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.

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Written by
Christian Simmons
Christian Simmons
Financial Writer
Christian Simmons is a writer for RetireGuide and a member of the Association for Financial Counseling & Planning Education (AFCPE®). He covers Medicare and important retirement topics. Christian is a former winner of a Florida Society of News Editors journalism contest and has written professionally since 2016.
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Savannah Hanson
Savannah Hanson
Senior Financial Editor
Savannah Hanson is a professional writer and content editor with over 16 years of professional experience across multiple industries. She has ghostwritten for entrepreneurs and industry leaders and been published in mediums such as The Huffington Post, Southern Living and Interior Appeal Magazine.
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Reviewed By
Aflak Chowdhury
Aflak Chowdhury
Medicare Expert
Aflak Chowdhury is a Medicare expert and independent insurance broker specializing in group health insurance. He has worked for major providers including Humana and Principal Financial Group and today works mainly in the small group market.
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Published: July 24, 2020
Updated: April 18, 2023
9 min read time
This page features 7 Cited Research Articles

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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.

During a special enrollment period, you may be able to:

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.

Here's a Tip

Medicare doesn’t consider COBRA or other retiree health plans as coverage based on current employment. You will not qualify for a special enrollment period when your COBRA coverage ends.

Source: U.S. Centers for Medicare & Medicaid Services

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.

Original Medicare

There are situations where you may qualify for a special enrollment period to sign up for Original Medicare without being hit with a late enrollment penalty.

For example, you can qualify for an enrollment period if you had coverage through an employer health plan and were still working.

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.

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.

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 lasts for two full months after the month you move back.

If you are released from jail, similar rules apply, with your chance to join a Medicare health or drug plan lasting two full months after you’re released from jail.

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.

Source: U.S. Centers for Medicare and Medicaid Services

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.

Examples of Qualifying Life Events That Trigger a Two-Month Enrollment Period

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.

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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.

In 2023, CMS also added an additional qualifier for those who miss their enrollment window. If you miss an enrollment period due to circumstances such as an emergency, natural disaster or incarceration, then you would become eligible for a special enrollment period.

Frequently Asked Questions About Medicare Special Enrollment Periods

Are there special enrollment periods for the Extra Help program?

If you become eligible for Medicare’s Extra Help program, you can switch your current Medicare prescription drug coverage plan one time during the following periods: January to March, April to June and July to September. Any changes go into effect on the first day of the following month.

Do I need to sign up for Medicare if I’m enrolled in coverage through the Health Insurance Marketplace?

It’s recommended you sign up for Medicare when you first become eligible, even if you’re currently enrolled in a Marketplace plan. Otherwise, if you try to enroll in Medicare after your initial enrollment period ends, you may have to pay a Part B late penalty for as long as you have Medicare.

Do Medicare Part B penalties apply for special enrollment periods?

If you had health insurance through your job or your spouse’s job when you first became eligible for Medicare Part B, you will have a Part B special enrollment period once you retire or lose your employer health care. You will not face a Medicare Part B penalty if you enroll during this time.

Last Modified: April 18, 2023

Christian Simmons is a writer for RetireGuide and a member of the Association for Financial Counseling & Planning Education (AFCPE®). He covers Medicare and important retirement topics for RetireGuide. His unique blend of business and writing backgrounds has equipped him to understand complex retirement topics and convey that information in an informed and easily digestible way.

Certified educator in personal finance
Bachelor’s degree in journalism from the University of Central Florida Burnett Honors College
Master’s degree in integrated business from the University of Central Florida

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