Certain life events can trigger a Medicare special enrollment period (SEP). For example, a SEP can begin if you move and your new location affects your coverage or if you become eligible for special programs.
Life happens. When a major change in your circumstances takes place, you may need to make a change to your Medicare coverage. Medicare’s special enrollment periods (SEPs) allow you to make changes to your Medicare plan in between open enrollment periods.
This article reviews special enrollment periods, including when they occur, what changes you can make during these periods, and the qualifying events that allow you to change your coverage during these periods.
Medicare has set aside certain months of the year when people can add or change their Medicare coverage. These periods are:
- Initial enrollment: This period is when you first become eligible for Medicare. This is a 7-month period surrounding your 65th birthday – 3 months before, the month of, and 3 months after, your 65th birthday.
- Open enrollment: The open enrollment period occurs from October 15 through December 7 each year.
- Medicare Advantage (Part C) open enrollment: Enrollment for Medicare Advantage plans occurs from January 1 through March 31 each year.
Sometimes, changes in life circumstances require you to change your healthcare coverage at other times during the year.
Medicare allows you to change your Medicare coverage in certain special circumstances. When one of these qualifying events happens in your life, it triggers a SEP.
Depending on the life event that has made you eligible for a SEP, you may be able to:
- switch from a Medicare Advantage (Part C) plan to Original Medicare (parts A and B)
- switch from Original Medicare to a Medicare Advantage plan
- switch to a different Medicare Advantage plan
- add, drop, or change your prescription drug coverage
- drop your Medicare coverage and opt for an employer-provided plan
You can change your Medicare coverage for a limited time after a qualifying event takes place. The following chart is a basic guide to qualifying life events for SEPs and the amount of time Medicare allows you to make a change.
To find out the exact date your SEP begins, you can contact Medicare directly.
| Special circumstance | Changes you can make | How long the SEP lasts |
|---|---|---|
| You move and your new home is out of your plan’s service area. | You can switch to a different Medicare Advantage (Part C) plan or Part D plan, or return to Original Medicare. | 2 months: If you tell your plan before you move, the SEP begins the month before you move. If you tell your plan after you move, your SEP begins the month you tell your plan about the move. |
| You move, and there are new plan options available at your new address. | You can switch to a different Part C or Part D plan. | 2 months: If you tell your plan before you move, the SEP begins the month before you move. If you tell your plan after you move, your SEP begins the month you tell your plan about the move. |
| You’re moving back to the United States after living abroad. | You can join a Part C or Part D plan. | 2 months |
| You move into or out of a skilled nursing facility, psychiatric facility, rehab hospital, or long-term care facility. | You can join a Part C or Part D plan, switch to a different Part C plan, return to Original Medicare, or drop your Part D plan. | Your SEP continues as long as you live at the facility or for 2 months after you move out. |
| You’ve just been released from jail. | You can join a Part C or Part D plan. | 2 months |
| You’re no longer eligible for Medicaid. | You can join a Part C or Part D plan, switch to a different Part C plan, return to Original Medicare, or drop your Part D plan. | 3 months |
| You no longer have health insurance from an employer or a union at your employer. | You can join a Part C or Part D plan. | 2 months |
| Your employment ends, or your employer-provided plan ends. | You can sign up for Medicare Part A or Part B. | 8 months |
| You have a chance to get coverage from an employer or a union plan. | You can drop your Part C or Part D plan and join your employer’s plan. | Your SEP ends when your employer allows you to join the plan. |
| You lose creditable coverage through no fault of your own. | You can join a Part C plan with Part D coverage or join a Part D plan. | Your SEP continues as long as you live at the facility or for two months after you move out. |
| You no longer have a Medicare cost plan. | You can join a Part D plan. | 2 months |
| You’re enrolling in a PACE program. | You can drop your Part C or Part D plan. | anytime |
| You’re no longer in a PACE program. | You can join a Part C or Part D plan. | 2 months |
