- Certain life events can trigger a Medicare special enrollment period (SEP).
- An SEP can begin when a change in your residence affects your coverage.
- SEPs also apply when you lose coverage, have a chance to get new coverage, or become eligible for certain special programs.
- The time you have to choose new coverage varies depending on the event that triggered the SEP.
Life happens. When a major change in your circumstances takes place, you may need to make a change to your Medicare coverage.
Medicare’s special enrollment periods (SEPs) allow you to make changes to your Medicare plan in between general enrollment periods.
Medicare has set aside certain months of the year when people can add or change their Medicare coverage. These periods are:
- Initial enrollment. This period is when you first become eligible for Medicare.
- Open enrollment. The open enrollment period goes from October 15 through December 7 each year.
- Medicare Advantage (Part C) open enrollment. This period is from January 1 though March 31 each year
Sometimes changes in your life circumstances make it necessary to change your healthcare coverage at other times during the year.
Medicare does allow you to change your Medicare coverage in certain special circumstances. When one of these qualifying events happens in your life, it triggers an SEP.
Depending on the life event that has made you eligible for an SEP, you may be able to:
- Switch from a Medicare Advantage (Part C) plan to original Medicare (parts A and B).
- Switch from original Medicare to a Medicare Advantage plan.
- Switch to a different Medicare Advantage plan.
- Add, drop, or change your prescription drug coverage.
- Drop your Medicare coverage and opt for an employer-provided plan.
You can change your Medicare coverage for only a limited time after a qualifying event takes place. The chart below is a basic guide to qualifying life events and the amount of time Medicare allows you to make a change.
To find out the exact date your SEP begins, you can contact Medicare directly.
| Special circumstance | Changes you can make | How long the SEP lasts |
|---|---|---|
| You move and your new home is out of your plan’s service area. | switch to a different Medicare Advantage (Part C) plan or Part D plan, or return to original Medicare | 2 months: If you tell your plan before you move, the SEP begins the month before you move. If you tell your plan after you move, your SEP begins the month you tell your plan about the move. |
| You move and there are new plan options available at your new address. | switch to a different Part C or Part D plan | 2 months: If you tell your plan before you move, the SEP begins the month before you move. If you tell your plan after you move, your SEP begins the month you tell your plan about the move. |
| You’re moving back to United States after living abroad. | join a Part C or Part D plan | 2 months |
| You move into or out of a skilled nursing facility, psychiatric facility, rehab hospital, or long-term care facility/ | join a Part C or Part D plan, switch to a different Part C plan, return to original Medicare, or drop your Part D plan | as long as you’re living at the facility or for 2 months after you move out |
| You’ve just been released from jail. | join a Part C or Part D plan | 2 months |
| You’re no longer eligible for Medicaid. | join a Part C or Part D plan, switch to a different Part C plan, return to original Medicare, or drop your Part D plan | 3 months |
| You no longer have health insurance from an employer or a union at your employer. | join a Part C or Part D plan | 2 months |
| Your employment ends or your employer-provided plan ends. | sign up for Medicare Part A or Part B | 8 months |
| You have a chance to get coverage from an employer or a union plan. | drop your Part C or Part D plan and join your employer’s plan | when your employer allows you to join the plan |
| You lose creditable coverage through no fault of your own. | join a Part C plan with Part D coverage or join a Part D plan | 2 months after you lose your coverage or you’re notified that your coverage has ended |
| You no longer have a Medicare cost plan. | join a Part D plan | 2 months |
| You’re enrolling in a PACE program. | drop your Part C or Part D plan | anytime |
| You’re no longer in a PACE program. | join a Part C or Part D plan | 2 months |
| You’re enrolling in TRICARE, VA, or another prescription drug plan. | drop a Part C plan with drug coverage or drop your Part D plan | anytime |
| Medicare sanctions your plan. | change to a different Part C plan | determined by Medicare on case-by-case basis |
| Medicare is ending your plan. | change to a different Part C plan | 2 months before your old plan ends until 1 month after your old plan ends |
| Medicare is not renewing your plan. | change to a different Part C plan | Dec 8 through the end of Feb |
| You’re now eligible for both Medicare and Medicaid. | join, switch, or drop your Part C plan | once during each of these periods: Jan–Mar, Apr–Jun, or Jul–Sep |
| You now qualify for the Extra Help program. | join, switch, or drop your Medicare Part D plan | once during each of these periods: Jan–Mar, Apr–Jun, or Jul–Sep |
| You’re enrolling in a State Pharmaceutical Assistance Plan (SPAP) or you lose coverage from an SPAP. | join a Medicare Part D plan or a Part C plan with Part D coverage | once per year |
| You dropped a Medigap policy when you joined a Part C plan. | drop Part C and return to original Medicare | 1 year after you joined the Part C plan |
| You have a special needs plan (SNP) but you don’t have the special need anymore. | change to a Part C or Part D plan | 3 months after your specified grace period closes |
| You joined the wrong plan because a federal employee made a mistake. | join a Part C or Part D plan, switch to a different Part C plan, or return to original Medicare | 2 months |
| You weren’t told that your private drug plan wasn’t as good as Medicare or your private drug plan is ending. | join a Part C plan with drug coverage or join a Part D plan | 2 months |
| Medicare just gave a 5-star rating to a plan in your area. | change to the 5-star Part C plan | one time between Dec 8 and Nov 30 |
If you think you may be eligible for an SEP, it’s important to contact Medicare right away to confirm your eligibility and to find out what deadlines apply.
Usually, if you sign up or make changes during an SEP, you won’t have to pay late enrollment penalties or fees — but there are exceptions.
If you have health insurance coverage through your employer and you work for an employer with fewer than 20 employees, it’s important to sign up for Medicare Part A and Part B when you’re first eligible or you may have to pay a late enrollment penalty.
If you don’t sign up for Medicare Part D (prescription drug coverage) when you become eligible and you don’t have creditable prescription drug coverage from another plan, an SEP may allow you to sign up for coverage. However, a penalty might still apply.
If you aren’t sure how Medicare works with your employer-provided health insurance, contact Medicare to make sure you sign up at the right time. Late enrollment penalties can continue for the entire time you have Medicare coverage.
Choosing the right plan for you
Before joining a new plan, it’s important to take some time to review your financial and healthcare needs. Doing some research and planning ahead can help you make the best choice.
Here are a few tips:
- Assess your current and potential healthcare needs. Are there doctors, facilities, or medications that you can’t compromise on for your care? This may impact your policy choice, particularly when deciding between original Medicare and Medicare Advantage.
- Consider your income. If you have a fixed or limited income, paying monthly premiums may be difficult. However, if you may need care that only Medicare Advantage would cover, this might be a good option to save costs in the long run.
- Look for cost savings programs. You may qualify for certain programs to help with your costs, including Medicaid and Extra Help.
- Find the right plan. Use Medicare’s plan finder tool to compare available Medicare Advantage plans in your area. You can search by prescription drugs you need, as well as covered providers and services.
Big changes in your life can affect your healthcare coverage.
To make sure you have the coverage you need, Medicare offers SEPs that allow you to add, drop, or change your Medicare plans outside of the typical enrollment periods that take place during the year.
If you move, lose coverage, or have a chance to get creditable healthcare coverage through a special program, your employer, or a union at your workplace, you may be able to take advantage of an SEP.
As soon as you’re aware of a change in your circumstances, contact Medicare to find out when and how you can change your coverage. You only have a certain amount of time to make the changes, and penalties can apply if you miss the deadlines.