does not apply to people on Original Medicare. You would need a Special Enrollment Period, such as one triggered by moving, losing other coverage, qualifying for Extra Help, or the availability of a five-star plan in your area.
What is the 5-star Special Enrollment Period?
If a Medicare Advantage or Part D plan rated five stars by Medicare is available in your area, you can switch into it once between December 8 and November 30 of the following year. Five-star plans are not offered in every county, so check what is available where you live.
When is my next chance to change plans if no Special Enrollment Period applies?
The next Annual Enrollment Period, which runs from October 15 through December 7 each year, with changes taking effect on January 1. In the meantime, keeping notes on your prescriptions, doctors, and out-of-pocket costs will make that comparison easier.
Get Help Sorting Out Your Options
People miss Medicare AEP every year for perfectly ordinary reasons, and in many cases another path is still open. If you are not sure which of these windows applies to you, a licensed agent at Maher Insurance Group can walk through your situation at no cost and explain what is possible between now and next October. Call (866) 220-2834 to talk it through, or if you prefer to start online, fill out our short questionnaire and we will follow up at a time that works for you.
Maher Insurance Group is a licensed independent insurance brokerage and is not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer. Contact Medicare.gov or 1-800-MEDICARE for information on all of your options.
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