National Senior Benefit Advisors

Your Medicare Experts

Licensed Insurance Agency

Trusted Checkmark (1)

Call our trusted friendly team today

(866) 877-1049

Special Enrollment Periods Based on Special Circumstances

Special Enrollment Periods Based on Special Circumstances

Sometimes, life events happen that may require you to change your healthcare plan in one way or another. Medicare came up with Special Enrollment Periods to help those with extenuating circumstances receive the coverage they need. A Special Enrollment Period will allow you to make necessary changes during time frames outside of your Initial Enrollment Period. It is important to understand the different enrollment periods, their requirements and their time frame window in order to know when it is best for you to apply. Learn about the many other Medicare Enrollment Periods here

In short, Special Enrollment Periods are designed to give additional time for individuals to enroll in Medicare plans based on their individual circumstances. If you are given a Special Enrollment Period, then you typically have a limited amount of time to add, drop or make changes to your Medicare Advantage coverage or your Medicare Part D prescription drug coverage. These types of Special Enrollment Periods are mainly designed for individuals who already have Medicare Part A and Part B and are looking to receive more coverage or change their coverage for Medicare Part C and Part D. 

There are a lot of different reasons as to why you may qualify for a Special Enrollment Period. In this blog post, we will be discussing some of the most common circumstances and the rules that come with each type of Special Enrollment Period. If any of these circumstances sound familiar to you, then you may be eligible for a Special Enrollment Period, which can save you from paying late fees. Because Special Enrollment Periods are only granted to individuals in certain circumstances, it is important to check with a Medicare expert to understand if you qualify for one and to clarify the rules and guidelines for your specific SEP. 

Reasons for a Special Enrollment Period

SEP: If you have moved 

In the instances where you have changed locations, you will qualify for a Special Enrollment Period. 

If you have moved somewhere that is outside of your current plan’s coverage, then you can switch to a new Medicare Advantage plan or Medicare Part D plan. If you let your plan know before you move, then you can switch plans any time between the month before you move to two months after you move. If you let your plan know after you move, then you can switch up until two months after you tell them. 

Furthermore, if you have moved back to America after living abroad, have moved into or out of a long-term care hospital or have been released from jail, you will also qualify for this type of Special Enrollment Period. In general, you can apply for a Medicare Advantage Plan or a Medicare Part D prescription drug plan during the first two months after you change locations. If you currently have a plan but move outside of its coverage area, you may be able to switch between a Medicare Advantage Plan and an Original Medicare Plan. If any of these circumstances sound similar to yours, speak to a Medicare expert to learn if you qualify for this kind of Special Enrollment Period. 

SEP: If you are eligible for both Medicare and Medicaid

 

SEP Medicare and Medicaid

If you are a low-income senior or social security recipient, then you are eligible for a Special Enrollment Period where you can join, switch or drop either a Medicare Advantage plan or a Medicare Part D plan. This type of Special Enrollment Period has three different time frames in which you can enroll: January to March, April to June, or July to September. Your new Medicare plan will go into effect at the beginning of the month after you enroll. There is also an opportunity for everyone to make changes to their Medicare plans during the Annual Election Period, which lasts from October 7 to December 15 each year. Learn more about Annual Election Periods here (link to AEP blogpost). 

SEP: If you are no longer eligible for Medicaid

You can enroll in a Medicare health plan during a Special Enrollment Period if you used to receive Medicaid benefits but no longer do. Under this type of SEP, you can join, switch or drop your Medicare Advantage or Medicare Part D plan. This enrollment period lasts for three months from when you are either no longer eligible or from when you are notified, whichever comes last. 

SEP: If you qualify for Extra Help benefits

Also known as Part D Low Income Subsidy (LIS), Extra Help is designed to help pay for some additional costs of Medicare Part D prescription drug coverage. You may qualify for Extra Help if your monthly income is up to $1,615, or $2,175 for couples, and if your assets are under certain limits. Further, if you are already enrolled in Medicaid, Supplemental Security Income or a Medicare Savings Program, then you automatically qualify for Extra Help. During a SEP for Extra Help, you can add, change or drop a Medicare Part D plan. You can make these changes once during one of these timeframes: January to March, April to June or July to September. Changes will take effect at the beginning of the month after you make the changes. 

SEP: If you previously received coverage from your or your spouse’s employer

This is one of the most common reasons for why you would be eligible for a Special Enrollment Period. Most people receive healthcare coverage from their employer or their spouse’s employer. When they retire or lose their job, this coverage will end. Instead of having to wait until the Initial Enrollment Period, you can join a Medicare Advantage plan or a Medicare Prescription Drug plan during a Special Enrollment Period that lasts for two months after the employer’s coverage ends. 

SEP: If you have an opportunity to receive other coverage

SEP: If you have an opportunity to receive other coverage

There are three basic circumstances in which you may have a chance to receive other healthcare coverage. 

If your employer or union offers healthcare coverage, then you will be able to drop your Medicare Advantage plan or Medicare Part D plan and switch to the private insurance that the employer is offering during this Special Enrollment Period. This period lasts whenever your employer or union allows you to start making these changes. 

Further, if you plan to enroll in other prescription drug coverage, such as TRICARE or VA Coverage, then you can receive qualification for a Special Enrollment Period. Under these circumstances, you can drop your Medicare Part D coverage at any time. 

Lastly, if you are enrolled in a Program of All-Inclusive Care for the Elderly (PACE), then you may qualify for a Special Enrollment Period where you can drop your Medicare Advantage or your Medicare Part D coverage at any time. 

SEP: If your plan changes its contract with Medicare

There may be a few circumstances where your Medicare plan gets changed. For instance, if Medicare decides to end your plan, then you are given a Special Enrollment Period to switch your Medicare Advantage plan or your Medicare Prescription Drug plan. During this Special Enrollment Period, you will have two months before you lose coverage and one month after to enroll in a different plan. 

If, for some reason, your Medicare plan’s contract is not renewed by Medicare, then you are given a Special Enrollment Period to join a different plan. This type of Special Enrollment Period lasts from December 8 until the last day in February. 

If your plan changes its contract with Medicare:

As you can tell, there are a wide variety of reasons that may qualify you for a Special Enrollment Period. Understanding Medicare Special Enrollment Periods may help you save time and money in the long run. If there are any changes you wish to make to your Medicare plan, including changing your Medicare Advantage plan or your Medicare Part D plan, look to see if you qualify for any type of Special Enrollment Period. If your extenuating circumstance was not listed above, check out this Medicare.gov article as an additional resource to see if you qualify for a Medicare Special Enrollment Period. You can also speak to a Medicare expert to find out what can be done to meet your needs. Medicare plans look different for everyone, so it is important that each beneficiary is accommodated for.  

Share this post

Share on facebook
Share on twitter
Share on linkedin
Share on pinterest
Share on print
Share on email

Leave a Comment

Your email address will not be published. Required fields are marked *

Have a question about medicare?

Book Your Free Consultation

Get Help With

  • Plan Comparisons
  • Help With Enrollment
  • Cost Comparisons
Learn More

Related Posts

How do I qualify for a Medicare Advantage Plan?

How do I qualify for a Medicare Advantage Plan?

In order to be eligible for Medicare Advantage, you must be enrolled in both Medicare Part A and Part B. Because Medicare Advantage plans are managed by private insurance groups and provide a network of doctors that you must use..

How much does a Medicare Advantage plan cost?

Recently, Medicare Advantage enrollment has taken off. In 2020, more than one-third of Medicare beneficiaries were enrolled in a Medicare Advantage plan. This number continues to grow about nine percent each year.