Medicare Advantage Special Enrollment Periods (SEP’s)
You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs) and are in addition to the regular enrollment periods that happen each year.
Rules about when you can make changes and the type of changes you can make are different for each SEP. The SEPs listed on the next paragraphs are examples. This list doesn’t include every situation.
Common Examples include:
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Changes in where you live
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You leave coverage from your employer or union.
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Changes in your plan’s contract with Medicare
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You dropped a Medicare Supplemental Insurance (Medigap) policy the first time you joined a Medicare Advantage Plan.
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You’re enrolled in a State Pharmaceutical Assistance Program (SPAP).
Changes in where you live
You move to a new address that isn’t in your plan’s service area.* or… You move to a new address that’s still in your plan’s service area, but you have new plan options in your new location.
You can…
Switch to a new Medicare Advantage or Medicare Prescription Drug Plan. * Note: If you’re in a Medicare Advantage Plan and you move outside your plan’s service area, you can also choose to return to Original Medicare. If you don’t enroll in a new MA plan during this SEP, you’ll be enrolled in Original Medicare when you’re disenrolled from your old Medicare Advantage Plan.
At this time...
If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move. If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months.
You move back to the U.S. after living outside the country….
You can…
Join a Medicare Advantage or Medicare Prescription Drug Plan.
At this time...
Your chance to join lasts for 2 full months after the month you move back to the U.S.
You just moved into, currently live in, or just moved out of an institution (like a skilled nursing facility or long-term care hospital).
You can…
■ Join a Medicare Advantage or Medicare Prescription Drug Plan.
■ Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan.
■ Drop your Medicare Advantage Plan and return to Original Medicare.
■ Drop your Medicare prescription drug coverage.
At this time...
Your chance to join, switch, or drop coverage lasts as long as you live in the institution and for 2 full months after the month you move out of the institution.
You’re released from jail….
You can…
Join a Medicare Advantage or Medicare Prescription Drug Plan.
At this time...
Your chance to join lasts for 2 full months after the month you’re released from jail.
Changes that cause you to lose your current coverage
You’re no longer eligible for Medicaid.
You can…
■ Join a Medicare Advantage or Medicare Prescription Drug Plan.
■ Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan.
■ Drop your Medicare Advantage Plan and return to Original Medicare.
■ Drop your Medicare prescription drug coverage.
At this time...
Your chance to change lasts for 2 full months after the month you find out you’re no longer eligible for Medicaid.
You find out that you won’t be eligible for Extra Help for the following year.
You can…
■ Join a Medicare Advantage or Medicare Prescription Drug Plan.
■ Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan.
■ Drop your Medicare Advantage Plan and return to Original Medicare.
■ Drop your Medicare prescription drug coverage.
At this time... Your chance to change is between January 1–March 31.
You leave coverage from your employer or union.
You can… Join a Medicare Advantage or Medicare Prescription Drug Plan.
At this time... Your chance to join lasts for 2 full months after the month your coverage ends.
You involuntarily lose other drug coverage that’s as good as Medicare drug coverage (creditable coverage), or your other coverage changes and is no longer creditable.
You can…
Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.
At this time...
Your chance to join lasts for 2 full months after the month you lose your creditable coverage or are notified of the loss of creditable coverage, whichever is later.
You have drug coverage through a Medicare Cost Plan and you leave the plan.
You can…
Join a Medicare Prescription Drug Plan.
At this time...
Your chance to join lasts for 2 full months after the month you drop your Medicare Cost Plan.
You drop your coverage in a Program of All-inclusive Care for the Elderly (PACE) plan.
You can…
Join a Medicare Advantage or Medicare Prescription Drug Plan.
At this time...
Your chance to join lasts for 2 full months after the month you drop your PACE plan.
If you have a chance to get other coverage like...
You have a chance to enroll in other coverage offered by your employer or union.
You can…
Drop your current Medicare Advantage or Medicare Prescription Drug Plan to enroll in the private plan offered by your employer or union.
At this time...
Whenever your employer or union allows you to make changes in your plan.
You have or you have a chance tp enroll in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage).
You can…
Drop your current Medicare Advantage Plan with drug coverage or your Medicare Prescription Drug Plan.
