Changing Medicare Plans While Living in a Care Facility: Where to Get Help

A person living in a nursing home or rehabilitation hospital may have Medicare plan-change rights outside the normal annual enrollment windows.

Medicare lists a Special Enrollment Period for people who live in, or recently moved out of, an institution such as a nursing home or rehabilitation hospital.

Do not assume the resident must wait until October 15–December 7 to change Medicare Advantage or drug coverage.

What the institutional Special Enrollment Period allows

Medicare says an eligible person can:

• join a Medicare Advantage Plan;
• join a Medicare drug plan;
• switch to another Medicare Advantage Plan;
• switch drug plans;
• drop Medicare Advantage and return to Original Medicare; or
• drop Medicare drug coverage.

The exact choice should be evaluated carefully.

How long it lasts

Medicare states the opportunity lasts:

• as long as the person lives in the institution; and
• for 2 full months after the month the person moves out.

Use the person’s exact institutional status and dates.

Do not change plans based on one benefit alone

Before switching, compare:

• current nursing-home network;
• doctors/specialists;
• drug formulary;
• pharmacy network;
• prior authorizations;
• cost sharing;
• Medigap implications if returning to Original Medicare;
• Medicaid/dual eligibility; and
• ongoing treatments.

A plan that looks better for SNF copays could be worse for another need.

Get neutral counseling

Medicare recommends State Health Insurance Assistance Programs (SHIPs) for free personalized counseling.

SHIP is not connected to an insurance company or health plan.

Use SHIP or 1-800-MEDICARE when the resident’s situation is complicated.

Institutional SEP worksheet

Institution type: ____________________

Institutional admission date: ____________________

Expected discharge date: ____________________

Current coverage: ____________________

Plan change being considered: ____________________

Facility network checked: ____________________

Doctors/drugs checked: ____________________

Medigap issue reviewed: ____________________

SHIP/Medicare counselor: ____________________

Effective date of change: ____________________

Frequently asked questions

Does every assisted-living resident get this SEP?

Medicare describes the institutional SEP for institutions such as nursing homes and rehabilitation hospitals; do not assume every residential setting qualifies.

Can the resident switch plans every month?

The institutional SEP creates broad timing flexibility, but exact enrollment/effective-date rules should be confirmed for the contemplated change.

Does moving out end the right immediately?

Medicare says it continues for two full months after the month the person moves out.

The practical goal

Institutional residence can create additional Medicare enrollment flexibility.

Use it carefully: verify the resident’s eligibility, compare the full plan—not one copay—and get neutral counseling before changing coverage.

Related NHP guides

• Medicare Advantage vs Original Medicare for Rehab
• What to Ask SHIP Before Choosing Coverage for a Possible Rehab Stay

Primary sources checked

• Medicare — Special Enrollment Periods
• Medicare — Understanding Medicare Advantage & Drug Plan Enrollment Periods
• Medicare — Helpful Tools / SHIP

*Editorial/source review: October 15, 2026. General education only. Home-health scope, ambulance coverage, annual plan changes, enrollment rights, and accessible-notice deadlines should be confirmed from current Medicare/plan materials.*