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Medicare Special Enrollment Period

Summary: Having a Medicare Special Enrollment Period allows you to change your coverage when you may otherwise be unable to. You’ll need to experience a qualifying life event to use a Special Enrollment Period for Medicare, but doing so will help you avoid penalties and lapses in coverage. Estimated Read Time: 16 mins

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Table of Contents:

  1. What Is a Medicare Special Enrollment Period?
  2. What Qualifies as a Special Enrollment Period for Medicare?
  3. What is a Special Enrollment Period for Medicare Part B?
  4. How Long Is the Medicare Special Enrollment Period?
  5. Trial Rights Special Enrollment Period
  6. Special Enrollment Period for Medicare When Moving
  7. Medicare Special Enrollment Period if You Were in Jail
  8. Medicare Special Enrollment Period for Extra Help
  9. Medicare Special Enrollment Period When Losing Coverage
  10. Medicare Special Enrollment Periods When Obtaining Other Coverages
  11. Encounter Changes in Medicare Plan’s Contract
  12. Changes Due to Other Circumstances
  13. Is There a Medicare Special Enrollment Period When Dual Eligible for Medicare and Medicaid?
  14. Is There a Special Enrollment Period for New Citizens?
  15. How To Qualify for Special Enrollment Period
  16. How to Enroll During a Medicare Special Enrollment Period

A Medicare Special Enrollment Period (SEP) can make you eligible to enroll in or change your Medicare benefits outside of a standard enrollment period. Multiple life events can trigger a Special Enrollment Period, and Medicare beneficiaries can use this period to maintain their health coverage without having a lapse or worry about having to undergo medical underwriting.

The Special Enrollment Period for Medicare is an important feature because without it you may otherwise have to wait for coverage. This could trigger a domino effect of negative outcomes which may see you spending more for healthcare services in the long run. You may even be forced to pay more for healthcare coverage down-the-line or even lose out on coverage options as a result.

Understanding each Medicare SEP and how they benefit you is key to ensure your healthcare costs are met with the appropriate coverage. Below, we’ll review the most common Special Enrollment Periods for Medicare.

What Is a Medicare Special Enrollment Period?

Your Medicare Special Enrollment Period, also known as a Special Election Period, is an opportunity to enroll in or change your Medicare coverage when you are experiencing a qualifying life event. While a Medicare SEP is allowed for all beneficiaries, you must have coverage that qualifies and be undergoing a qualifying life event.

For example, if you decide that you are unhappy with your Medicare Part C coverage and want to switch, but it’s outside of the Medicare Annual Enrollment Period, you’ll have to wait until the fall. However, if you are moving to a new city that requires you to enroll in a different plan option, you’d be given the opportunity to make changes because of Special Enrollment Period Medicare provides.

Everyone experiences different life changes and shouldn’t have to forgo healthcare coverage because of them. Again, you’ll need to undergo a qualifying event, but if you do, you’ll receive a Special Enrollment Period for Medicare. Starting in 2024, there are even more potential SEPs that will become available.

Just as beneficiaries experience changes, so too does the Medicare program. Managed by the Centers for Medicare & Medicaid Services (CMS), the government will begin allowing those who sign up for either part of Original Medicare (Parts A and B) due to an “exceptional situation” to have an SEP. In this case, your Medicare special enrollment is allotted for two months, and you can sign up for a Medicare Advantage or Part D plan.

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What Qualifies as a Special Enrollment Period for Medicare?

Medicare Special Enrollment Periods come when a qualifying life event allows you to make changes to your Medicare Advantage and Medicare Part D prescription drug coverage. Here are the most common examples that qualify under Medicare special enrollment qualifications:

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You’ve Moved to an Area Your Plan Doesn’t Offer Coverage

The SEP Medicare provides here works in a few ways. Those who notify their carrier before moving will receive a Special Enrollment Period that starts the month before they make the move and will last for two months following the completion of the move.

If you wait to tell your carrier until after you move, your SEP begins the month your carrier was notified and will last two more months afterward. Anyone who doesn’t enroll in a new Medicare Advantage or Part D plan using an SEP will rely on Original Medicare by default.

You’ve Lost Your Coverage From an Employer

If you are no longer receiving coverage from your place of work, here’s how your Special Enrollment Period for Medicare works:

  • For Part B coverage, you’ll have eight months following the end of your employer’s plan or your time of employment ends.
  • For beneficiaries with Medicare Advantage or Part D plans, you’ll have an SEP for two months following the conclusion of your coverage.

You Decide To Enroll in Another Coverage, Such as Employer Coverage or TRICARE

An SEP because there are chances to enroll in coverage from your employer is available. This includes the military community who are eligible for TRICARE. You’ll need to act when you are notified of the opportunity to take advantage of this period.

