Qualifying for a Special Enrollment Period

Special enrollment periods are available for certain beneficiaries.

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Special Enrollment Periods

After the Open Enrollment Period ends, you are locked into your plan. There are, however, special circumstances that may qualify you for a Special Enrollment Period. Think of Special Enrollment Periods (SEPs for short) as lifelines. They allow you to make changes to your Medicare plan outside the normal enrollment windows in response to certain life events. This article will explain everything you need to know about SEPs so you remain covered without interruptions. 

Special Enrollment Period Examples

There are a few key reasons you might qualify for a SEP. These generally involve changes in your life that affect your current coverage or present an opportunity to get new coverage:

  • Moving: Did you relocate? If your current plan doesn’t cover your new service area, a SEP lets you choose a new one. Moving is one of the most common reasons people qualify for a Special Enrollment Period. When you move, you may relocate to an area uncovered by your plan. If this happens, you will need to get new coverage and therefore, qualify for a SEP. 
  • Coming Home: Moving back to the U.S. after living abroad qualifies you for a SEP to join a Medicare plan.
  • Changes in Where You Live: Moving into or out of a nursing home or similar facility also triggers a SEP.
  • Were you just released from Incarceration? If you recently were released from prison, you can use a SEP to enroll in a Medicare plan.

Sometimes, life throws curveballs that can affect your current coverage. You may have an opportunity to enroll if one of the following is the case:

  • Medicaid Changes: Losing Medicaid eligibility opens a window for a SEP to join a Medicare plan. You lose eligibility for Medicaid if you start earning more, age out, or other specific causes. You will also receive a Special Enrollment Period if you leave your coverage from your employer or union or leave your Medicare cost plan unless this occurs during Open Enrollment.
  • Job Change? Coverage Change: Whether you choose to leave a job or your company lets you go, losing your employer’s health insurance qualifies you for a SEP.
  • Losing Drug Coverage: Did you lose drug coverage as good as standard Medicare drug coverage? A SEP can help you find a new plan. If you lose your drug coverage involuntarily or drop your coverage in a Program of All-inclusive Care of the Elderly (PACE) plan, contact an agent to see what new plan you should get coverage with during your SEP.

These are the most common reasons for SEPs, but there are others. It’s always best to check and see if your situation qualifies:

  • Dual Eligibility: Qualifying for both Medicare and Medicaid can offer additional enrollment options. If you recently gained Medicaid, you are eligible to enroll in a new plan for beneficiaries who have dual eligibility. 
  • Plan Changes its Contract with Medicare: If Medicare takes action against your plan or if your plan’s contract gets terminated, you may qualify for a SEP. If your plan changes its contract with Medicare, that can directly affect your coverage. In some cases, Medicare can terminate your plan’s contract. Medicare changes each year, so it is important to review your coverage annually. A Medicare Advantage Plan, as well as a Medicare Prescription drug plan or Medicare Cost Plan’s contract with Medicare, may not renew, which is the reason you may qualify for a Special Enrollment Period
  • Enrollment Errors and Other Situations: Mistakes happen! Errors in enrollment or other unique circumstances may also qualify you for a SEP. This situation may be more uncommon than other enrollment periods, and you should be very careful when using this as it varies from situation to situation. 

Understanding your eligibility and the qualifying events that can lead to eligibility is critical. Medicare’s Special Enrollment Periods offer a flexible solution for keeping your coverage aligned with your life’s changing landscape. By understanding the eligibility criteria and the various qualifying life events, you can find opportunities and periods to enroll and ensure continuous and appropriate coverage. Do you have questions about SEPs or need help choosing a new Medicare plan? Contact one of our licensed agents today. We can help you find the plan you need and an enrollment period that fits.

Don’t go without Medicare coverage! Review your plan, and determine whether or not you qualify for a
Special Enrollment Period!

Visit Medicare.gov for an extended list of other special situations that may qualify you for a SEP

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This article was revised on 3/21/24.

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