But there may be circumstances when you qualify to join Medicare or change Medicare Advantage or prescription drug coverage outside of typical enrollment periods. In those cases, you might be eligible for a special enrollment period or SEP.
Here’s what you should know about special enrollment periods.
What is a special enrollment period?
A special enrollment period, or SEP, is a period when you’re allowed to join or make changes to your Medicare coverage based on certain life events, such as leaving a job or moving out of your plan’s service area. The rules about how long a SEP lasts or what you’re allowed to do during the SEP depend on why you qualify for the SEP.
When do you qualify for a special enrollment period?
There are many reasons you might be able to use a SEP. Some include:
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You moved. This includes moving outside your plan’s service area, moving back to the United States after living abroad or moving into or out of a skilled nursing facility.
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You lost your current coverage. This includes losing Medicaid eligibility, leaving a job that provided health insurance or losing creditable prescription drug coverage.
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You have an opportunity to get other coverage. This includes having the option to sign up for a private insurance plan offered by your employer.
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Your plan changed. Maybe Medicare sanctioned your plan due to a problem or ended your plan’s contract.
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Your eligibility changed. You’re now eligible for both Medicare and Medicaid, you qualify for Extra Help with Medicare prescription drug coverage or you’re enrolled in a special needs plan and you no longer have the medical condition that led you to sign up for it.
How long is the special enrollment period?
The length of your SEP will depend on the reason you qualify. Here are some situations and the length of the SEP that applies to them:
|
Qualifying SEP event |
Length of SEP |
|---|---|
|
You move to a spot that isn’t in your plan’s service area. |
If you alert your plan before the move, your SEP starts the month before the month you move and continues for two months after. If you alert your plan after the move, your SEP starts the month you tell your plan, plus an additional two months. If you don’t enroll in a new Medicare Advantage plan, you’ll be enrolled in Original Medicare. |
|
You move back to the U.S. after time abroad. |
Two months after the month you return to the U.S. |
|
You move into a skilled nursing facility. |
The entire time you live there and the two months after you leave. |
|
You lose Medicaid eligibility. |
Three months from the date you’re no longer eligible or the date you’re notified, whichever occurs later. |
|
You end employer health coverage. |
Your SEP to join a Medicare Advantage plan or prescription drug plan lasts two months after the month your coverage ends. Your SEP to join Medicare Part B lasts eight months after group health coverage or employment ends. |
|
Medicare ends your plan’s contract. |
The two months before and month after your contract ends. |
|
You’re eligible for both Medicare and Medicaid. |
You can join, switch or end your plan one time during each period from January to March, April to June and July to September. |
For more information on qualifying events and timelines, visit Medicare.gov.
What is the 5-star special enrollment period?
Medicare gives overall performance star ratings to Medicare plans on a five-point scale, with five stars being the best. These ratings are based on information from the plans themselves, health care providers and member surveys. They are updated each year.
If you’re not currently in a five-star Medicare Advantage plan, Medicare drug plan or Medicare cost plan, and there’s one available in your area, you can switch to a five-star plan during a special enrollment period. Each year it goes from Dec. 8 to Nov. 30 the following year, and you may change only once during that time.
There are some caveats:
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Suppose you switch from a Medicare Advantage plan with prescription drug coverage to a Medicare Advantage plan that doesn’t include prescription drug coverage. In that case, you might lose your drug coverage, and you may have to wait until the next official enrollment window to sign up again. (This may result in late penalties.)
What if you get Extra Help?
If you’re eligible for both Medicare and Medicaid or you qualify for Extra Help paying for Medicare drug coverage, there are special enrollment periods that apply to your situation. During these SEPs, you can join, change or quit your Medicare Advantage plan or prescription drug coverage.
You can make a change one time during each of the following periods:
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January to March.
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April to June.
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July to September.
Changes take effect on the first day of the following month.
If you’re enrolled in a state pharmaceutical assistance program, or SPAP, or you lose SPAP eligibility, you can join a Medicare drug plan or Medicare Advantage plan with drug coverage once during the calendar year.
This post was originally published on Nerd Wallet