Medicare Decides to End Its Contract With Your Plan

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If the Medicare program ends its contract with your Medicare Advantage or Part D plan, you’re going to need to find an alternative option. Should this affect your coverage, you’ll have the Special Enrollment Period Medicare offers is for two months before the end of your contract and another full month afterward.

Various Individual Reasons That Affect Your Coverage

Maybe you’ve moved back in the United States after living abroad. In this case, you’ll receive a Medicare SEP for two months beginning the month after you return stateside. Perhaps you’ve moved into a skilled nursing facility. In this case, you’ll have a Medicare Special Enrollment Period while you’re there and it lasts for up to two months after you leave.

Some beneficiaries may be enrolled in Medicaid but lose their eligibility. The SEP Medicare allows here is for three months. This can be either from the date you are no longer eligible for Medicaid benefits or when you are notified as such. It depends on which happens later and is based on the latest date.

Ultimately, Medicare beneficiaries have plenty of specific Special Enrollment Periods that might apply depending on their situation. Explore specific Special Enrollment Periods for Medicare below, the rules that apply to your coverage, and if you have questions about your specific situation, be sure to reach out to a licensed agent to discuss the details.

What is a Special Enrollment Period for Medicare Part B?

The Medicare Part B Special Enrollment Period allows you to delay enrolling without a lifelong penalty when you first become eligible. You must meet at least one of the eligibility requirements below to qualify for a Medicare Special Enrollment Period for Part B.

Eligibility Requirements for the Medicare Part B Special Enrollment Period are as follows:

  1. You’re eligible for Medicare due to a disability
  2. You had creditable employer group coverage when you first became eligible
  3. No more than eight months have passed since your employer group coverage was canceled

You’ll need to print and mail both SEP Medicare Part B forms to the Social Security Administration (SSA):

  1. CMS 40B
  2. CMS L564

Your employer will need to complete Form CMS L564. You can also upload the completed forms to your My Social Security account.

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Even if you are still in a group health plan because of your job, you can still enroll in Medicare Part B through an SEP for Medicare. Should you leave your place of work or if the coverage from your company provides goes away, you’ll have eight months from that month, whichever is first, to sign up for Part B coverage and avoid the penalty.

How Long Is the Medicare Special Enrollment Period?

Each Medicare Special Enrollment Period has its own guidelines, including the length of time you have to enroll. Medicare Special Enrollment Periods and their length of availability all deal with the qualifying life event that triggers them. For example:

  • If you are moving back to the United States after living abroad, you’ll have two full months after the month you move back.
  • On the other hand, if you were to become ineligible for Medicaid, you’ll have three full months from either the date you’re no longer eligible or notified, whichever one is later.

To better understand how much time you have, you must disclose your situation to a licensed agent and act immediately to avoid any coverage delays.

Trial Rights Special Enrollment Period

Medicare beneficiaries have two different types of trial rights Special Enrollment Periods:

  • When you are enrolling in a Medicare Advantage plan upon first becoming eligible for Original Medicare. Note: This does not apply to beneficiaries who started Original Medicare (Part A and Part B) before age 65 or chose to delay it, and are now turning 65 years of age.
  • When you drop a Medicare Supplement plan and are joining a Medicare Advantage plan for the first time but are looking to switch back within a year.

Special Enrollment Period for Medicare When Moving

When moving to a different ZIP Code or service area, different rules will apply to qualify you for a Medicare Special Enrollment Period. It’ll also matter where you are moving from. For example, you can get a Special Enrollment Period for Medicare for moving across town, but you’ll have a different SEP if you’re moving back into the U.S. altogether.

Having to deal with enrolling in coverage when you move can be a hassle for some beneficiaries and prove to make travel a bit more difficult. For these reasons and more, some decide to enroll in a Medicare Supplement plan, or Medigap plan, as a viable coverage alternative.

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. In fact, some Medigap plans even offer a foreign emergency travel benefit if you travel abroad.

While this is the case regardless of whether you’re moving to another county within the same state or a new one, you’ll still want to notify your Medigap carrier that you moved so they can update their records.

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The exception to the scenario for Medicare Supplement plans above is if you’re moving to one of the states with their version of standardized Medigap plans. These states are Massachusetts, Minnesota, and Wisconsin. You’ll want to consider enrolling in one of their state-specific plans that offer similar benefits to the lettered plans in the other 47 states.

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.

For more information, click the link to discover tips for moving to another state with Medicare.

Medicare Special Enrollment Period if You Were in Jail

When institutionalization or incarceration ends, Medicare SEP rules state you should act immediately to enroll in Medicare. You can enroll in a new plan upon release from jail to avoid issues with your coverage and penalties.

