Understanding Medicare Special Enrollment Period | Medicare Plan Finder

Find Out If You Qualify for a Special Enrollment Period


Medicare Special Enrollment Period

Did you know that you can only enroll in Medicare plans during certain times of the year? If you want to enroll in Medicare Advantage, you’ll have to first figure out when you can do so

What are the different Medicare enrollment periods?

There are three main Medicare enrollment periods:

  • Initial Enrollment Period
  • Annual Enrollment Period
  • Special Enrollment Period

Your initial enrollment period is when everyone is eligible to enroll in Medicare plans. It begins three months before your 65th birthday and ends three months after. Next is the Annual Enrollment Period, and it lasts from October 15 through December 7 of each year. The third and final period does NOT apply to everybody - and that’s the special enrollment period.

When is my Medicare Special Enrollment Period? | Medicare Plan Finder

The Medicare Special Enrollment Period (SEP)

Some Medicare beneficiaries are eligible for a Special Enrollment Period, or SEP. You can either have an SEP for a set period of time, or you can have a lifelong SEP. An SEP allows you to enroll in a new Medicare plan or make changes to your current coverage outside of the normal enrollment periods. Remember that those who do not have an SEP can only make changes during AEP (October 15 - December 7) every year. If you qualify for an SEP, you should take advantage of your ability to get yourself into a better plan.

Who qualifies for a Medicare SEP?

To qualify for a lifelong SEP, you must fall into at least one of the following categories:

  • 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

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)
  • Lose or gain a job
  • Move into or out of a facility
  • Leave imprisonment
  • Gain or lose Medicaid eligibility

If any of those circumstantial events apply to you, you will have 60 days from the event to change your health care plan.

Medicare Special Enrollment Period | Medicare Plan Finder

What changes can be made during a Special Enrollment Period?

During your special enrollment period, you can:

  • Switch to a new plan in your area
  • Move from one Medicare Advantage plan to another
  • Add Medicare Advantage to your existing coverage
  • Switch from Medigap to Medicare Advantage
  • Change or add a form of prescription drug coverage

If you aren’t sure whether or not you qualify for a Special Enrollment Period, we can help you. We can also help you figure out if you are eligible for LIS (otherwise known as Extra Help) or another health care savings program, which will allow you to change plans at any time.

To set up a free appointment with one of our licensed agents in your area, call 1-844-431-1832.

Have questions? Ask a Benefits Advisor!