Medicare Special Enrollment Periods

Medicare Special Enrollment Periods

You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs) and are in addition to the regular enrollment periods that happen each year. Rules about when you can make changes and the type of changes you can make are different for each SEP.

Some examples of circumstances that qualify a beneficiary for a Special Enrollment Period to switch either a Medicare Advantage or a Medicare Prescription Drug Plan include:

Switching Medicare Plans

Some examples of circumstances that qualify a beneficiary for a Special Enrollment Period to switch either a Medicare Advantage or a Medicare Prescription Drug Plan include:

  • Moving out of a plan’s network or moving to a new location with new plan options
  • Changes in institutional status, such as moving into, currently living in, or moving out of a skilled nursing facility or long-term care hospital
  • Becoming eligible for both Medicare and Medicaid or qualifying for the Extra Help program
  • Losing eligibility for assistance programs such as Medicaid and the Extra Help program
  • Changes in a plan’s contract with Medicare, such as termination before the end of the contract year

Joining a Medicare Plan

Outside of the Annual Election Period (AEP), also known as the Annual Enrollment Period, beneficiaries may have the option to join a Medicare Advantage or Medicare Prescription Drug Plan under certain special circumstances, such as:

  • Moving back to the United States after living outside of the country for a period of time
  • Being released from jail
  • Moving into, currently living in, or moving out of an institution such as a long-term care hospital or a skilled nursing facility
  • Leaving employer or union coverage
  • Losing eligibility for Medicaid or the Extra Help program
  • Involuntarily losing creditable drug coverage other that Medicare Part D coverage
  • Leaving a Medicare Cost Plan or a Program of All-Inclusive Care for the Elderly (PACE) plan

Dropping a Medicare Plan

By qualifying for a Special Enrollment Period under certain circumstances, a beneficiary may completely drop their Medicare Advantage or Prescription Drug Plan coverage. Some of these circumstances include:

  • Changes in institutional status, including moving into, out of, or currently residing in an institution such as a skilled nursing facility or a long-term care hospital
  • Having the option to enroll in other health care coverage through an employer or union
  • Enrolling in drug coverage that is at least as good as Medicare prescription drug coverage, such as TRICARE or VA coverage
  • Enrolling in a Program of All-inclusive Care for the Elderly (PACE) plan

Call Independent Insurance Consultants to see if you may qualify for a Medicare Special Enrollment Period.

Toll Free 1-866-691-5571

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