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6 Reasons Why You May Be Eligible for Medicare Special Enrollment

medicare-special-enrollment-eligibility

All Medicare beneficiaries may enroll, switch, or drop Medicare plans during the Medicare Annual Enrollment Period which occurs at the same time every year, from October 15 to December 7. However, if you qualify based on specific circumstances, for a Medicare Special Enrollment Period (SEP), you may have another opportunity to enroll, switch or drop Medicare plans outside your Initial Enrollment Period and the Medicare Annual Enrollment Period.

Here’s a summary of the circumstances that may qualify you for a Medicare Special Enrollment Period:

  1. A change in your living situation.
    • You move to a new address that’s outside your current plan’s service area.
    • You move back to the U.S. after living outside the country.
    • You move into, currently live in, or move out of a long-term care facility.
    • You’re released from incarceration.
  2. A loss of coverage.
    • You no longer have coverage through your employer or union (including COBRA).
    • You’re no longer eligible for Medicaid.
    • You had drug coverage through a Medicare Cost Plan, but leave the plan.
  3. An opportunity to enroll in different coverage.
    • You have the opportunity to enroll in other coverage offered by your employer or union.
    • You enrolled in the Program of All-inclusive Care for the Elderly (PACE) plan.
    • You have the opportunity to enroll in new Five-Star plans available in your area.
  4. Your plan no longer has a contract with Medicare.
    • Medicare terminates your plan’s contract.
    • Your Medicare Advantage, Prescription Drug or Medicare Cost Plan’s contract with Medicare aren’t renewed.
  5. You qualify for Medicare Extra Help.
    • You have a Medicare Savings program (partial dual eligibility).
    • You receive Supplemental Security Income benefits but don’t receive Medicaid.
    • You’re eligible to receive Medicaid and Medicare known as dual eligibility.
  6. A severe or disabling condition makes you eligible for a Special Needs Plan.
    • You have Diabetes, Chronic Obstructive Pulmonary Disease (COPD), End-Stage Renal Disease, Lou Gehrig’s disease or a heart condition.
    • You have a Special Needs Plan (SNP) and no longer have the condition that qualifies as a special need.

    Most Special Enrollment Periods only allow you to enroll in or change Medicare Advantage, Supplement, or Prescription Drug plans. Special Enrollment Periods range from one to three months, so it’s a good idea to enroll early to avoid missing your enrollment window and having to wait until the next Medicare Annual Enrollment Period.

Get the help you need during Medicare Special Enrollment Periods and more

Our Medicare Advocates are available to help you confirm your eligibility for a Medicare Special Enrollment Period. They’re also happy to help you find, compare, and enroll in Medicare plans. For assistance, call 1-800-991-4407 / TTY 711 from 10 a.m. to 9 p.m. ET, Monday through Friday.