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Missed Medicare Open Enrollment? You May Still Have Options

Jessica Lippert

Medicare Open Enrollment ended on December 7th. If you didn’t make changes during that time, you may still be able to switch plans. This article discusses your options, including Special Enrollment Periods (SEPs) and the Medicare Advantage Open Enrollment Period. 
 

If Your Plan Is Ending 

If you got a letter saying your plan is ending and you did not pick a new one by December 7th, you qualify for a Special Enrollment Period (SEP) and can enroll in a new plan until February 28th. 

To have your new coverage start on January 1st, you must enroll by December 31st. If you enroll after that, your new coverage will start the first of the following month. This could leave you without coverage for a short time. 

If your Medicare Advantage plan ends on December 31, 2025, you may also be able to buy a Medigap policy. This is called "Guaranteed Issue" rights. Your termination letter will explain your rights—keep this letter as proof. You have 63 days from when your old coverage ends to use these rights. 
 
Note: If you have full Medicaid benefits, you cannot buy a Medigap policy. 

 

If Your Doctor Isn't in Your New Plan's Network 

Medicare announced a temporary fix for people who picked a plan based on wrong information. This temporary Special Enrollment Period (SEP) is for Medicare beneficiaries who enrolled in a Medicare Advantage plan based on incorrect provider directory information listed on the Medicare.gov Plan Finder.

To qualify for this SEP, you must meet all the following criteria: 

  • You enrolled in a Medicare Advantage plan through Medicare.gov during Open Enrollment 

  • Your coverage starts between January 1, 2026 and December 1, 2026 

  • You found out your doctor isn't actually in your plan's network within three months of your coverage start date 

  • You chose your plan based on incorrect provider information on Medicare.gov 
     

To use this Special Enrollment Period, contact 1-800-MEDICARE (1-800-633-4227). 
 

If You Were Misled or Pressured to Enroll 

If someone gave you false information, pressured you to enroll in a plan, or you were misled by deceptive marketing tactics, you may qualify for a Special Enrollment Period to switch plans. Call 1-800-MEDICARE (1-800-633-4227) to report what happened. The CMS Regional Office will review your case and decide if you can change plans based on this. 
 

Other Reasons You May Be Able to Switch 

There are additional SEPs for circumstances that may arise after Open Enrollment has ended. You may qualify to make changes if you:  

  • Lose eligibility for Extra Help. 
  • Get automatically enrolled into a Part D prescription drug plan by CMS. 
  • Enroll in or lose eligibility for PACE/PACENET 
     

For a full list of reasons you may be able to switch plans, click here. 

 
Already in a Medicare Advantage Plan? 

If you're in a Medicare Advantage plan on January 1st, you have another chance to make changes. From January 1st through March 31st, you can: 

  • Switch to a different Medicare Advantage plan, or 

  • Leave Medicare Advantage and go back to Original Medicare (you can also add a Part D drug plan) 

Any changes you make will start the first day of the following month. 

 

Need Help? Call PA MEDI

Beneficiaries seeking help understanding Special Enrollment Periods or comparing Medicare options during the Medicare Advantage Open Enrollment Period can turn to Pennsylvania Medicare Education and Decision Insight, PA MEDI, for free, unbiased counseling. Trained PA MEDI counselors can help evaluate plan choices and assist in selecting the coverage that best fits individual needs. 

PA MEDI’s statewide helpline is available at 1-800-783-7067. Additional information, including local events and contact details, can be found on the PA MEDI website.