Medicare Special Enrollment Periods (SEP)​

When Do You Qualify for a Medicare Special Enrollment Period?

Special Enrollment Periods cover a wide range of circumstances. Here are some of the most common:

You Moved

If you relocate to an area that isn’t covered by your Medicare Advantage or Medicare Part D prescription drug plan, or where you have access to a new plan that wasn’t offered at your previous address, you’ll have the opportunity to switch. This SEP applies to situations like moving back to the United States after living abroad and moving into or out of a skilled nursing facility.

• 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 do not notify your plan of your move, your plan will disenroll you after six months.
• Your SEP lasts two months following your disenrollment.
• You will have a similar SEP even if your new address is in your plan’s service area, but you have new plan options available that were not previously available at your old address.
• If you’re moving back to the United States after living abroad, you have two months to enroll after the month you return to the U.S.
• When you move into an institution such as a skilled nursing facility, you can enroll the entire time you live there, up until two months after you leave.

You Lost Your Existing Coverage

You may qualify for an SEP because of losing Medicaid eligibility, leaving a job that provided health insurance, or losing creditable prescription drug coverage (for coverage to be considered creditable, it must provide benefits that are equivalent to or better than a Medicare Part D plan).

• If you delayed enrolling in Medicare Part B because you had health insurance through an employer, your SEP continues eight months after the coverage or the employment ends, whichever  comes first. The same applies if you are currently on a spouse’s health plan and their coverage ends.
• Your SEP to join a Medicare Advantage plan or prescription drug plan lasts two months after the month your coverage ends.
• If you’re no longer eligible for Medicaid or a Medicare Savings Program, you will have three months to change Medicare Advantage or Part D drug plans, starting the date you are notified you will lose benefits.

Medicare Ended Your Plan’s Contract

The Centers for Medicare and Medicaid Services (CMS) may remove your plan due to a reported problem or end your plan’s contract. Under certain circumstances, insurance carriers may choose not renew their contract with the CMS or to stop providing plans in your area at the end of the year. If Medicare ends your plan’s contract, your SEP starts two months before and concludes one month after your contract ends. You can also expect to receive a notice of what has happened and what your options are.

You’re Eligible for Different Coverage

You may have become eligible for both Medicare and Medicaid, qualified for Extra Help with Medicare prescription drug coverage, or been enrolled in a Special Needs Plan that you no longer qualify for.

• You are eligible for both Medicare and Medicaid: Dual eligibility allows beneficiaries to combine Medicare and Medicaid benefits to expand coverage and assist with costs. Dual eligible people have a monthly SEP to switch to a different Medicare Part D plan plan or to leave their Medicare Advantage plan and return to Original Medicare while joining a stand-alone Part D plan.
• You qualify for Extra Help: The Extra Help (also called the Low Income Subsidy) program helps those with limited income and financial resources to lower or cut Part D costs. If you’re eligible for this subsidy, you have a monthly SEP to change Part D plans or drop a Medicare Advantage plan. If you lose eligibility for Extra Help, that also qualifies you for an SEP when you can join or drop a Medicare Advantage or Part D plan.
• You are diagnosed with a chronic condition: If there’s a Chronic Condition Special Needs Plan (C-SNP) available in your area that fits your needs, you can use an SEP to enroll at any time.

You Enrolled in or Left the Program of All-Inclusive Care for the Elderly (PACE)

PACE programs are available in certain areas to provide services and coverage that help people stay in their own homes. If you are already enrolled in Medicare, you may qualify for a two-month Medicare SEP.

You Were Recently Released From Incarceration

If you were formerly incarcerated and demonstrate you are eligible for Medicare, show you did not enroll or re-enroll in Medicare Part A or B during another enrollment period, and have proof you were officially released on or after January 1, 2023, you will be eligible for a 12-month SEP beginning the day of release from incarceration. If you qualify for a Medicare Advantage or Medicare Part D prescription drug plan, you will have a two-month window to enroll.

You Received Misleading Plan Information

If you believe you have been misled into joining a Medicare Advantage plan, you could be eligible for a two-month SEP allowing you to switch out of a plan that you joined based on erroneous, incomplete, or ambiguous information. You must apply to Medicare for this SEP, and your case will be further investigated. If CMS decides that your claim is valid, you will be able to join another Medicare Advantage plan or switch back to Original Medicare if originally enrolled in a Medicare Advantage plan. You may also decide to join a stand-alone Part D drug plan in this case as well.

There’s a Five-star Medicare Advantage Plan Available in Your Area

Based on information gathered from member satisfaction surveys, plans, and healthcare providers, Medicare shares an overall performance rating on a five-star scale. If there are any plans with five-star ratings available to you, you can switch plans once between December 8 and November 30 of the following year.