Relatively new, the passing of 42 C.F.R. § 406.27(d) provides an incarceration SEP for eligible beneficiaries. You can use this Medicare SEP for both Parts of Original Medicare if you don’t qualify for premium-free Part A coverage.

Starting on the date you are released from custody, you’ll have 12 months and can enroll in coverage without facing penalties. You’ll receive your coverage the first day of the following month when you enroll. However, if you pay the premiums, you can have retroactive coverage of 6 months for Original Medicare only.

Eligible beneficiaries will need to apply using form CMS-10797 through the Social Security Administration. Remember, retroactive coverage is not available outside of Original Medicare. This includes Part D.

Medicare Special Enrollment Period for Extra Help

When you are eligible for Extra Help, you also qualify for a continuous Special Enrollment Period for Medicare. You can drop, join or switch plans once during each period, January through March, April through June, and July through September.

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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 following month.

Medicare Special Enrollment Period When Losing Coverage

There are several instances in which you may find you lose your current coverage. When a person loses coverage, that indicates eligibility for a Medicare Advantage Special Enrollment Period or an SEP that applies to Part D These include the following:

You Lose Employer Health Coverage

When you lose health coverage from an employer or union, you can join a different Medicare plan for up to two months.

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 Medicare Part D prescription drug plan. 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 Medicare Part D through a cost plan and you leave that plan, you can enroll in a new policy for up to two months after you leave your old plan.

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Your Program of All-Inclusive Care For the Elderly (PACE) Coverage Drops

Dropping your coverage in your PACE plan means you can enroll in a new plan for two months with a Medicare Special Enrollment Period.

Medicare Special Enrollment Periods When Obtaining Other Coverages

Below is a list of circumstances that qualify you for an SEP due to obtaining another type of coverage that’s equal to Medicare.

Employer-Offered Coverages

You can enroll in group coverage your current employer or workers union offers. To do this, you would drop your current Medicare coverage and join in a private plan through your workplace. You can do this whenever your employer advises you can make changes to your coverage.

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.

PACE Plan

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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 the Annual Enrollment Period (AEP).

Encounter Changes in Medicare Plan’s Contract

Below is a list of circumstances that qualify you for a Special Enrollment Period for Medicare due to changes in your plan’s contract with Medicare.

Sanctions and Medicare

If Medicare ultimately takes 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.

Your Contract Ends Early

Those whose health plan ends in the middle of the contract year can switch to another Medicare plan two months before the contract ends and up to one full month after it ends if the policy isn’t for another contract year.

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Changes Due to Other Circumstances

You may find yourself in a position where you face a different set of circumstances that qualify you for a Medicare Special Enrollment Period. Below are qualifying life events that can trigger your eligibility.

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 Medicare Advantage plan and return to Original Medicare, or you can choose to decline your drug coverage. You can make changes to your policy for three months from the date you’re no longer eligible or the notification date.

No Longer Eligible for Medicaid

Those no longer eligible for Medicaid coverage can enroll in a new plan, switch plans, drop their Medicare 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.

Is There a Medicare Special Enrollment Period When Dual Eligible for Medicare and Medicaid?

When eligible for Medicare and Medicaid, you can choose to change plans, whether you are switching, joining, or dropping plans. Changing plans is an option because dual-eligibility and low-income subsidy qualify you for a Medicare Special Enrollment Period.

You can do this once throughout the following dates:

  • January-March
  • April-June
  • July-September

Those getting Extra Help can make changes once during the above time frames.

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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. This is possible either the month that you lose your eligibility or when you get the notification.

Suffer From a Severe Condition

If there’s a Medicare Advantage Special Needs Plan and you have a severely disabling condition, you can join 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.

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You can choose to:

  • enter a new Medicare plan
  • switch from your current policy to a new one
  • drop your Medicare Advantage plan and return to Original Medicare
  • or drop your drug coverage.

These changes can take a full two months after the month you receive notification of the error.

Is There a Special Enrollment Period for New Citizens?

You need to be a United States Citizen and resident for at least five years before you can qualify for any Special Enrollment Period Medicare offers. Therefore, no, new citizens will need to wait until they reach this threshold before an SEP will apply.

How To Qualify for Special Enrollment Period

Not everyone qualifies for an SEP and it’s important to understand where you stand. You can have a Medicare Special Enrollment Period if you fall under the following criteria:

To Have an SEP You Need to Be Eligible for Medicare Benefits

An SEP is available for Medicare benefits. Therefore, you’ll need to be eligible for the Medicare program in order to have a Special Enrollment Period. These periods don’t apply to those who are not enrolled in some form of Medicare.

Experience a Qualifying Life Event

While being a Medicare beneficiary is important, an SEP isn’t always available by default. In order to be eligible, you’re going to need to experience a qualifying life event recognized by Medicare that triggers your Special Enrollment Period.

