Special Enrollment Period
What are Medicare Special Enrollment Periods?
Special Enrollment Periods (SEPs) allow beneficiaries to change their Medicare Advantage plans or Medicare Part D plans due to a special circumstance. Common reasons for a SEP include moving, losing employer coverage, and Medicaid eligibility, to name a few.[mfn referencenumber=1]Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021[/mfn]
[keytakeaways]
- Special Enrollment Periods allow a person to enroll in a Medicare plan outside the normal enrollment periods.
- Moving to a new area may qualify for a Special Enrollment Period.
- Losing healthcare coverage may qualify a beneficiary for a Special Enrollment Period.
- Qualifying for a secondary coverage plan may allow for a Special Enrollment Period.
- Medicare Advantage or Part D plans being discontinued may qualify a beneficiary for a Special Enrollment Period.
- Being diagnosed with a severe medical condition may qualify for a Special Enrollment Period.
- Many more circumstances can allow for a Special Enrollment Period, check the full list at Medicare.gov.
[/keytakeaways]
Special Enrollment Periods (SEPs) are enrollment periods for Medicare Advantage and Part D plans that are only available under certain circumstances[mfn referencenumber=1]Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021[/mfn]. Listed below are the most common SEPs and their timeframes for enrolling in Medicare plans.
What if I Lost My Current Coverage Plan?
If a beneficiary moves and their new area has different Medicare Advantage or Medicare Part D plans available, they have two months to enroll in a new plan or three months if they notify Medicare before they move. If a beneficiary is moving into a long-term healthcare facility, they can switch Medicare Advantage plans and Part D plans at any time during their stay and up to two months after they leave. Beneficiaries can also switch from Advantage to Medicare Part A and Part B coverage during their stay, but cannot switch back.[mfn referencenumber=1]Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021[/mfn]
Beneficiaries may have been delaying enrollment because they had creditable employer coverage. If so, they can enroll in a Medicare Advantage or Medicare Part D up to two months after that coverage ends. Beneficiaries should check with Medicare to confirm their employer’s coverage is creditable before delaying enrollment.[mfn referencenumber=1]Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021[/mfn]
A beneficiary might be a Medicare Advantage or Medicare Part D plan member and that plan becomes unavailable through Medicare. Medicare will notify them when a plan will be discontinued. They will have three months to enroll in a new plan, starting two months before their old plan is discontinued and ending one month afterward.[mfn referencenumber=1]Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021[/mfn]
What if I Qualify for a New Coverage Plan?
Beneficiaries might be enrolled in Part D or an Advantage plan with drug coverage and suddenly qualify for a secondary creditable drug plan like Medicaid or Veteran Affairs. If this happens beneficiaries can drop their Medicare drug plan at any time to enroll in that secondary creditable drug plan. Beneficiaries can use that secondary payer in conjunction with Medicare as their primary payer for their healthcare services.[mfn referencenumber=1]Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021[/mfn]
A severe chronic condition may require a beneficiary to enroll in a Special Needs Plan (SNP) available through Medicare Advantage. If there is an SNP that requires having that condition, they can enroll at any time. Once a beneficiary is enrolled, they cannot make changes to the SNP until the Annual Enrollment Period.[mfn referencenumber=1]Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021[/mfn][mfn referencenumber=2]Medicare.gov, “Joining a health or drug plan“, Accessed September 25, 2021[/mfn]