A Special Enrollment PeriodA Special Enrollment Period is an opportunity outside of a standard enrollment period in which your specific circumstances allow you an opportunity to make changes to your Medicare-related coverage. (SEP) gives you the ability to make changes to your Medicare coverage outside of regular enrollment periods.
One of the most important SEPs is the one granted to you after you leave employer-sponsored health insurance and want to enroll in Medicare.
Other events that trigger SEPs include a change of address and documented issues with your current Medicare.
Life doesn’t happen on a schedule, so you can’t count on major moments in your life aligned with Medicare’s schedule.
Fortunately for you, that’s when Medicare may do something special for you.
While Medicare’s annual calendar limits changes to an Open Enrollment Period (January 1-March 31) and an Annual Enrollment Period (October 15-December 7), you can make changes to your Medicare coverage during your personal SEPs.
While you may qualify for a SEP for a lengthy list of very specific reasons, [i] here are some of the most common situations.
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If you are wondering if Medicare Part B is optional or mandatory, some people delay enrollment when they turn 65 because they’re employed and covered by their employer’s group health insurance plan. When your employment ends or you leave your group health plan, that triggers a valuable SEP.
When your employer-sponsored coverage ends, you have an eight-month SEP to enroll in Part B without penalty (you likely already enrolled in Part A at age 65 because it provides hospital insurance, usually without a monthly premium). During this SEP, you also have the option to enroll in a Medicare Advantage and/or Part D prescription drug plan that takes effect at the same time your enrollment in Part B begins.
If you opted awhile back to stay in an employer plan, check to see how your current insurance compares to the premiums and coverage offered by Part B or a Medicare Advantage plan.
Speaking of Medicare Advantage…
Medicare Advantage (MA) plans as well as Medicare Part D plans (drug coverage) are often tied to where you live, so a change of address can necessitate a change of plan.
If you move to an area that isn’t covered by your MA or Part D plan, you’ll have the opportunity to switch to a different plan during a SEP. You will have a similar SEP even if your new address is in your plan’s service area but also opens the door for you to enroll in a new plan that wasn’t offered at your previous address.
Most SEPs related to moving last for two full months after the month you move or the month that you inform your plan administrator of your move.
There are separate, specific SEPs for leaving skilled nursing facilities and incarceration. A licensed insurance agent can help with SEPs that apply to you.
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Another common SEP is triggered not by your actions but by the actions of others.
If Medicare terminates its contract with your MA or Part D plan or levies sanctions against one of your plans that impacts your coverage, you’ll be granted a SEP to make changes. That’s also the case if you joined a particular plan due to an error made by a federal employee or if you were misinformed about the quality of a Part D plan compared to your private drug coverage.
The length of these SEPs varies, but in all instances, you should receive a notice of what has happened and what your options are.
What if I’m on Original Medicare and move to a different part of the country?
In this case, you would be granted a Special Enrollment Period if you have Part D to go along with Original Medicare. Original Medicare allows you to visit providers who accept Medicare anywhere in the country.
If my COBRA coverage ends, do I get a Special Enrollment Period?
While COBRA allows you to continue on the health insurance plan you were on before you left a job, ending COBRA doesn’t qualify you for a Special Enrollment Period for Medicare.
In that scenario, however, you should have started an eight-month SEP to enroll in Medicare Part B based on leaving the job before you started on COBRA.