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What is a Medicare Special Enrollment Period?

| December 22, 2022
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      This Special Enrollment Period (SEP) is one of the more complicated Medicare enrollment periods. Not every Medicare beneficiary will be eligible for this SEP and for those that do qualify they will have to prove their qualification.   

       During the SEP, you may join, switch, or drop a Medicare Advantage or prescription drug plan outside the basic enrollment periods. You may even have guarantee issue rights for a Medicare Supplement during this time. To qualify for an SEP, certain events must occur that require you to change your coverage. Common scenarios include:  

  • Your employer-provided plan ends.  
  • Your plan no longer is available in your area where you reside.  
  • You lose or gain Medicaid coverage.  
  • You move and your plan does not offer that coverage in your new service area. 
  • Maybe you just moved out of an institution like a skilled nursing facility or long-term care facility.  
  • Maybe you were incarcerated and were just released from prison. 
  • Medicare ends, or terminates, your plan’s contract 
  • Your Medicare Advantage, Prescription Drug Plan or Medicare Cost Plan is not renewed with Medicare. 
  • You develop a severe or disabling condition, and there’s a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with your medical condition. 
  • Or maybe the opposite happened, you were on a SNP for your condition, but now your condition no longer qualifies you for that coverage. 
  • You enrolled in your State’s Pharmaceutical Assistance Program (SPAP) or maybe you lost eligibility to your SPAP. 

This list only a partial list of the qualifying list for eligibility into a Special Needs Plan. But they are the most common reasons of how someone may qualify. Rules vary depending on what changes you can make and when you can make them. Please call our office or visit Medicare.gov for more details 

 

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