Medicare Special Enrollment Period – A Special Enrollment Period (or SEP) is a unique window of time you can use to change your Medicare plans if you have a qualifying life event. SEPs pertain to Medicare Advantage and Medicare Part D prescription drug plans.
There is a long list of special circumstances that allow you to change your Medicare plan.
Change in Residence
You moved to an address that is not in your current plan’s service area. In this case, you can switch your Medicare Advantage (Part C) and/or Part D plan to a different one or move back to Original Medicare. You have two full months to make this change.
You moved, and your new address is within the plan’s service area, but now you have more plan options. As in the scenario above, you have two full months to switch Part C or Part D plans or move back to Original Medicare.
You moved back to the U.S. after living abroad. You have two full months to join a Medicare plan.
You moved out of or into an institution like a long-term care hospital or skilled nursing facility. In this case, you can switch plans for a full two months after moving into or out of an institution. You may also qualify for a special kind of Medicare Advantage plan called an I-SNP (Institutional-Special Needs Plan).
You were released from jail. If you were already enrolled in Original Medicare (Parts A and B), you have two months to enroll in additional coverage.
Loss of Current Coverage
You lost your coverage from an employer. You have two full months from your termination date to enroll in other coverage.
You are no longer eligible for Medicaid. If you are no longer eligible for Medicaid, you can join a Medicare Advantage or Part D plan. If you are enrolled in a D-SNP (Dual-Eligible Special Needs Plan), you will need to select a different kind of plan. You have three months from your last day of Medicaid eligibility or when you were notified, whichever occurs later.
Your current prescription drug coverage is no longer credible. You may join a Part D plan or a Medicare Advantage plan within two months of being notified or coverage termination, whichever is later.
You left drug coverage in Medicare Cost Plan. You may join a Part D plan within two months of dropping the Medicare Cost Plan.
You dropped your coverage in a PACE plan. You can join a Part C or Part D plan within two months of leaving the PACE plan.
Opportunity for Other Coverage
You gain access to a credible, employer-sponsored plan. If you or your spouse has decided to enroll in a credible health insurance plan, you can disenroll from your current Medicare plans and move to the employer plan whenever the employer allows for enrollment.
You enrolled in a PACE plan. You can drop your current Medicare plans at any time.
You enrolled in credible drug coverage. This happens most frequently when a beneficiary has VA or TRICARE benefits. You can drop your Medicare coverage at any time.
Change in Medicare Contracts
Medicare terminated your current plan’s contract. You may switch Medicare plans beginning two months before the contract terminates and must make changes by one full month after the contract end date.
Your current plan was not renewed by Medicare. If your current plan is not renewed for the upcoming year, you can change plans from December 8 through the last day of February.
Other Special Circumstances
There are a number of other circumstances that would allow you to change your Medicare Advantage or Part D plan. Some of those circumstances include:
- Gaining eligibility for Medicaid (in conjunction with Medicare)
- Qualifying for Extra Help
- Enrolling or losing eligibility for a State Pharmaceutical Assistance Program (SPAP)
- Wishing to enroll in a Medigap plan within the first 12 months of your first time in a Medicare Advantage plan (called the Trial Right)
- Developing or being cured of a chronic condition covered under a C-SNP (Chronic-Special Needs Plan)
- Joining or termination coverage under a plan due to a mistake made by a federal employee
Want to know if you qualify for a special enrollment period? Call to speak with one of our licensed insurance agents. We’ll ask a few questions about your specific situations to determine if you qualify for a SEP that would allow you to change your current Medicare plans.
