Medicare Special Enrollment Period

A Medicare Special Enrollment Period (SEP) can make you eligible for benefits. Multiple life events can trigger this enrollment period. An SEP allows you to change your Medicare coverage outside the standard enrollment periods. Below, we’ll review the most common Special Enrollment Periods for Medicare.

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 Special Enrollment Period for Medicare Part B.

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Eligibility Requirements for the Medicare Part B Special Enrollment Period:

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 Medicare Part B Special Enrollment Period 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.

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 prescription drug coverage. Here are the most common examples that qualify:

• You’ve moved.
• You’ve lost your coverage.
• There is an opportunity to enroll in another coverage, such as employer coverage or TRICARE.
• The contract between your plan and Medicare changes.
• Various special situations arise which affect your coverage.

Medicare beneficiaries have plenty of specific Special Enrollment Periods that might apply depending on their situation. Explore specific scenarios below and the rules that apply to your coverage.

Trial Rights Special Enrollment Period

Seniors 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: Seniors that started Original Medicare (Part A and Part B) before age 65 or chose to delay it, this does not apply once you turn 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.

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 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.

The exception to the 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.

Here is a list of tips for moving to another state with Medicare.

Moving to Another State with Medicare Advantage or Part D

Specific scenarios and terms apply to your SEP when you move to another state with Medicare Advantage or Medicare Part D. Explore the different qualifying life events that can provide you with a Medicare Special Enrollment Period.

Your new home address isn’t in your plan’s service region

If you move to a different state 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 for two months. However, tell the company after the move, and the SEP begins the month you notify them, plus the following two months.

Your new home is still within your plan’s service area, but new plan options are available

You can select a new plan if your new ZIP Code is within the service area but with new plan options. 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 join a plan if you don’t have one or switch your current policy.

Also, you may choose to drop your Medicare Advantage plan and return to Original Medicare, or you can drop Part D. If you continue 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.

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 and can do so for two full months.

Medicare Special Enrollment Period for Extra Help

When you are eligible for Extra Help, you also qualify for a continuous SEP. You can drop, join or switch plans once 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 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 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 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.

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

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 an SEP 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.

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.

Changes Due to Other Circumstances

You may find yourself in a position where you face a different set of circumstances that qualify you for an SEP. 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.

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.

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.

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 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.

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 an SEP to enroll in Medicare.

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 Advantage Enrollment Periods.

With a Medicare expert 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 rate comparison form to see rates in your area now.

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