Special Enrollment Periods & Medicare Advantage
Outside of the Annual Election Period (AEP), there are circumstances where you can make changes to your Medicare Advantage (Part C) & Medicare Part D Prescription Drug plans. These circumstances are known as Special Enrollment Periods or SEPs. The regulations on when and what changes you can make differ by SEP.
Changes in Residence
My new address is not in my current plan’s service area
You Can:
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
- Return to Original Medicare (Note: If you do not enroll in a new Medicare Advantage (Part C) plan during the required time frame, you will be enrolled in Original Medicare when you lose coverage from your former plan).
When:
Notify your plan before you move, and your SEP begins the month before you move and lasts for a full two months post-moving.
If you tell your plan after moving, your SEP begins the month you tell your plan and lasts for a full two months after.
I am still in my current plan’s service area, but there are new plan options at my new address
You Can:
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
- Return to Original Medicare (Note: If you do not enroll in a new Medicare Advantage (Part C) plan during the required time frame, you will be enrolled in Original Medicare when you lose coverage from your former plan).
When:
Notify your plan before you move, and your SEP begins the month before you move and lasts for a full two months post-moving.
If you tell your plan after moving, your SEP begins the month you tell your plan and lasts for a full two months after.
I am returning to the US after living abroad
You Can:
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
SEP begins the month you move back and lasts for two months post-moving.
I just moved into/out of or currently live in an institution like a long-term care hospital or skilled nursing facility
You Can:
- Join a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
- Return to Original Medicare
- Drop your Medicare Prescription Drug Plan
When:
This SEP will last as long as you live in the facility and for two months once you leave the facility.
I was just released from jail.
You Can:
- Join a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
You have a full two months post-release to enroll in a plan if you kept paying for your Original Medicare Part A & B. If you have never enrolled in Medicare, you have to do that before enrolling in a Medicare Advantage (Part C) plan.
Loss of Coverage
I am no longer eligible for Medicaid
You Can:
- Join a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
- Return to Original Medicare
- Drop your Medicare Prescription Drug Plan
When:
This SEP will last for three whole months once you are no longer eligible or notified, whichever is later.
I just left my employer-sponsored coverage or COBRA
You Can:
- Join a Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
This SEP will last two full months after the month your coverage ends.
I involuntarily lost my other creditable drug coverage, or my coverage has changed to no longer be creditable.
You Can:
- Join a Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
This SEP will last a2 full months after you lose your creditable coverage or you’re notified your current coverage is not creditable, whichever is later.
I left my Medicare Cost Plan
You Can:
- Join a Medicare Prescription Drug Plan
When:
This SEP will last two full months after you drop your Medicare Cost Plan.
I dropped my PACE (Program of All-Inclusive Care for the Elderly) plan coverage.
You Can:
- Join a Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
This SEP will last a2 full months after you lose your creditable coverage or you’re notified your current coverage is not creditable, whichever is later.
Opportunity for Other Coverage
I have the opportunity to enroll in employer or union coverage.
You Can:
- Drop your Medicare Advantage (Part C) or Medicare Part D Prescription Drug Plan to enroll in the private plan
When:
- When your employer or union allows you to make changes or enroll in the private plan
I am enrolling in other creditable coverage such as TRICARE or VA Coverage
You Can:
- Drop your Medicare Advantage (Part C) or Medicare Part D Prescription Drug Plan
When:
- Anytime
I enrolled in a PACE plan.
You Can:
- Drop your Medicare Advantage (Part C) or Medicare Part D Prescription Drug Plan
When:
- Anytime
Plan Changes Its Contract with Medicare
Medicare took a sanction because of a problem with the plan that affected me.
You Can:
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
- Medicare determines your ability to switch on a case-by-case basis
My plan’s contract with Medicare has been terminated/ended.
You Can:
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
- Your chance to switch begins two months before the contract ends and lasts until one entire month after
Medicare did not renew the contract with my Medicare Advantage (Part C) Plans/Medicare Part D Prescription Drug Plan/Medicare Cost Plan.
You Can:
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
- December 8 until the last day of February
Other Special Circumstances
I am now eligible for Medicare and Medicaid.
You Can:
- Join, drop, or switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
- Once during each of these periods: January – March, April – June, July – September
- Changes you make will take effect on the first day of the following month. You cannot use the SEP in October – December. However, the Medicare Annual Election Period (AEP) lasts from October 15 – December 7, with changes occurring on January 1.
I qualify for Extra Help for my Medicare Part D Prescription Drug Coverage.
You Can:
- Join, drop, or switch Medicare Prescription Drug Plans
When:
- Once during each of these periods: January – March, April – June, July – September
- Changes you make will take effect on the first day of the following month. You cannot use the SEP in October – December. However, the Medicare Annual Election Period (AEP) lasts from October 15 – December 7, with changes occurring on January 1.
I am enrolled in or lost eligibility for SPAP (State Pharmaceutical Assistance Program)
You Can:
- Join a Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
- Once during each calendar year
I dropped a Medigap (Medicare Supplement) plan when I joined a Medicare Advantage (Part C) plan for the first time
You Can:
- Drop your Medicare Advantage (Part C) plan and Enroll in Original Medicare. You will be eligible to enroll in a Medigap policy
When:
- You can drop your Medicare Advantage (Part C) plan within the first 12 months of enrolling for the first time
A Medicare Chronic Special Needs Plan (SNP) is available for individuals with my severe or disabling condition.
You Can:
- Join a Medicare Chronic Special Needs Plan
When:
- Anytime, but your opportunity to make changes ends for this SEP
I no longer have the condition that qualified me for a Special Needs Plan.
You Can:
- Switch from a Special Needs Plan to a Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
- Your opportunity begins when you lose your special needs status and lasts up to 3 months after your Special Need Plan’s grace period is over
I joined/did not join a plan due to an error by a federal employee.
You Can:
- Join a new Medicare Advantage (Part C) plan with drug coverage or Medicare Prescription Drug Plan
- Switch to a new Medicare Advantage (Part C) with drug coverage or Medicare Prescription Drug Plan
- Return to Original Medicare
- Drop your Medicare Prescription Drug Plan
When:
- Your SEP lasts two full months after the month you receive the notice of error from Medicare
I was not appropriately told that my private drug coverage was not creditable coverage.
You Can:
- Join a Medicare Advantage (Part C) plan with drug coverage or Medicare Prescription Drug Plan
When:
- Your SEP lasts two full months after the month you receive the notice of error from Medicare or your plan
I was not appropriately told the private drug coverage I lost was creditable coverage.
You Can:
- Join a Medicare Advantage (Part C) plan with drug coverage or Medicare Prescription Drug Plan
When:
- Your SEP lasts two full months after the month you receive the notice of error from Medicare or your plan
