A Special Enrollment Period (SEP) lets you change Medicare plans outside the usual fall Open Enrollment when certain things happen, like your plan leaving Medicare or you moving out of its service area. Medicare.gov lists each situation with its own time window. One doctor leaving your plan's network doesn't automatically give you one, though Medicare.gov says a significant change to a plan's provider network can, case by case.
My plan is leaving Medicare. What can I do?
Medicare.gov says you'll get a notice, usually in October, if your plan is leaving the Medicare program in the coming year. If your plan's contract with Medicare isn't renewed, you can switch to another Medicare Advantage Plan or drug plan between December 8 and the last day of February of the following year.
If you don't join another Medicare Advantage Plan before your plan ends, Medicare.gov says you'll be enrolled in Original Medicare. If you want drug coverage, you'd need to join a Medicare drug plan.
You can also choose a new plan during regular Open Enrollment, October 15 to December 7, so there's no gap on January 1. That's usually the simplest path.
What to say when you call 1-800-MEDICARE (1-800-633-4227):
"I got a notice that my plan, [plan name], is leaving Medicare next year. What are my options, what's my deadline, and when would new coverage start?"
I'm moving. Do I get a Special Enrollment Period?
If you move to a new address that isn't in your plan's service area, Medicare.gov says you can switch to a new Medicare Advantage Plan or drug plan, or go back to Original Medicare. Your chance to switch:
- Starts when you move, and lasts for 2 full months after you move.
- Can start the month before you move, if you tell your plan before you move.
If you move out of the area and don't pick a new plan, Medicare.gov says you'll be enrolled in Original Medicare when your old plan drops you. Plans can, and sometimes must, disenroll people who move out of the service area.
Don't forget to update your address with Social Security, which keeps Medicare's address on file. That way, notices and bills reach you.
What if a parent moves into or out of a nursing home?
Medicare.gov lists a Special Enrollment Period for people who live in, or recently moved out of, an institution like a nursing home or rehabilitation hospital. They can join, switch, or drop a Medicare Advantage Plan or drug plan. The chance lasts as long as they live there and for 2 full months after the month they move out.
This can help if the nursing home's preferred pharmacy or doctors aren't in your parent's current plan. See skilled nursing facility bills and Medicare.
My doctor left the network. Can I switch plans?
Not always. Medicare.gov's Special Enrollment Period list doesn't include one for a single doctor leaving a plan. It does list an SEP, decided case by case, if you're notified of a significant change in your plan's provider network. Other options:
- Medigap after a significant network change. Medicare's Medigap booklet lists "your plan's network has a significant change" as a situation that can give a guaranteed right to buy a Medigap policy when you switch to Original Medicare. Ask 1-800-MEDICARE whether your plan's change counts as significant.
- The Medicare Advantage Open Enrollment Period, January 1 to March 31, if you're in a Medicare Advantage Plan. See the Medicare Advantage Open Enrollment Period.
- Fall Open Enrollment, October 15 to December 7.
Before switching, ask the plan if you can keep seeing the doctor for a while to finish a course of treatment. Some plans may help with that.
What to say to your plan:
"My doctor, [name], is leaving your network on [date]. I'm in the middle of [treatment]. Is there any way to keep seeing them to finish treatment? Can you help me find an in-network doctor who can take over?"
If you get a bill after the doctor left, see Medicare Advantage out-of-network bills.
What other Special Enrollment Periods might apply?
Medicare.gov lists several more. A few that come up for families:
- Medicaid or Extra Help. If you have Medicaid or get Extra Help, you can change drug coverage once a calendar month, with some exceptions. See Extra Help with drug costs.
- 5-star plans. If a plan with a 5-star quality rating is offered in your area, you can switch to it once between December 8 and November 30.
- Low-rated plans. If your plan has had a rating below 3 stars for 3 years in a row, you can switch any time you're in it.
- First-year trial. If you joined a Medicare Advantage Plan when first eligible at 65, you can drop it within the first year and go back to Original Medicare. See leaving Medicare Advantage: can you get Medigap?