Qualifying for a Special Enrollment Period

Special Enrollment Periods

After the Open Enrollment Period ends, you are locked in to your plan. There are however, special circumstances that may qualify you for a Special Enrollment Period. During this window, you can make changes to your Medicare Advantage and Medicare Prescription Drug Coverage.

Special Enrollment Period Exemptions

Some of the most common exemptions that will qualify you for Special Enrollment include moving, losing or having to change your coverage, your plan changing it’s contract with Medicare, and other special situatuions.


Moving is one of the most common reasons people qualify for a Special Enrollment Period. When you move, you may relocate to an area that is not covered by your plan. If this happens, you will need to get new coverage, and therfore qualify for an SEP. Other reasons related to moving include moving into a nursing facility or long-term care facility, or moving back into the country after living abroad. Moving out of prison will also qualify you for a Special Enrollment Period.

Losing Your Current Coverage

You can lose your coverage for a number of reasons, including no longer being eligible for Medicaid. You lose eligibility for Medicaid if you start earning more, age out, or other specific causes. If you leave your coverage from your employer or union,  or leave your medicare cost plan you will also be given a Special Enrollment Period unless this occurs during Open Enrollment. If you lose your drug coverage involuntarily, or dropeed 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.

You Have the Chance to get Other Coverage

You have to option to get different coverage by enrolling in other coverage offered by your employer or union. Review what your employer or union offers to ensure it covers everything that you need before switching. You may decide you need different drug coverage, like Medicare prescription drug coverage. Pay close attention to what medications you need, without coverage, some medications cost much more. The PACE plan, or Program of All-inclusive Care of the Elderly, is another plan you can change to. This plan is centered around having a team of health care professionals working with you instead of going into a nursing facility.

Your Plan Changes its Contract with Medicare

If your plan changes its contrat 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 My Medicare Advantage Plan, as well as a Medicare Prescription drug plan, or Medicare Cost Plan’s contract with Medicare may may not be renewable, which is the reason you  qualify for a Special Enrollment Period

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

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

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