There are multiple life events that can make you eligible for a Special Enrollment Period. A SEP allows you to make changes to your Medicare coverage outside the standard enrollment periods. Below, we’ll go over the most common Medicare Special Enrollment Periods.
Special Enrollment Period for Medicare Part B
The Special Enrollment Period for Part B of Medicare gives you the option to delay enrolling when you first become eligible without incurring a lifelong penalty. You must meet at least one of the eligibility requirements below to qualify for a Part B SEP.
Eligibility Requirements for a Special Enrollment Period for Part B:
The CMS L564 form will need to be completed by your employer. You can also upload the completed forms to your My Social Security account.
Trial Rights Special Enrollment Period
If you were enrolled in a Medigap plan and decided to enroll in a Medicare Advantage plan for the first time, you’ll be granted trial rights. You’ll have 12 months from the effective date of your Advantage plan to drop it, enroll back into Original Medicare, and enroll in a Medigap plan again.
Medicare Special Enrollment Period for Moving
When moving to a different zip code or service area, different rules will apply to qualify you for a Special Enrollment Period.
Moving to Another State with Medigap
With Medicare Supplements, as long as you’re moving within the United States, and not outside the country, you won’t have to change your coverage as long as that same plan is available at your new location. This is the case regardless if you’re moving to another county within the same state, or moving to a new state. You’ll still want to notify your Medigap carrier that you moved to they can update their records.
The exception to the above is if you’re moving to one of the states that have their own version of standardized Medigap plans. This includes Minnesota, Massachusetts, and Wisconsin. You’ll want to look into enrolling in one of their state-specific letter plans. Do not drop your current Medigap plan without consulting with your agent first, otherwise, there’s a high probability that you may not be able to enroll back into it.
Moving to Another State with Medicare Advantage or Part D
Your new home address isn’t in your plan’s service region
If you end up moving to a different state that happens to fall outside the service region, you can change to a new plan. Those with a Medicare Advantage Plan can switch back to Medicare. Tell the plan before the move; then, the SEP begins the month you move and extends two months. However, tell the company after the move, and the SEP begins the month you notify them plus two months.
Your new home is still within your plan’s service area, but new plan options are available
If your new zip code is within the service area but with new plan options, you can select a new plan. Your SEP starts the month the company knows of the move and lasts for two months after.
You’ve recently moved back to the United States
If you were living in another country and move back to the U.S., you can enroll in a new plan for up to two months.
You’ve moved into or out of a health facility
If you recently moved into, currently reside in, or recently moved out of a nursing facility, you have several options. You can choose to join a plan if you don’t have one, or switch your current policy. Also, you may choose to drop your Advantage plan and return to Medicare, or you can drop Part D. If you are continuing to live within the nursing facility, you can join, switch plans, or even drop your coverage. You can do this for up to two months after you move out of the health facility.
Special Enrollment Period if You Were in Jail
When institutionalization or incarceration comes to an end, Medicare SEP rules state you should act immediately to enroll in Medicare. You can enroll in a new plan upon release of jail and can do so for two full months.
Special Enrollment Period Enrollment for New Citizens
You need to be a United States Citizen and resident for at least five years before you can qualify for a SEP to enroll in Medicare.
Special Enrollment Period With Extra Help
When you qualify for Extra Help, you also qualify for a continuous SEP. You can drop, join or switch plans one time during each period; January through March, April through June, and July through September. You can’t make changes from October through December with this Special Enrollment Period. When making a change, the new policy will go into effect on the first day of the next month.
Special Enrollment Period for Medicare When Losing Coverage
There are several instances in which you may find you lose your current coverage. When a person loses coverage, that is an indication of eligibility for a Medicare Special Enrollment Period.
You lose employer health coverage
When you lose health coverage from an employer or union, you can join a different Medicare plan up to a full two months after.
You lose creditable prescription coverage, or it changes dramatically
Losing drug coverage equal to Medicare’s means you can switch to another plan with drug coverage or a stand-alone Part D. This Special Enrollment Period continues for two full months after the month you lose your drug coverage, or you get a notification.
