What Happens When Your Healthcare Needs Change Outside of Medicare’s Annual Election Period?

Posted by Rolando Arellano, J.D.
Estimated Reading Time 1 minute 18 seconds

As we age, our healthcare needs can change quickly. A new diagnosis, an unexpected hospitalization, or the need for specialized care may raise questions about whether your current Medicare plan still fits your needs. But what can you do if these changes happen outside of the Medicare annual enrollment period?”

Typically, Medicare enrollment is limited to specific times of the year, like the Medicare Annual Enrollment Period in the fall. However, certain life events may qualify you for a Special Enrollment Period (SEP), which allows you to make changes to your plan outside of the standard timeline.

You may qualify for a SEP if:

• You move to a new address that is outside your current plan’s service area
• You lose other health coverage
• You enter or leave a skilled nursing facility
• Your plan changes its contract with Medicare

But if your healthcare needs change, such as needing new medications, more frequent doctor visits, or access to specialists, you may not automatically qualify for a SEP. This can feel frustrating, especially if you are suddenly paying more out-of-pocket.

In these cases, it is important to:

• Review your current plan’s coverage and out-of-pocket costs.
• Explore other resources, like Medicaid or prescription assistance programs
• Plan ahead for the next enrollment period to switch to a plan that better suits your evolving needs

Even when plan changes cannot be made immediately, you can still take proactive steps to manage costs and get the care you need. Talk with your provider about generic medication options, local clinics that offer income-based services, or alternative therapies that are covered under your current plan.

If your healthcare needs have changed and you are unsure of your next steps, connect with a licensed insurance agent to review your options. We can help you understand your options and prepare for the right time to update your Medicare coverage.