Medicare Advantage Special Enrollment Periods in Texas for 2026

Most people can only change Medicare Advantage plans during the fall Annual Enrollment Period, October 15 to December 7, or during Medicare Advantage Open Enrollment, January 1 to March 31. A Special Enrollment Period, or SEP, is an exception that lets you change outside those windows. Here are the ones that come up most often for Texas residents.

Common Special Enrollment Periods

• Integrated Care SEP. People who have both Medicare and Medicaid, or who receive Extra Help, can join or switch to certain Dual Eligible Special Needs Plans on a monthly basis. D-SNPs are a type of Medicare Advantage plan built around that combined coverage.
• You move. If you move out of your plan’s service area, or move somewhere with new plan options, you get a window to change. This matters in Texas, where networks are often built county by county.
• You lose other coverage. Involuntarily losing employer, union or retiree coverage opens an SEP. This is the one that applies to most people retiring after 65.
• Your plan leaves or changes. If your plan terminates its contract, stops serving your county, or is sanctioned by Medicare, you get a window to move.
• Five-star plans. If a plan in your area carries a five-star rating from Medicare, you may switch into it once during the year.
• Chronic conditions. A qualifying chronic condition can let you enroll in a Chronic Condition Special Needs Plan designed for it.
• Exceptional circumstances. Medicare grants SEPs for situations such as a FEMA-declared disaster, an error by a federal employee, or incorrect information from a plan.

TRS-Care Medicare Advantage

Retired Texas educators covered by TRS-Care can enroll in TRS-Care Medicare Advantage when they turn 65, when they have a qualifying special enrollment event such as involuntarily losing coverage or adding a dependent, or during a limited-time enrollment opportunity offered by TRS.

What is different about 2026

• The average monthly premium across all Medicare Advantage plans is projected at $14.00, down from $16.40 in 2025, and many plans charge no premium beyond the Part B premium of $202.90.
• Your out-of-pocket spending on covered Part D drugs is capped at $2,100 in 2026, rising to $2,400 in 2027, and no plan may charge a drug deductible above $615 in 2026 or $700 in 2027.
• The Medicare Prescription Payment Plan lets you spread those out-of-pocket drug costs across the year in monthly installments rather than paying at the counter. You have to opt in.

Before you use an SEP

Check that your doctors and hospitals are in the new plan’s network for the year you are enrolling in, and that your prescriptions are on its formulary. Texas plan networks and formularies vary widely between counties and change each year.

Talk to a licensed iHealthAgents advisor

We can walk you through what these amounts mean for your own coverage and compare every plan available where you live.

Book a time with a licensed advisor, or call Illinois 312-726-6565 or Texas 972-666-0578.

This article is for educational purposes only and is not a substitute for advice about your specific situation. Figures shown are the 2026 and 2027 amounts published by the Centers for Medicare & Medicaid Services.