You leave a Medicare cost plan
If you have Part D through a cost plan and you end up leaving that plan, you can enroll in a new policy for up to two months after you leave your old plan.
Your PACE coverage drops
Dropping your coverage in your PACE plan means you can enroll in a new plan for two months with a SEP.
SEPs When You Obtain Other Coverage
Below is a list of circumstances that qualify you for a SEP due to obtaining another type of coverage that’s equal to Medicare.
You can enroll in group coverage that’s offered by your current employer or workers union. To do this, you would drop your current Medicare coverage and would join in a private plan offered by your workplace. You can do this whenever your employer advises you can make changes to your plans.
Prescription Drug Coverages
If you’re enrolling in a drug plan that is just as good as Medicare, you can drop your current Medicare plan at any time.
If you decide to enroll in a PACE plan, you can drop your current Medicare plans at any point in time.
5-Star Medicare Advantage Plan in your Service Area
If there is a 5 star Medicare Advantage plan in your area, you can enroll in this once between December 8th and November 30th, unless you select this coverage during AEP.
Encounter Changes in Medicare Plan’s Contract
Below is a list of circumstances that qualify you for a SEP due to changes with your plan’s contract with Medicare.
Sanctions and Medicare
If Medicare ends up taking official action because of an issue with your plan, and this affects you, you can switch your Medicare plan. Medicare may review making this switch for you, depending on the situation at hand.
Contract ends early
Those that have a health plan coming to an end in the middle of the contract year can switch to another Medicare plan two months before the contract ending and up to one full month after it ends if the policy isn’t for another contract year.
Changes because of other circumstances
You may find yourself in a position where you face a different set of circumstances that qualify you for a SEP.
No Longer Qualify for Extra Help
Those no longer eligible for Extra Help in the upcoming year have several options. You can choose to join a new plan or switch your plan. Further, you can drop your Advantage plan and return to Medicare, or you can choose to decline your drug coverage. You can make changes to your policy for three months from the date in which you’re no longer eligible, or the notification date.
Ineligible for Medicaid
Those no longer eligible for Medicaid coverage can enroll in a new plan, switch plans, drop advantage plan and return to Medicare, or even drop Part D. You can make these changes up to three months from the date that you’re no longer eligible for Medicaid, or when you get a notification.
Special Enrollment Period for Medicare and Medicaid
When eligible for Medicare and Medicaid, you can choose to change plans, whether it be switching, joining, or dropping plans. Changing plans is an option because dual-eligibility and low-income subsidy qualify you for a Special Enrollment Period.
You can do this once throughout the following dates:
Those getting extra help can make changes once during the above time frames.
Enrolled in an SPAP Program
You can choose to join a Medicare plan once during the calendar year.
Enrolled in an SPAP Program and you lose eligibility
You can choose to join a new Medicare plan. You can do this either the month that you lose your eligibility or when you get the notification.
Suffer from a severe condition
If there’s a Special Needs Plan and you have a severely disabling condition, you can join into a Medicare Chronic Care SNP at any time.
Errors by a Federal Employee
If you join a plan or decide to not participate because of a mistake by a federal employee, you have a few options.
You can choose to:
enter a new Medicare plan
switch from your current policy to a new one
drop your Advantage plan and return to Medicare
or drop your drug coverage.
These changes can take a full two months after the month you get notification of the error.
How to Get Help Understanding Medicare Special Enrollment Periods
Not all Special Enrollment Periods for Medicare are listed above. To find out if you qualify for a SEP, give us a call.
About This Site
MedicareFAQ.com (hereinafter “the Site” or “this Site”) is an online resource for people seeking to learn more about their insurance options. Elite Insurance Partners LLC does not endorse any particular insurance plan, provider, or agent. Any information provided about any particular insurance plan, provider, or agent shall not be construed as an endorsement by Elite Insurance Partners LLC.
Copyright and Proprietary Rights Information
This website is owned and maintained by Elite Insurance Partners LLC. No content or images may be downloaded or reproduced without our prior and explicit consent.
