For most people eligible for Medicare, after their Initial Enrollment Period (IEP) has passed, the only time they can enroll in, change or disenroll from a Medicare Advantage plan (also known as Medicare Part C) or a Part D prescription drug plan is each year during the Medicare Annual Enrollment Period (AEP). This period begins on October 15th and ends on December 7th. A Special Enrollment Period (SEP) takes place outside the standard enrollment periods such as AEP and may be granted to people with special circumstances.
Reasons A SEP May Be Granted
During the SEP, you may be able to enroll or make changes to your Medicare Advantage plan or Part D prescription drug plan. A Special Enrollment Period may be allowed for a variety of reasons. Some of the more common reasons may include but are not limited to:
- Loss of employer coverage
- Medicare ends its contract with your plan
- You move out of the service area of the plan
- You are eligible for both Medicare and Medicaid benefits
- You live in or move in or out of an institution such as a long-term care hospital or skilled nursing facility
- You lose drug coverage that was equal to or better than that offered by Medicare (also known as creditable coverage)
- You want to disenroll from your Medicare Advantage plan within 12 months of joining it
- You have a disability, are turning 65, and are eligible for new plan options
- You enroll in or disenroll from the PACE program
- Your plan stops contracting with a substantial number of providers as determined by Medicare
There are many reasons a SEP may be granted, and the list above does not include all qualifications for a Special Enrollment Period. If you believe you may be eligible, contact CMS at the number below to submit a request.
Requesting A SEP
Suppose you have experienced any of the situations above or another situation that prevented you from enrolling in Medicare once you became eligible. In that case, you are encouraged to call 1-800-MEDICARE and request a Special Enrollment Period.
Special Enrollment Period Timing
The start and end of a SEP and the changes you can make will vary depending on the reason it is granted. If you are granted a SEP, you will be provided with the start and end dates as well as your enrollment options.
What Qualifies for a Medicare Special Enrollment Period to Switch Plans?
People who already have Medicare may qualify for a 2-month Special Enrollment Period with certain qualifying life events. This Special Enrollment Period lets you switch to a different Medicare Advantage or Part D prescription drug plan.
You may qualify for a 2-month Medicare Special Enrollment Period in the following situations:
- You move out of your plan’s service area.
- Your plan closes, stops serving the area where you live, significantly reduces its provider network or your plan consistently receives low Medicare star ratings.
- You want to enroll in a 5-star plan at any time or drop your first Medicare Advantage plan within 12 months of enrolling.
- You move into or out of a qualified institutional facility, like a nursing home.
- You are enrolled in or lose eligibility for a qualified State Pharmaceutical Assistance Program.
- You have Medicare financial assistance such as Medicaid, a Medicare Savings Program or Extra Help, or you gain or lose eligibility for any of these.
- You enroll in or leave the Program of All-Inclusive Care for Elderly (PACE).
- You gain or lose eligibility for a Special Needs Plan.
Some situations not listed here may qualify for a Special Enrollment Period as well. If you have questions about your personal situation, call your State Health Insurance Assistance Program for help.