Contact Your Plan or Medicare About Your Qualifying Life Event

To take advantage of any SEP Medicare leaves available, you’re going to need to contact your carrier if it involves Medicare Advantage or Part D coverage. For those receiving a Medicare SEP for Part B, you’ll need to contact Social Security with the appropriate forms.

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How to Enroll During a Medicare Special Enrollment Period

Not all Medicare Special Enrollment Periods are listed above. To find out if you qualify for an SEP, give us a call. We can help you through any of the various Medicare Enrollment Periods.

With a licensed agent on your side, making a decision during your Medicare Special Enrollment Period is so much easier. If you have a qualifying life event, we can help you compare all the options in your area. You can also use our compare plans button below to review coverage options in your area.

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Special Enrollment Periods, Medicare. Accessed September 2023.
    https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods
  2. How to Apply for Medicare Part B (Medical Insurance) During Your Special Enrollment Period, SSA. Accessed September 2023.
    https://www.ssa.gov/pubs/EN-05-10012.pdf
  3. Medicare Special Enrollment Period for Formerly Incarcerated Individuals: What Advocates Need to Know, Justice In Aging. Accessed September 2023.
    https://justiceinaging.org/wp-content/uploads/2023/07/Medicare-SEP-for-Formerly-Incarcerated-Individuals-Issue-Brief.pdf
Jagger Esch

Jagger Esch

Medicare Educator
Jagger Esch is the Medicare Educator for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

10 thoughts on "Medicare Special Enrollment Period"

  1. Hi,
    I am a retiree since 2014 and have par A Medicare since then. In addition, during all this time I participated in my wife’s group health insurance provided by her employer until her retirement in April, 2023.
    We have not applied for Part B immediately after her retirement because of different circumstances and would like to start coverage in 2024. It will be 9 month since dropping the coverage by my wife’s employer, so we don’t qualify for Special Enrollment Period. If we apply during General Enrollment in January, 2024, will we be penalized in premiums?
    Thanks a lot.

    1. If you lost group coverage in April 2023 and plan to enroll during the General Enrollment Period in 2024, you will NOT be penalized for premium. This is because you had less than a 12 month lapse in coverage.

  2. Hello, I am 72 and have worked for many years with a large (20+) employer, about 25 to 30 hours per week. I have part A but not B. If I decide it’s better for me (I’m single) to sign up for part B and an MAPD plan, is dropping my employer coverage the same as “loosing” my employer coverage? If so do I get 3 months of SEP? Or do I need to use the AEP????
    Thanks for any advice.

    1. Hi Christine – leaving the coverage you currently have through your employer or group qualifies you for a special enrollment period, even if it is voluntary and you stay at your job. After your employer coverage ends, you’ll have two full months to choose an Advantage or Part D prescription drug plan.

  3. Hello. I am curious if someone can confirm, if I obtained Part B Medicare during the 8 month SEP after my former employer’s private coverage ended, however I missed applying for Part D within the two month SEP, does issuance of Part B coverage create a second 2 month SEP during which i can apply for Part D? I thought someone from the Medicare office advised me of this SEP, however the insurance provider has no clue about a second 2 month SEP for Part D . I would hate to have to wait for the annual open enrollment period and have a larger penalty for the rest of my life. Thanks for your help…

    1. Hi Hal! No, your Part B effective date does not trigger another SEP for Part D. You will not have a large penalty if you have to wait until AEP with an effective date in January. It’s 1% per month you went without coverage, it’s not as high as the Part B penalty. So, if you ended up delaying Part D for 6 months, you would be penalized 6%. The average premium for Part D is about $33. If you do the math, your penalty is less than $2.

  4. my mother lives in my state but in a different town. She owns her home. I want to move her in with me for about 80% of the time because of her health, but keep her home so she can still go back there to visit once an a while. She will continue to homestead her home. We have change most of her mail to us, but other goes to her original home. Can she do an SEP to change her plan for my area as she will be here 80%+ of the time?

    1. Hi Ann! Yes, as long as you can show proof of residency through her mail, your mom can use a SEP to switch plans.

  5. My spouse and I are currently covered by Medicare Advantage plans. I will be “unretiring” in January 2021 and will be eligible for group insurance [+20]. If I understand correctly, I can opt for group coverage and drop Part B. What about my spouse, if I add her to my company group plan? Can we drop her Part B too?

    1. Hi James! Great question. Yes, your spouse can drop Part B and join your employer’s group plan. There will be a form your employer fills out and gives you when you and your spouse leave the group plan that will show Medicare you had other creditable coverage. That form will allow you to re-enroll in Part B without incurring any penalties.

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