While every effort is made to ensure the accuracy of the content of medicarefaq.com, we cannot be held accountable for typographical errors, errors of fact, or any other error or inconsistency found on this website. We hereby disclaim all liability from any damages resulting from the use of this website, or any services provided on any Elite Insurance Partners LLC website.
Links to Third Party Sites
This Site may contain links to sites that are controlled by third parties. These linked sites are not under the control of Elite Insurance Partners LLC, and Elite Insurance Partners LLC is not responsible for the contents of any linked site or any link contained in a linked site.
Information Collected by Elite Insurance Partners LLC
Elite Insurance Partners LLC uses this website to collect personally-identifiable information. When you use our service, you are authorizing the sharing of your inquiry and your personal information with Elite Insurance Partners LLC. The personal information we collect may include, but is not limited to:
These technologies help companies measure the effectiveness of ads, content, user experience and other marketing activities.
How Information Is Collected
We only collect your personally-identifiable information when you choose to share it with us. We will not collect any personally-identifiable information without your consent. The information you choose to share with us may be collected through this website, another website in the Elite Insurance Partners LLC network, or collected over the phone by one of Elite Insurance Partners LLC licensed insurance agents.
Cookies and other technologies, such as web beacons or tags, may be sent to visitors of this website. “Cookies” are text-only pieces of information that a website transfers to an individual’s hard drive or other web site-browsing equipment for record-keeping purposes. Cookies allow the website to remember important information that will make your use of the site more convenient. A cookie will typically contain the name of the domain from which the cookie has come, the “lifetime” of the cookie, and a randomly generated, unique number or other value. A “beacon,” “tag,” or “tracking pixel,” is a one pixel by one pixel image placed on a web asset or email. When your browser connects to a web page and the web page contains a web beacon image, your browser makes a request to the web server to download that image — and with this request, the server logs certain details like your IP address, the date and time, and more.
With cookies, web beacons and other technologies, the information collected and used is always anonymous and does not enable any third-party to identify you individually.
How Information Is Used & Opting-Out
By choosing to submit your personally-identifiable information to us, you are authorizing Elite Insurance Partners LLC to use this information for any purpose in our sole discretion. An Elite Insurance Partners LLC licensed agent may contact you by phone, email, mail, or other form of communication to fulfill your inquiry and provide you with other offers you may be interested in. You expressly consent to receive these communications whether you are on any Federal or state DNC (Do Not Call) and/or DNE (Do Not Email) list or registry.
Although it is our hope that you find this service valuable, if you would prefer not to participate, you can opt-out of this activity at any time by following the browser-specific instructions at the following link: https://www.usa.gov/optout-instructions
If you no longer wish to receive further communications from Elite Insurance Partners LLC, you may “opt-out” at any time and we will remove you from our mailing list within 10 days. You may opt-out of receiving emails by following the “Unsubscribe” link at the bottom of our emails, or by contacting us via the information below.
Elite Insurance Partners LLC 34125 Us Highway 19 North – Unit 200 Palm Harbor, FL 34684 firstname.lastname@example.org 1 (800) 845-2484
Changes to This Policy
This website is owned and operated by Elite Insurance Partners LLC.
Aetna Health and Life Insurance Company (An Aetna Company)
American Continental Insurance Company (An Aetna Company)
American Retirement Life Insurance Company (A Cigna Company)
Anthem Blue Cross Blue Shield
Blue Cross Blue Shield
Central States Indemnity (A Berkshire Hathaway Group Company)
Continental Life Insurance Company (An Aetna Company)
ForeThought Life Insurance
Gerber Life Insurance
Government Personnel Mutual
Individual Assurance Company
Loyal American Life Insurance Company (A Cigna Company)
Mutual of Omaha
New Era Life Insurance
Omaha Insurance Company (A Mutual of Omaha Company)
Philadelphia American Life Insurance
SilverScript (A CVS Caremark Company)
Standard Life and Casualty
Stonebridge Life Insurance (A TransAmerica Company)