Medicare Special Enrollment Period
A special enrollment period (SEP) allows you to make changes to your Medicare coverage when specific events happen in your life — such as losing employer health insurance or moving to a new location. This is different from the initial, open and general enrollment periods.
What Is a Medicare Special Enrollment Period?
Certain life events and situations qualify you for a Medicare special enrollment period. There are more than 20 qualifying special circumstances listed by the U.S. Centers of Medicare & Medicaid Services.
Rules about when you can make changes to your Medicare plan and the type of changes you can make vary for each special enrollment situation.
If you miss your special enrollment period window, you may have to wait until the next Medicare open enrollment period, which takes place every year from Oct. 15 to Dec. 7.
A special enrollment period is different from your initial enrollment period, or the time when you first become eligible for Medicare.
For most people, this period starts three months before your 65th birthday and ends three months after your birth month.
- Enroll in Medicare Part A and/or Part B.
- Enroll in a Medicare Part D prescription drug plan.
- Switch from one Medicare Advantage plan to another.
- Switch from one Part D plan to another.
- Drop you Part D drug plan completely.
- Drop your Medicare Advantage plan and return to Original Medicare.
What Are the Special Enrollment Periods by Medicare Plan and How Do I Qualify?
You may qualify under a special enrollment period due to different reasons depending on the type of Medicare plan that you have. Generally, this period can be triggered by some sort of life event that has caused you to lose your current health care coverage.
But there are several different scenarios.
A common way you may qualify for a special enrollment period to enroll in Original Medicare is if you lose your current health coverage. For example, you can delay enrolling in Part A and Part B if you are still working when you first become eligible and have coverage through an employer health plan.
Once you retire or lose that coverage, you can qualify for a special enrollment period to sign up for Original Medicare without facing a late enrollment penalty.
On the flip side, you may also qualify for a special enrollment period to drop Original Medicare coverage. This could happen if you had Medicare but now have the choice to enroll in other coverage through your employer or union. You also can qualify if you now will receive coverage through the U.S. Department of Veteran Affairs or a Program for All-Inclusive Care for the Elderly (PACE) plan.
Other situations include if you are a U.S. citizen returning to the United States after living outside the country. Your Medicare special enrollment period begins the month you move back to America and lasts for two full months after that.
If you are released from jail, similar rules apply. Your chance to join a Medicare health or drug plan lasts two full months after the month you’re released from jail.
Medicare Advantage and Part D
You can also qualify for a special enrollment period to replace your Medicare Advantage or Part D coverage. Since many of these plans require you to stay within a network, one of the most common occurrences that will trigger a special enrollment period is if you move out of your plan’s area.
If this happens, you will be allowed to find and enroll in a new plan without having to wait for one of the traditional enrollment periods.
Below are many of the scenarios that may allow you to make changes to your Medicare Advantage or Part D coverage.
