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6 Important Facts About Medicare Special Enrollment Periods

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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). Here’s what you need to know.

1. Special Enrollment Periods are based on specific circumstances.

A Special Enrollment Period can occur at any time during the year and is triggered by your circumstances, rather than being based on certain dates. You won’t be notified that you qualify for a Medicare Special Enrollment Period.

2. There are lots of special circumstances!

The special circumstances leading to a Special Enrollment Period are too numerous to list here, but fall into five major categories:

  • Your living situation has changed
  • You’ve lost your healthcare coverage
  • You have a chance to receive different coverage
  • Your plan no longer has a contract with Medicare
  • You’re eligible for Medicaid, have a disability/special needs, or experienced an error in enrollment

Learn more about Medicare Special Enrollment specific circumstances.

3. Special Enrollment Periods are open for limited times.

Special circumstances create Special Enrollment Periods (SEP) of varying lengths, often ranging one to three months. You may want to enroll early to ensure you don’t miss your enrollment window. If you don’t enroll during your Special Enrollment Period, you may have to wait until the next Annual Enrollment Period, causing a potentially costly gap in coverage.

4. Medicaid eligibility may qualify you for a Medicare Special Enrollment Period.

If you’re eligible for both Medicare and Medicaid, you’re eligible for a Special Enrollment Period at least three times a year. Other Medicaid-related circumstances may qualify you for more.

Learn more about dual-eligibility.

5. Special Enrollment Periods are primarily for Medicare Part C and D plans.

Most Special Enrollment Periods only allow enrollments or changes in Medicare Advantage, Supplement, or Prescription Drug plans. Special Enrollment Periods for Medicare Part A and/or Part B only occur if you were part of a group health plan or volunteering outside the country and didn’t enroll during your initial enrollment period.

6. Help with Special Enrollment Periods is available.

Our Medicare Advocates are available to assist you, including helping you find, compare, and enroll in Medicare plans. They may also be able to help you determine if you’re eligible for a Medicare Special Enrollment Period. For assistance, call 1-800-991-4407 / TTY 711 from 10 a.m. to 9 p.m. ET, Monday through Friday.

You can also find and compare Medicare plans through our convenient Medicare Online Enrollment Portal.