Special Enrollment Period MedicareMarch 29, 2019
Most people are only eligible to enroll in Medicare during their Initial Enrollment Period (three months before and after your 65th birthday) or during the Annual Enrollment Period (October 15 – December 7). However, there are several circumstances that may allow you to enroll in a Special Enrollment Period Medicare plan, including Part B, Medicare Advantage, Medicare Supplements, or Part D, outside of the initial and annual enrollment periods!
If you qualify for a SEP, you should take advantage of your ability to get yourself into a better plan. This includes:
- Switching to a new plan in your area
- Moving from one Medicare Advantage plan to another
- Enrolling in Medicare Advantage for the first time
- Switching from a Medicare Supplement plan to Medicare Advantage
- Adding or changing prescription drug coverage
Different Types of SEPs
There are two main types of SEPs – lifelong and circumstantial. Lifelong SEP means you qualify for a SEP every year, unless your eligibility changes. For example, if you were eligible for Medicaid, but your income increased drastically, you may no longer be eligible. Circumstantial SEP means you qualify for a special enrollment period one time, depending on your circumstances. For example, if you move to a new service area, you will be able to make changes one time, unless you qualify for a different reason at a later date.
Another way you can qualify for a SEP is through a 5 star Medicare plan. If you are not currently enrolled in a 5 star Medicare plan, but one becomes available in your area, you can enroll in a better plan without being penalized. To learn more, click here.
To qualify for a lifelong SEP, you must fall into at least one of the following categories:
- Be eligible for Medicaid or a Medicare Savings Program
- Part of SPAP (State Pharmaceutical Assistance Program)
- Be enrolled in a SNP (Special Needs Plan)
- Have a chronic illness or disability & receive Social Security benefits
- In a Medicare Savings Program or LIS (Extra Help)
Many people who qualify for a lifelong SEP are eligible for a Special Needs Plan. You must live in an area that supports a SNP plan as they are not available everywhere. Then, to be eligible, you must have a special need. In the case of SNPs, special needs can mean Medicaid-eligible/low-income (D-SNP), institutionalized (I-SNP), or diagnosed with a severe or disabling chronic condition (C-SNP).
To qualify for a circumstantial SEP, you must:
- Move to a new service area
- Involuntarily lose your coverage (for example, if your plan stops accepting Medicare assignment)
- Find a contract violation with your plan
- Lose or gain a job with group health insurance
- Move into or out of a facility
- Leave imprisonment
- Enter or leave a health facility
- Gain or lose Medicaid eligibility
- Gain or lose Medicare Savings Program or LIS eligibility
- Have been automatically enrolled in Part D
Special Enrollment Period Medicare Part B
In some cases, you may have a Special Enrollment Period for Medicare Part B (and Part A). If you are covered by a group health plan from your employer (and you are still employed), you may be granted a Special Enrollment Period. This SEP will begin the month after your group health plan or your employment ends and will generally last for eight months.
In most cases, this means that even though you are passing your Initial Enrollment Period, you will not face a late enrollment penalty fee (due to your employer coverage still being active).
How long does the special enrollment period last?
Special enrollment periods typically last 60 days. This means you have roughly two months to change or enroll in a different plan. However, depending on your circumstances, you may be limited to the changes you can make and the time frame could differ. Your best bet is to speak with a licensed agent and discuss eligibility and plan options. To ask any questions or to speak with a licensed agent, fill out this form.
Is being eligible for Medicare a qualifying event?
Being eligible for Medicare is not a qualifying event for a special enrollment period. If you are about to turn 65, you are eligible to enroll through your initial enrollment period, not a special enrollment period. The only events that qualify you for a SEP are listed above. If you have any questions on if your situation applies, fill out this form, and we will be in touch with you.
Do I qualify for a Special Enrollment Period Medicare Plan?
We get it, enrollment periods can be confusing, and it can be difficult to know if you qualify. If you aren’t sure whether or not you qualify for a special enrollment period medicare plan, or which enrollment period you need to use to enroll, we can help you. We can also help you figure out if you are eligible for
This blog was originally published on 4/17/17, but was updated on 3/29/19.