There are multiple life events that can make you eligible for a Special Enrollment Period. The SEP allows you to make changes to your Medicare coverage outside the standard enrollment periods. An example of a life event that would qualify you for a SEP is if you moved to a different state. 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:
- Your eligible for Medicare due to a disability
- You had creditable employer group coverage when you first became eligible
- No more than eight months have passed since your employer group coverage was canceled
You’ll need to print and mail the following two forms to Social Security:
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
Medicare Special Enrollment Period for Moving
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.
Here is a list of tips for moving to another state with Medicare.
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
Special Enrollment Period Enrollment for New Citizens
Special Enrollment Period With Extra Help
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.