Special Enrollment Periods

When certain events happen in your life, if you move or if you lose insurance coverage, you may be granted a special enrollment period (SEP)(A period where you can make changes to your Medicare Advantage and prescription drug coverage. The rules about the types of changes and when you can make them are different for each SEP)

Changing where you live
I've moved out of my plan's service area

 

  • If you inform your plan before you move, your special enrollment period will start the month before the month you move and continues 2 full months after you move.
  • If you inform your plan after you move, your special enrollment period starts the month you tell the plan and continues 2 additional full months.

You can switch to a new Medicare Advantage Plan or Medicare Prescription Drug Plan during this time. If you are enrolled in a Medicare Advantage Plan, you could also return to Original Medicare. If you don’t enroll in a new Medicare Advantage plan during your special enrollment period you will be automatically enrolled in Original Medicare when you are disenrolled from your old Medicare Advantage Plan.

 

I moved within my plan's service area, but I have new plan options in my new location.
  • If you inform your plan before you move, your special enrollment period will start the month before the month you move and continues 2 full months after you move.
  • If you inform your plan after you move, your special enrollment period starts the month you tell the plan and continues 2 additional full months.

You can switch to a new Medicare Advantage Plan or Medicare Prescription Drug Plan during this time.

I moved back to the U.S. after living outside the country

Your special enrollment period will start when you move back to the U.S. and lasts 2 full months. During this time you can enroll in a Medicare Advantage Plan or Medicare Prescription Drug Plan.

I just moved into, currently live in, or just moved out of an institution (like a skilled nursing home or long-term care hospital)

You can join, switch, or drop your coverage as long as you live in the institution plus an additional 2 full months after the month you move out of the institution.

I have been released from jail

You can join a Medicare Advantage Plan or Medicare Prescription Drug Plan up to 2 full months after the month you were released from jail.

Losing your current coverage
I'm no longer eligible for Medicaid

Your special enrollment period starts 3 full months from the date you’re no longer eligible or the date you’re notified (whichever is later). You can join a Medicare Advantage plan or Medicare Prescription Drug Plan, switch Medicare Advantage plans or Medicare Prescription Drug Plans, return to Original Medicare, or drop your Medicare coverage altogether.

I've left my employer or union coverage (including COBRA coverage)

Your special enrollment period lasts 2 full months after the month your coverage ends. During this time you can join a Medicare Advantage Plan or Medicare Prescription Drug Plan.

I've involuntarily lost other drug coverage that is not as good as Medicare drug coverage, (Creditable coverage), or my other coverage changes and is no longer creditable.

Your special enrollment period lasts 2 full months after the month you lose creditable coverage or are notified that you’ve lost creditable coverage (whichever is later). During this time you can enroll in a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.

I had drug coverage through a Medicare Cost Plan and left the plan

Your special enrollment period lasts 2 full months after you drop the Medicare Cost Plan. During this time you can enroll in a Medicare Prescription Drug Plan.

I dropped my coverage in a Program of All-inclusive Care for the Elderly (PACE) plan

Your special enrollment period lasts 2 full months after the month you drop your Program of All-inclusive Care for the Elderly (PACE) plan. During this time you can enroll in a Medicare Advantage Plan or Medicare Prescription Drug Plan.

You have a chance to get other coverage
My employer or union is offering me the chance to enroll in the other coverage.

Your special enrollment period occurs when your employer or union allows you to make changes to your plan. During this time you can drop your current Medicare Advantage Plan or Medicare Prescription drug Plan to enroll in the plan offered by your employer or union.

I have or am going to enroll in other coverage that is as good as Medicare Prescription Drug coverage (like TRICARE or VA coverage)

At any time, you can drop your current Medicare Advantage Plan with drug coverage or Medicare Prescription Drug Plan to enroll in the other coverage

I have enrolled in a Program of All-inclusive Care for the Elderly (PACE) plan.

At any time, you can drop your current Medicare Advantage Plan or Medicare Prescription Drug Plan.

Your plan changes its contract with Medicare
Medicare takes official action (a "sanction") in response to a problem with the plan that affects me

Your special enrollment period is determined by Medicare on a case-by-case basis. During this time you can switch your Medicare Advantage Plan or Medicare Prescription Drug Plan.

Medicare terminates my current plan's coverage.

Your special enrollment period starts 2 months before and ends 1 month after the contract ends. During this time you can switch your Medicare Advantage Plan or Medicare Prescription Drug Plan.

My Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan's contract with Medicare isn't renewed

Your special enrollment period occurs from December 8th to the last day in February. During this time you may enroll in another Medicare Advantage Plan or Medicare Prescription Drug Plan.

Other special situations
I'm eligible for Medicare and Medicaid

You have 3 special enrollment periods:

  • Jan – Mar
  • Apr – June
  • July – Sept

During these times you may join, switch, or drop your Medicare Advantage Plan or Medicare Prescription drug coverage (you may only make changes to your coverage one time during each period)

Any changes you make will take effect on the first day of the following month. To make another change, you will have to wait for the next period. You cannot use this Special Enrollment Period October – December, but everyone with Medicare can make changes from Oct 15 – Dec 7 that will take effect on Jan 1.

I qualify for Extra Help to pay for my Medicare prescription drug coverage

You have 3 special enrollment periods:

  • Jan – Mar
  • Apr – June
  • July – Sept

During these times you may join, switch, or drop your Medicare Advantage Plan or Medicare Prescription drug coverage (you may only make changes to your coverage one time during each period)

Any changes you make will take effect on the first day of the following month. To make another change, you will have to wait for the next period. You cannot use this Special Enrollment Period October – December, but everyone with Medicare can make changes from Oct 15 – Dec 7 that will take effect on Jan 1.

I dropped a Medigap policy the first time I joined a Medicare Advantage Plan.

If this happens, for 12 months after you join the Medicare Advantage Plan you’ll be able to drop your Medicare Advantage Plan and enroll in Orginal medicare. In this case, you will have special rights to buy a Medigap Policy.

I have a severe or disabling condition, and there's a Medicare Chronic Care Special Need Plan (SNP) available that serves people with my condition.

You can join a Medicare Chronic Care Special Needs Plan (SNP) at any time, however, once you join, you can no longer make changes using this SEP

I no longer have a condition that is served by the Special Needs Plan I'm enrolled in.

Your special enrollment period starts at the time you lose your Special Needs status and lasts up to 3 months after your SNP’s grace period ends. During this time you can switch from a Special Needs Plan (SNP) to a Medicare Advantage Plan or Medicare Prescription Drug Plan. 

I joined a plan, or chose not to join a plan due to an error by a federal employee.

Your special enrollment period lasts for 2 full months after the month you were notified of the error by Medicare.

During this time you may:

  • Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.
  • Switch from your current plan to another Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.
  • Drop your Medicare Advantage Plan with drug coverage and return to Original Medicare.
  • Drop your Medicare prescription drug coverage.
It was not properly explained that my other private drug coverage was not as good as Medicare drug coverage (creditable coverage)

Your special enrollment peroid lasts for 2 full months after the month you were notified of the error by Medicare.

During this time you may enroll in a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.