Understanding Medicare Special Enrollment Period | Medicare Plan Finder

Find Out If You Qualify for a Special Enrollment Period


Medicare Special Enrollment Period (SEP)

Most people can only enroll in Medicare or change Medicare plans during one very specific time of year, but there is one enrollment period that operates a bit differently. If you are eligible for an SEP, you can enroll in or change Medicare plans during almost any time of the year!

You can either have a SEP for a set period of time, or you can have a lifelong SEP.  A 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 a SEP can only make changes during AEP (October 15 - December 7) every year. If you qualify for a SEP, you should take advantage of your ability to get yourself into a better plan.

Medicare Special Enrollment Period | Medicare Plan Finder

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

5 Star Medicare Advantage Plans Enrollment

There is one other way that you can qualify for a SEP: through a new 5-star Medicare Advantage plan! Medicare scores Medicare Advantage and Part D plans in categories like care quality, customer service, complaints, responsiveness, available preventative health benefits, etc. Every year, scores are released before AEP (the Annual Enrollment Period) so that beneficiaries can make educated choices based on “star ratings.” How does this apply to enrollment periods?

If you do not currently have 5-star Medicare Advantage plans available in your zip code, and then a new 5-star plan becomes available, you have the right to switch from your plan into the 5-star option even if it is not AEP. This essentially gives you a “Medicare Special Enrollment Period.” However, your only option during this period will be to switch into the 5-star plan. You would not be able to switch from one three or four-star plan into another three or four-star plan.

What changes can be made during a Special Enrollment Period?

There is a handful of changes you can make during your SEP:

  • 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

SEPs are NOT for those enrolling in Medicare for the first time. If you are about to turn 65, you should instead enroll during your Initial Enrollment Period. If you already turned 65 and you missed your Initial Enrollment Period, you need to enroll during the General Enrollment Period.

When can you Enroll in Medicare?

We know that the different enrollment periods can be confusing. If you aren’t sure whether or not you qualify for a Medicare Special Enrollment Period, 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 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!