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Medicare Special Enrollment Periods


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 Special Enrollment Periods for Medicare.

What’s a 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:

  1. Your 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 the following two forms to Social Security:

  1. CMS 40B
  2. CMS L564

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.

Is There a Special Enrollment Period for Moving with Medicare?

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.

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.

Is there a 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 from jail and can do so for two full months.

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 a SEP to enroll in Medicare.

Is there a Special Enrollment Period for 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.

Is there a 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.

Employer-Offered Coverages

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.

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 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 Due to 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.

Is there a Special Enrollment Period when Dual Eligible 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:

  • 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. 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 Enroll in Medicare with a Special Enrollment Period

Not all Special Enrollment Periods for Medicare are listed above. To find out if you qualify for a 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 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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Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

6 thoughts on “Medicare Special Enrollment Periods

  1. 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.

  2. 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.

  3. 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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