Can I Switch Part D Plans Mid-Year If My Medication Needs Change?

It happens more often than you’d think.

You start the year with a Medicare drug plan that covers your needs just fine. Then your doctor prescribes something new. Or one of your medications suddenly gets more expensive. Or you realize your plan no longer covers a drug you’ve been taking for years.

So the natural question becomes:“Can I switch my Medicare Part D plan in the middle of the year?”

The answer is: sometimes. But not always.

Medicare Part D Plans Are Typically Locked in for the Year

Once the Annual Enrollment Period (October 15 – December 7) ends, most people are “locked in” to their drug plan for the calendar year.

That means you generally can’t change your Part D plan mid-year just because your medication needs have changed.

But there are some exceptions.

You May Qualify for a Special Enrollment Period (SEP)

There are certain situations where Medicare will allow you to switch plans mid-year. These include:

• You qualify for Extra Help (a program that lowers drug costs for people with limited income)

• You move to a new area and your current plan doesn’t operate there

• You lose other creditable drug coverage

• You live in or move into a nursing home or other institution

• Your plan drops your coverage through no fault of your own

If any of those situations apply to you, you might be able to make a change right away — no need to wait until the next enrollment window.

What If You Don’t Qualify for a Special Enrollment Period?

If you don’t fall under one of the categories above, you’ll most likely need to wait until the next Annual Enrollment Period in the fall to make a switch.

In the meantime, there may be other options:

• Your doctor may be able to prescribe a covered alternative

• Some manufacturers offer discount programs or coupons

• You might qualify for state-based assistance programs

We can help you explore those options and see what’s available in your area.

Bottom Line

You can’t always change your Part D plan just because your prescriptions change — but in some cases, Medicare does allow mid-year switches.

If your current plan no longer meets your needs, let’s talk. We’ll help you figure out whether you qualify for a Special Enrollment Period, and if not, how to reduce your out-of-pocket costs until you can make a change.