|Special Circumstance||What You Can Do|
|You move to an area outside of your current plan’s service area or to an area that offers new options.||Find and switch to a new Medicare Advantage plan or Part D plan.|
|You lived abroad but have moved back to the U.S.||Find and join a Medicare Advantage plan or Part D plan.|
|You have been released from jail.||Find and join a Medicare Advantage plan or Part D plan.|
|You have moved out of an institution.||Find and join a Medicare Advantage or Part D plan, or switch from Medicare Advantage back to Original Medicare.|
|You were eligible for Medicaid but aren’t anymore.||Switch over to a Medicare Advantage plan or Part D plan.|
|You currently have Extra Help but won’t be eligible next year.||Switch over to a Medicare Advantage plan or Part D plan.|
|You are no longer covered by your employer or union.||Find and join a Medicare Advantage plan or Part D plan.|
|You had creditable drug coverage but involuntarily lost it.||Find and join a Medicare Advantage plan that includes drug coverage or Part D plan.|
|You left a Medicare Cost Plan that you had drug coverage through.||Find and join a Part D plan.|
|You leave your PACE plan.||Find and join a Medicare Advantage plan or Part D plan.|
|You join a PACE plan.||Leave your current Medicare Advantage plan or Part D plan.|
|You now can enroll in coverage from an employer or union.||Leave your current Medicare Advantage plan or Part D plan.|
|Medicare sanctions your current plan.||Switch to another Medicare Advantage or Part D plan.|
|Your current plan terminates its contract with Medicare or isn’t renewed by Medicare.||Switch to another Medicare Advantage or Part D plan.|
|You have been enrolled in a plan that has a star rating lower than three for three years.||Switch to another Medicare Advantage or Part D plan with a star rating of three or higher.|
|Your plan was taken over by the state.||Switch to another Medicare Advantage or Part D plan.|
|You become eligible for both Medicare and Medicaid or Extra Help.||Join or drop a Medicare Advantage or Part D plan.|
|You’re enrolled in SPAP.||Find and join a Medicare Advantage plan or Part D plan.|
|A Special Needs Plan is available that covers your condition.||Join the Special Needs Plan.|
|You either joined or did not join a plan due to a federal employee’s error.||Drop your coverage and join a different Medicare Advantage or Part D plan.|
|You weren’t correctly informed that your drug plan does not qualify as creditable coverage.||Switch to a Medicare Advantage plan that includes drug coverage or a Part D plan.|
How Long Is Each Special Enrollment Period?
How long your special enrollment period lasts will depend on the type of event that qualified you for the period. It typically will last either two months or eight months.
The shorter of the enrollment windows is typically triggered by a qualifying life event. This is any event that causes you to lose your current coverage — for example, if you moved and now need to find a new plan or have access to different plans.
- You move out of your plan’s network area
- You move back to the U.S. after living abroad
- You are released from jail
- You no longer qualify for Medicaid or Extra Help
You can also qualify for a longer special enrollment period, which lasts eight months. This period is usually reserved for Americans who stayed in the workforce after they first became eligible for Medicare or had some other form of creditable coverage.
When they retire or lose that coverage, they will then have an eight-month window to enroll in Original Medicare. But it’s important to remember that, even if you qualify for the eight-month period, you will only have two months to enroll in Medicare Advantage or Part D.
Other Medicare Special Enrollment Periods
There are some additional circumstances that could trigger a special enrollment period for you. One relates to Medicare Star Ratings, which are released by CMS.
Star ratings are a way to compare how good different Medicare Advantage plans are. The lowest rating a plan can earn is one star, with the highest rating being five stars. The rating is based on how effective the plan is in serving its beneficiaries.
You may be eligible for a special enrollment period to switch to a five-star plan if one is available in your area. This period lasts from Dec. 8 to Nov. 30 each year and can only be used once.
You also can be eligible for a special enrollment period if you qualify for Extra Help to pay for drug coverage or if you’re eligible for both Medicare and Medicaid.
If you have Extra Help or Medicaid, you can make changes to your coverage one time from January to March, April to June or July to September.
Frequently Asked Questions About Medicare Special Enrollment Periods
6 Cited Research Articles
- U.S. Centers for Medicare and Medicaid Services. (2021, November) Understanding Medicare Advantage and Medicare Drug Plan Enrollment Periods. Retrieved from https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf
- U.S. Centers for Medicare and Medicaid Services. (n.d.). Medicare & the Marketplace. Retrieved from https://www.medicare.gov/about-us/medicare-the-marketplace
- U.S. Centers for Medicare and Medicaid Services. (n.d.). Part A and B Sign Up Periods. Retrieved from https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start
- U.S. Centers for Medicare and Medicaid Services. (n.d.). Should I Get Parts A & B? Retrieved from https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-can-i-sign-up-for-medicare
- U.S. Centers for Medicare and Medicaid Services. (n.d.). Special Circumstances (Special Enrollment Periods). Retrieved from https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances-special-enrollment-periods
- U.S. Centers for Medicare and Medicaid Services. (n.d.). Special Enrollment Periods If You Get Extra Help. Retrieved from https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-enrollment-periods-if-you-get-extra-help