At this time...
Anytime.
You enroll in a Program of All-inclusive Care for the Elderly (PACE) plan.
You can…
Drop your current Medicare Advantage or Medicare Prescription Drug Plan.
At this time...
Anytime.
You live in the service area of one or more Medicare Advantage or Medicare Prescription Drug Plans with an overall quality rating of 5 stars.
You can…
Join a Medicare Advantage, Medicare Cost, or Medicare Prescription Drug plan with an overall quality rating of 5 stars.
At this time...
One time between December 8–November 30.
Changes in your plan’s contract with Medicare
Medicare takes an official action (called a “sanction”) because of a problem with the plan that affects you.
You can…
Switch from your Medicare Advantage or Medicare Prescription Drug Plan to another plan.
At this time...
Your chance to switch is determined by Medicare on a case-by-case basis.
Your plan’s contract ends (terminates) during the contract year.
You can…
Switch from your Medicare Advantage or Medicare Prescription Drug Plan to another plan.
At this time...
Your chance to switch starts 2 months before and ends 1 full month after the contract ends.
Your Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan’s contract with Medicare isn’t renewed for the next contract year.
You can…
Switch from your Medicare Advantage or Medicare Prescription Drug Plan to another plan.
At this time...
Between October 15 and the last day in February.
Changes due to other special situations
You’re eligible for both Medicare and Medicaid.
You can…
Join, switch, or drop a Medicare Advantage Plan or Medicare prescription drug coverage.
At this time...
Anytime.
You qualify for Extra Help paying for Medicare prescription drug coverage.
You can…
Join, switch, or drop Medicare prescription drug coverage.
At this time...
Anytime.
You’re enrolled in a State Pharmaceutical Assistance Program (SPAP).
You can…
Join either a Medicare Prescription Drug Plan or a Medicare Advantage Plan with prescription drug coverage.
At this time...
Once during the calendar year.
You’re enrolled in a State Pharmaceutical Assistance Program (SPAP) and you lose SPAP eligibility.
You can…
Join either a Medicare Prescription Drug Plan or a Medicare Advantage Plan with prescription drug coverage.
At this time...
Your chance to switch starts either the month you lose eligibility or are notified of the loss, whichever is earlier. It ends 2 months after either the month of the loss of eligibility or notification of the loss, whichever is later.
You dropped a Medicare Supplemental Insurance (Medigap) policy the first time you joined a Medicare Advantage Plan.
You can…
Drop your Medicare Advantage Plan and enroll in Original Medicare. You’ll have special rights to buy a Medigap policy.
At this time...
Your chance to drop your Medicare Advantage Plan lasts for 12 months after you join the Medicare Advantage Plan for the first time.
You have a severe or disabling condition, and there’s a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with your condition.
You can…
Join a Medicare Chronic Care SNP that serves people with your condition.
At this time...
You can join anytime, but once you join, your chance to make changes using this SEP ends.
You joined a plan, or chose not to join a plan, due to an error by a federal employee.
You can…
■ Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.
■ Switch from your current plan to another Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.
■ Drop your Medicare Advantage Plan with drug coverage and return to Original Medicare.
■ Drop your Medicare prescription drug coverage.
At this time...
Your chance to change coverage lasts for 2 full months after the month you get a notice of the error from Medicare.
You weren’t properly told that your other private drug coverage wasn’t as good as Medicare drug coverage (creditable coverage).
You can…
Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.
Your chance to join lasts for 2 full months after the month you get a notice of the error from Medicare.
You weren’t properly told that you were losing private drug coverage that was as good as Medicare drug coverage (creditable coverage).
At this time...
Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan.
Your chance to join lasts for 2 full months after the month you get a notice of the error from Medicare.
You DON’T have Medicare Part A coverage, and you enroll in Medicare Part B during the Part B General Enrollment Period (January 1–March 31).
You can…
Sign up for a Medicare Prescription Drug Plan.
At this time...
Between April 1–June 30.
For more information about signing up, including instructions on how to enroll in a Medicare Advantage Part D or Medicare Supplemental Insurance plan call
610-399-8700 today!