| You’re enrolling in TRICARE, VA, or another prescription drug plan. | You can drop a Part C plan with drug coverage or drop your Part D plan. | anytime |
| Medicare sanctions your plan due to a problem with your plan. | You can change to a different Part C plan. | SEP length is determined by Medicare on a case-by-case basis |
| Medicare is ending your plan. | You can change to a different Part C plan. | 2 months before your old plan ends until 1 month after your old plan ends |
| Medicare is not renewing your plan. | You can change to a different Part C plan. | Dec 8 through the end of Feb |
| You’re now eligible for both Medicare and Medicaid. | You can join, switch, or drop your Part C plan. | The SEP occurs once during each of these periods: • Jan to Mar • Apr to Jun • Jul to Sep |
| You now qualify for the Extra Help program. | You can join, switch, or drop your Medicare Part D plan. | The SEP occurs once during each of these periods: • Jan to Mar • Apr to Jun • Jul to Sep |
| You’re enrolling in a State Pharmaceutical Assistance Plan (SPAP) or you lose coverage from an SPAP. | You can join a Medicare Part D plan or a Part C plan with Part D coverage. | once per year |
| You dropped a Medigap policy when you joined a Part C plan. | You can drop Part C and return to Original Medicare. | 1 year after you joined the Part C plan |
| You have a special needs plan (SNP) but you no longer have a qualifying special need. | You can change to a Part C or Part D plan. | 3 months after your specified grace period closes |
| You joined the wrong plan because a federal employee made a mistake. | You can join a Part C or Part D plan, switch to a different Part C plan, or return to Original Medicare. | 2 months |
| You weren’t told that your private drug plan wasn’t as good as Medicare or your private drug plan is ending. | You can join a Part C plan with drug coverage or join a Part D plan. | 2 months |
| Medicare just gave a 5-star rating to a plan in your area. | You can change to the 5-star Part C plan. | one time between Dec 8 and Nov 30 |
If you think you may be eligible for a SEP, contact Medicare right away to confirm your eligibility and find out what deadlines apply. Usually, if you sign up or make changes during a SEP, you won’t have to pay late enrollment penalties or fees — but there are exceptions.
If you have health insurance coverage through your employer and you work for an employer with fewer than 20 employees, it’s important to sign up for Medicare Part A and Part B when you’re first eligible, or you may have to pay a late enrollment penalty.
If you don’t sign up for Medicare Part D (prescription drug coverage) when you become eligible, and you don’t have creditable prescription drug coverage from another plan, a SEP may allow you to sign up for coverage. However, a penalty might still apply.
If you’re not sure how Medicare works with your employer-provided health insurance, contact Medicare to ensure you sign up at the right time. Late enrollment penalties can continue for the entire time you have Medicare coverage.
Choosing the right plan for you
Before joining a new plan, it’s important to review your financial and healthcare needs. Doing some research and planning ahead can help you make the best choice.
Here are a few tips:
- Assess your current and potential healthcare needs: Are there doctors, facilities, or medications that you can’t compromise on for your care? This may affect your policy choice, particularly when deciding between Original Medicare and Medicare Advantage.
- Consider your income: If you have a fixed or limited income, paying monthly premiums may be difficult. However, if you may need care that only Medicare Advantage would cover, this might be a good option to save costs in the long run.
- Look for cost savings programs: You may qualify for certain programs to help with your costs, including Medicaid and Extra Help.
- Find the right plan: Use Medicare’s plan finder tool to compare available Medicare Advantage plans in your area. You can search by prescription drugs you need as well as covered providers and services.
Big changes in your life can affect your healthcare coverage. To ensure you have the coverage you need, Medicare offers special enrollment periods (SEPs) that allow you to add, drop, or change your Medicare plans outside of the typical yearly enrollment periods.
If you move, lose coverage, or have a chance to get creditable healthcare coverage through a special program, your employer, or a union at your workplace, you may be able to take advantage of a SEP.
As soon as you’re aware of a change in your circumstances, contact Medicare to find out when and how you can change your coverage. You only have a certain amount of time to make the changes, and penalties can apply if you miss the deadlines.