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Medicare Special Enrollment Period

October 6, 2016

In addition to enrollment periods that occur annually and when you first become eligible for Medicare, you may receive a Special Enrollment Period when life changes affect your existing coverage or cause you to lose your existing coverage. A Medicare Special Enrollment Period (SEP), also referred to as the Special Election Period, allows you to enroll in Medicare or enroll in or change your Medicare Advantage and/or Medicare prescription drug coverage outside of the Initial Enrollment Period or other standard enrollment periods without penalty. There are different SEPs to cover different circumstances. Your circumstance determines what type of change can be made to your Medicare coverage and when the change can be made.  Listed below are some of the more common circumstances people may encounter that might give rise to a Special Enrollment Period in which they may switch, enroll or disenroll from a Medicare Advantage plan and/or stand-alone Medicare Part D Prescription Drug Plan.

Switching Medicare Plans

Personal circumstances that may qualify for a Special Enrollment Period to switch either a Medicare Advantage (with or without prescription drug coverage) or a stand-alone Medicare Prescription Drug Plan include but are not necessarily limited to:

  • Permanent move in residence either outside your plan’s service area or into a new location with new plan options— Your Special Enrollment Period depends upon when you inform your current plan administrator. If you give notice before you move, your Special Enrollment Period begins the month before you move and continues 2 months after you move. If you give notice after you move, your Special Enrollment Period begins the month of notice and lasts 2 more months after the notice.
  • Changes in institutional status, such as moving into, currently living in, or moving out of a skilled nursing facility or long-term care hospital— Your opportunity to switch your Medicare Advantage plan and/or stand-alone Medicare Part D Prescription Drug Plan lasts as long as you live in an institution and for 2 full months after the month you move out of the institution.
  • Become eligible for both Medicare and Medicaid or qualifying for the Extra Help program—If you become eligible for Medicare and Medicaid, you may switch Medicare Advantage plans or stand-alone Part D Prescription Drug Plans anytime.  Similarly if you receive Extra Help, you can switch Medicare Part D Prescription Drug Plan anytime.  Your coverage begins the first day of the month after you qualify for Extra Help and enroll in a plan.
  • Losing eligibility for assistance programs such as Medicaid and the Extra Help program—Your opportunity to change Medicare Advantage plans or stand-alone Prescription Drug Plans lasts for 2 full months after the month you find out you’re no longer eligible for Medicaid or Extra Help. If you lose your coverage for the next year, you may change plans from January 1 – March 31.

Enrolling in a Medicare Plan

Outside of the Annual Election Period (AEP), also known as the Annual Enrollment Period, you may have the option to enroll in a Medicare Advantage plan (with or without prescription drug coverage) or Medicare Part D Prescription Drug Plan under certain special circumstances, such as:

  • Moving back to the United States after living outside of the country for a period of time— Your opportunity to enroll lasts for 2 months after the month you move back to the U.S.
  • Being released from jail—Your opportunity to enroll lasts for 2 full months after the month you’re released from jail.
  • Moving into, currently living in, or moving out of an institution such as a long-term care hospital or a skilled nursing facility — Your opportunity to enroll in a Medicare Advantage plan and/or stand-alone Medicare Part D Prescription Drug Plan lasts as long as you live in an institution and for 2 full months after the month you move out of the institution.
  • Leaving employer or union group health coverage—You can enroll in a Medicare Advantage plan and/or a Medicare Part D Prescription Drug Plan up to two months after your employment or employer health insurance ends. Remember, you must have Part A and Part B to enroll in a Medicare Advantage plan. You have up to 8 months to enroll in Part A and Part B after your employment or employer’s health insurance ends, whichever event comes first.
  • Losing eligibility for Medicaid or the Extra Help program—Your opportunity to enroll in a Medicare Advantage plan and/or Medicare Part D Prescription Drug Plan lasts for 2 full months after the month you find out you’re no longer eligible for Medicaid. If you lose your coverage for the following year, you may enroll in a plan from January 1–March 31.
  • Involuntarily losing creditable drug coverage other that Medicare Part D coverage— You can enroll in a stand-alone Medicare Part D Prescription Drug Plan during the 2 full months after the month you lose your creditable coverage or you’re notified that your current coverage is no longer creditable, whichever is later. You may be able to enroll in a Medicare Advantage Prescription Drug Plan if you already have Part A and Part B.

Dropping a Medicare Plan

By qualifying for a Special Enrollment Period under certain circumstances, you may completely drop your Medicare Advantage plan or Medicare Part D Prescription Drug Plan and return to Original Medicare or another coverage. Some of these circumstances include:

  • Changes in institutional status, including moving into or out of an institution such as a skilled nursing facility or a long-term care hospital – Your opportunity to disenroll from a Medicare Advantage plan and/or stand-alone Medicare Part D Prescription Drug Plan lasts as long as you live in an institution and for 2 full months after the month you move out of the institution.
  • Have the opportunity to enroll in other health care coverage through an employer or union— You can disenroll in your Medicare Advantage plan and/or stand-alone Medicare Part D Prescription Drug Plan and enroll in an employer or union sponsored group health plan whenever your employer or union allows you to make changes in your plan.
  • Have the opportunity to enroll in prescription drug coverage that is at least as good as Medicare prescription drug coverage, such as TRICARE or VA coverage— You can disenroll from your Medicare Advantage Prescription Drug plan or stand-alone Medicare Part D Prescription Drug Plan anytime you enroll in creditable prescription drug coverage, such as TRICARE or VA coverage.