SEP: Medicare Special
Enrollment Periods

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A Medicare Special Enrollment Period (SEP) is a window of time in which you can enroll in Medicare or change your Medicare plan based on qualifying life events. Special Enrollment Periods are used when enrolling in Medicare outside of the standard enrollment periods, such as your initial enrollment, the Annual Enrollment Period, or the Medicare Advantage Open Enrollment Period. If you meet the specific criteria needed for a special enrollment, you may be eligible to enroll in Medicare or change your current plan.

What events qualify for a Special Enrollment Period?

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The most common reasons you may qualify for a Special Enrollment Period include moving to a new area, losing employer coverage, and a change in your Medicaid status. However, there are many reasons you may be eligible for a Special Enrollment Period, including:

  • Your current plan no longer has a contract with Medicare
  • You qualify for Medicare Extra Help
  • A medical condition makes you eligible for a Special Needs Plan
  • You have been affected by a natural disaster or weather emergency

These are common instances that make a Medicare-eligible individuals qualify for special enrollment, but there are many more possible qualifications for Special Enrollment Periods.

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Medicare Made Easy Part 6: 6 Reasons You May Be Eligible for a Medicare Special Enrollment Period”

Five-Star Special Enrollment Period

Every year, Medicare evaluates plans based on a 5-star rating system. Survey results and healthcare provider information give the overall performance star ratings of plans yearly. It uses a five-star rating system, with one being low and five being high. This rating system is used to help you compare plans based on their quality and performance. The ratings are updated every year.

A 5-star Special Enrollment Period may be used one time between December 8 and November 30, provided you meet the plan’s enrollment requirement, to switch to a Medicare Advantage, Prescription Drug, or Medicare Cost plan in your area

What makes you eligible for a Medicare Special Enrollment Period (SEP)?

To be eligible for a Special Enrollment Period, you must already be enrolled in Original Medicare (Parts A and B). However, there are some Special Election Periods that don’t require Part B Medicare enrollment, such as when you lose employer coverage. In order to be eligible for premium-free Part A, you must be 65 years or older, and you or your spouse must have worked and paid Medicare taxes for at least 10 years. You may also be eligible for premium-free Part A at any age if you have ESRD or you receive Social Security Disability Insurance benefits. You have the ability to receive Part A at age 65 without paying a premium if:

  • You or your spouse had Medicare covered by government employment
  • You are receiving retirement from Social Security and/or Railroad Retirement Board
  • You are eligible to receive Social Security and/or Railroad benefits but you have not yet filed for either

After you or your spouse’s employment or health coverage ends (whichever happens first), you have the ability to enroll in Medicare Parts A and/or B with a Special Enrollment Period. This is only if you meet the other requirements.

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When are Special Enrollment Periods?

Special Enrollment Periods take place outside of regular enrollment periods, such as Annual Enrollment and Medicare Advantage Open Enrollment. Special Enrollment Periods begin and end depending on the circumstances of the special event. Special Enrollment Periods typically last 2-3 months from the start of the event, but this can vary depending on the type of special enrollment. Because of this, it’s a good idea to avoid missing your enrollment window and having to wait until the next Medicare Annual Enrollment Period.

If already have Medicare and you do not enroll in a new plan during your special enrollment period, you will revert back to Original Medicare (Parts A and B). You can then choose to enroll in a Medicare Advantage or Part D Prescription Drug plan during the next Annual Enrollment Period. It’s important to keep in mind that Original Medicare’s coverage does not include vision, dental, hearing or prescription drugs and there may be a penalty for not having prescription drug coverage if you sign up later.

Enrollment Eligibility

Annual Enrollment Period (AEP)

Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?

Initial Enrollment Period (IEP)

Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.

Special Enrollment Period (SEP)

You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.

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