Qualifying Life
Events for SEPs

Medicare Enrollment Periods typically fall into clear categories that happen on the same dates every year, or during the months surrounding your 65th birthday. The exceptions to these strict enrollment periods are Medicare Special Enrollment Periods (SEPs). A Medicare Special Enrollment Period is a period in which you can enroll in Medicare or change your Medicare plan based on special circumstances, also known as qualifying life events. If you meet the qualifying life event criteria, you may be eligible to enroll in Medicare or change your current Medicare plan. 

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Moving 

Moving to a new location, whether that be to a new zip code, in or out of a long-term care facility, release from incarceration, or back to the US after living outside the country, is one of the most common qualifying life events for a Special Enrollment Period. Special enrollments due to moving typically start the month you declare your move and last for two months after your move.

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Dual Eligible

If you are eligible for both Medicare and Medicaid, you have three opportunities for special enrollment throughout the year. You can change your plan once during each of the following: January to March, April to June, and July to September. You can still participate in the Annual Enrollment Period from October 15 to December 7.  

Medicaid Extra Help Eligibility 

Individuals who qualify for Extra Help with Medicare prescription drug coverage can join, change, or drop Medicare prescription drug coverage at any time. Coverage will begin at the start of the month after you ask to join a plan. 

Loss of Coverage as a Qualifying Life Event

  • Lose employer coverage:
    When you become eligible for Medicare, you may choose to stay enrolled in your employer or union coverage. When you finally leave that group plan, you may be eligible for special enrollment.  

  • No longer eligible for Medicaid:
    Some common reasons for losing eligibility in Medicaid include your income increasing suddenly or to above what Medicaid allows, or your household size changing. If you lose your Medicaid coverage, you may be eligible for a Special Enrollment Period to enroll in a new plan.   

  • Leave a Medicare Cost Plan:
    If you leave your Medicare Cost Plan, you can use a SEP to join a Medicare Prescription Drug plan.  

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Changes to Current Plan’s Contract with Medicare  

  • Medicare terminates your plan’s contract: If Medicare terminates your plan’s contract, this is considered a qualifying event, and you have three months to enroll in a new plan starting two months before your plan’s contract termination and ending one month after.  
  • Medicare doesn’t renew your carrier’s plan: Medicare doesn’t renew all plans year after year. If the plan you’re enrolled in isn’t renewed, you have from December 8 to the last day of February to find and enroll in a new plan.  

Opportunity for New Coverage


Typically, the qualifying life event for this SEP is when your employer offers a new plan. If you have the opportunity to enroll in coverage through your employer or union, you can do so whenever your employer allows. 

Five-Star Special Enrollment


You can use a special enrollment to enroll in a Medicare Advantage, Prescription Drug or Medicare Cost plan with a 5-star rating once per year, between December 8 and November 30 provided you meet the plan’s enrollment requirement.Every year, Medicare evaluates plans based on a 5-star rating system. Plans are rated on a scale of one to five, with five considered excellent.  

No Longer Qualifying for a Special Needs Plan  


If you no longer have a condition that qualifies for a Special Needs Plan, can you lose Medicare benefits? You won’t lose your opportunity for benefits entirely; you will just be required to switch to a new plan. For example, you can switch to Original Medicare or enroll in a Medicare Advantage or Prescription Drug plan. Your enrollment window starts when you no longer qualify and runs for three months.  

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Weather Emergencies 

Natural disasters can happen in an instant and may be considered a qualifying life event for a Special Enrollment. If you live in an area where the Federal Emergency Management Agency (FEMA) declared an emergency or disaster, you may be eligible for a SEP. These enrollment windows run from the start of the qualifying life event and lasts until the end of the calendar year. 

Events that may be considered a weather emergency or natural disaster includes: earthquake, fire, drought, chemical emergency, flood, poisoning, heat wave, hurricane, landslide, terrorism, power outage, thunderstorm, tornado, tsunami, volcano, wildfire, and snowstorm.

Medicare Before Turning 65 


Typically, Medicare eligibility begins a few months before you turn 65, but there are a few exceptions.  

  • If you have qualified for Social Security Disability Insurance (SSDI) for 24 months 
  • If you have Lou Gehrig’s Disease/ ALS 
  • If you have End-Stage Renal Disease  

If you meet one of these criteria, you may be automatically enrolled in Medicare benefits. In others, you must enroll. Medicare benefits for individuals under 65 are the same as those over 65. Those who are already enrolled in Original Medicare (Parts A and B) may also be eligible for a Medicare Advantage or Medicare Supplement plan.  

Two or three months can go quickly when you’re in the midst of major life changes. Making an important decision like choosing health insurance should not be placed on the back burner. We recommend evaluating choices and making a decision as soon as possible. Remember, there may be penalties for enrolling late or having gaps in coverage! 

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Last Updated: November 1, 2022 MULTIPLAN_ETQEZMwebsite_0722_M