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.
Types of Special Enrollment Periods
Certain situations qualify you for a special enrollment period. For a full list of situations, visit Medicare.gov.
- Change of Residence
- If you’re enrolled in a Medicare Advantage or Part D drug plan and move to an area outside your plan’s network, you qualify for a special enrollment period. During this time, you may return to Original Medicare (Part A and Part B) or you can switch to a new Medicare Advantage or Part D plan. Your enrollment window begins the month you tell your plan provider and lasts two more full months after that.
- Loss of Employer Health Insurance
- If you receive health insurance through an employer’s group health plan (or your spouse’s employer plan), you can delay Medicare Part A and/or Part B. To delay coverage, your employer must have at least 20 employees. Ask your benefits manager at work whether you have group health plan coverage as defined by the Internal Revenue Service. Once you leave your job or lose your health insurance (whichever comes first), you have an eight-month special enrollment period when you can sign up for Medicare without facing a late enrollment penalty.
- Other Coverage Losses
- You may be able to drop your current Medicare coverage during a special enrollment period if you have a choice to enroll in other coverage through your employer or union. You can also drop Medicare anytime if you choose to enroll in coverage from the U.S. Department of Veteran Affairs or a Program for All-Inclusive Care for the Elderly (PACE) plan.
Other situations also qualify you for special enrollment.
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.
5 Cited Research Articles
- Medicare.gov. (n.d.). Medicare & the Marketplace. Retrieved from https://www.medicare.gov/about-us/medicare-the-marketplace
- Medicare.gov. (n.d.). Part A and B sign up periods. Retrieved from https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods
- Medicare.gov. (n.d.). Should I get Parts A & B? Retrieved from https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/should-i-get-parts-a-b
- Medicare.gov. (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
- Medicare.gov. (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