When and how you can change your Medicaid plan
You can change your Medicaid plan during your state's annual open enrollment period, which usually runs from November through January, though the exact dates vary by state. Outside that window, you can switch plans only if you have had a may have access to life event — a change in income, loss of health coverage, birth of a child, move to a new county, or similar circumstance. Your state Medicaid office decides which events may have access to and how long after the event you have to make the switch, typically 30 to 60 days.
The process itself is straightforward: you contact your state Medicaid agency, your current plan, or a Medicaid counselor, tell them which plan you want to join, and submit the request in writing or online. Your new plan takes effect on the first day of the following month, or sometimes immediately if you are switching due to a may have access to event. You do not need permission from your current plan to leave.
Key Takeaways
- Open enrollment for Medicaid runs at different times in different states, but most fall between November and January each year.
- Outside open enrollment, you can switch plans only after a may have access to life event such as a job loss, move, or change in household size.
- Contact your state Medicaid office, your current plan, or a local Medicaid counselor to request the change in writing or online.
- Your new plan usually begins on the first of the next month, though some states process may have access to-event switches faster.
- You keep your Medicaid coverage during the switch — there is no gap in your benefits.
Finding your state's open enrollment dates
Each state runs its own Medicaid program and sets its own open enrollment window. Most states align with the federal calendar and open enrollment in November, but some states have different schedules. Your state Medicaid website will list the exact start and end dates for the year you are in.
To find your state's dates, search "[your state] Medicaid open enrollment" or call your state Medicaid office directly. You can also contact a local Area Agency on Aging, a community health center, or a Medicaid counselor — they have current calendars and can tell you whether your state is currently in open enrollment. If you miss the window and do not have a may have access to event, you will have to wait until the next year to switch.
What counts as a may have access to life event
A may have access to event is a change in your circumstances that affects your Medicaid coverage or the plan you need. Common may have access to events include: loss of job or income, increase in income that moves you into a different Medicaid category, birth or adoption of a child, death of a household member, move to a different county or state, loss of other health coverage, change in your immigration status, or release from incarceration.
Some states also count events like marriage, divorce, or a change in your living situation. Your state Medicaid office has a full list of what it recognizes. The key point: you must report the event and request the plan change within the timeframe your state allows, usually 30 to 60 days. If you wait longer, you will have to wait for the next open enrollment.
How to submit your request to change plans
Start by contacting your state Medicaid office, your current Medicaid plan, or a Medicaid counselor. You can find your state office number on your Medicaid card or by searching "[your state] Medicaid contact." Many states also let you change plans through their online portal or by mail.
When you contact them, have your Medicaid member ID ready and know which plan you want to switch to. If you are not sure which plan is best for you, ask the counselor to walk you through the options — they can compare costs, doctors, and pharmacies across plans at no cost. Submit your request in writing (by mail, email, or through the online portal) so you have proof of when you asked. Verbal requests over the phone are usually accepted, but written confirmation is safer.
What happens to your coverage during the switch
Your current Medicaid plan stays active until your new plan begins, so you have no gap in coverage. Your new plan usually starts on the first day of the next calendar month. If you switch because of a may have access to event, some states process the change faster — your new plan might start within days or weeks rather than waiting for the next month.
Before your new plan takes effect, you will receive a welcome packet with your new member ID, a list of doctors and hospitals in the plan's network, and information about how to use your benefits. Keep your old member ID until you receive the new one. If you need care before the new plan starts, use your current plan's doctors and pharmacies.
Choosing between Medicaid managed care plans
Most states offer multiple Medicaid plans to choose from, usually managed care organizations that contract with the state. Each plan has different doctors, hospitals, pharmacies, and costs. Before you switch, compare the plans on these points: whether your current doctor is in the new plan's network, which hospitals are covered, which pharmacies are included, and whether there are any copays or other out-of-pocket costs.
Your state Medicaid website usually has a plan comparison tool. You can also call each plan directly and ask about specific doctors or medications. A Medicaid counselor can walk you through the comparison at no cost. Do not choose a plan based on price alone — if your doctor is not in the network, you may have to pay out of pocket or switch doctors.
What to do if you miss the deadline or open enrollment ends
If you miss open enrollment and do not have a may have access to life event, you cannot change plans until the next open enrollment period. However, if you believe you have a may have access to event, contact your state Medicaid office and explain the situation. Some states allow exceptions or have a grace period for people who did not know about the deadline.
If your current plan is not working for you — your doctor left the network, your medication is not covered, or you are having trouble getting care — ask your state Medicaid office whether you have grounds for a mid-year switch. Some states allow switches for plan performance issues or network problems. Document the problem in writing and keep records of any denials or access issues.
Frequently Asked Questions
Can I change plans more than once a year?
Only during open enrollment or after a may have access to life event. If you switch plans during open enrollment, you cannot switch again until the next open enrollment period unless something changes in your life. If you switch because of a may have access to event, you generally cannot switch again for at least 12 months unless another may have access to event occurs.
What if my doctor is not in my new plan's network?
Contact your new plan and ask whether your doctor can be added or whether you can see them out of network. Some plans allow out-of-network care for established patients. If your doctor cannot be added, you will need to choose a new doctor in the plan's network or consider switching to a different plan that includes your doctor.
Do I have to pay anything to change plans?
No. Changing Medicaid plans is free. You do not pay a fee to switch, and your Medicaid coverage continues without interruption. If a website or person asks you to pay to change your plan, it is a scam.
What if I change plans and then regret it?
If you switched during open enrollment, you cannot switch back until the next open enrollment period. If you switched because of a may have access to event, you may be able to switch again if another may have access to event occurs. Contact your state Medicaid office to ask about your options.
How do I know if my new plan has started?
You will receive a new member ID card in the mail before your coverage begins. Your state Medicaid office will also send a confirmation letter with your effective date. Call your new plan's customer service number to confirm your coverage is active before you use any services.