Medicare Special Enrollment Periods allow Medicare beneficiaries to make changes to coverage outside of regular enrollment periods.Special Enrollment Periods generally apply only to Medicare Advantage or prescription drug plans. There is an exception to the rule — if you have delayed your Part B coverage past age 65. This typically happens if you were still covered by an employer’s, or your spouse’s employer’s, health insurance plan.Certain events can qualify you for a Special Enrollment Period to make Original Medicare coverage changes, like if you move out of your plan’s coverage area.
What Is a Medicare Special Enrollment Period?
A Medicare Special Enrollment Period (SEP) is a chance to make changes to your Medicare coverage outside of the normal enrollment windows. In most cases, you enter Medicare at set milestones. These milestones include:
Turning 65Receiving Social Security Disability Income (SSDI) for 24 consecutive monthsReceiving a diagnosis of end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS)
When these events apply to you, you become eligible for Original Medicare and you can enroll. Sometimes, though, a unique event occurs that gives you an opportunity to change your coverage. These are Special Enrollment Periods.
What Are the Normal Enrollment Periods?
Standard events trigger your Medicare eligibility. Assuming you meet the citizenship requirements, you will enter Medicare as soon as you meet one of the criteria mentioned above. Each of these events has a window for enrollment.
Turning 65
Most Americans become eligible for Medicare when they turn 65. This is known as aging into Medicare. When you age into Medicare, you have a seven-month window during which you can enroll. This is called the Initial Coverage Election Period, and it includes:
Three months before your 65th birthdayThe month you turn 65Three months after the month you turn 65
You can enroll in Original Medicare at any time during this window. In some circumstances, your enrollment may be automatic, e.g., if you choose to receive Social Security at age 65. In other cases, you might need to manually enroll. Regardless of how you enroll, you can also choose a Medicare Advantage plan, prescription drug plan, or Medicare Supplement plan during your Initial Election Period.
Disability
If you receive SSDI for 24 consecutive months, you’re eligible for Medicare. You will automatically enter on the first day of the 25th month of SSDI payments. You can add prescription drug coverage or enroll in Medicare Advantage at this time, too.
ESRD or ALS
Once you’ve been diagnosed with either of these diseases, there’s a short waiting period. For ESRD, you usually enter Medicare on the first day of the fourth month you receive dialysis. With ALS, you enter Medicare on the first day of the fifth month after you apply for SSDI. You can add drug coverage or choose Medicare Advantage once you’re enrolled in Original Medicare.
Is There a Special Enrollment Period for Medicare Part B?
Technically, the term Special Enrollment Period applies only to Medicare Advantage or prescription drug plans. However, there is one instance where you can think of a Part B Special Enrollment Period. This would be when you’ve delayed your Part B coverage past age 65. You would do this if you were still covered by an employer’s, or your spouse’s employer’s, health insurance plan. When you retire, or if you lose coverage, you’re entitled to an enrollment window for Part B. In this case, you’ve given eight months to enroll in Medicare and choose a plan. If this applies to you, your enrollment is not considered late, and you won’t pay any late enrollment penalties.
Special Enrollment Period for Medicare Advantage and Prescription Drug Plans
Once you’ve signed up for Original Medicare, you generally can only change your coverage during the Annual Enrollment Period (AEP). AEP is from October 15 to December 7 each year. Any changes made are effective the following January 1. However, certain events can qualify you for a Special Enrollment Period. Some of the more common reasons for a Special Enrollment Period are:
Moving out of your plan’s service areaQualifying for MedicaidLosing Medicaid coverageMoving into or out of an institution (like a nursing home)Your Medicare Advantage plan loses, or fails to renew, its contract with CMS
Other times you’d qualify for a Special Enrollment Period are more rare and complicated. If you think you might be entitled to an SEP, contact Medicare or a licensed health insurance agent. When you qualify for an SEP, you can make any of the following changes:
Change Medicare Advantage plansJoin Medicare Advantage for the first timeChange prescription drug plansDrop Medicare Advantage and return to Original Medicare
In addition to these, you can enroll in a Medicare Supplement insurance plan if you were enrolled in Medicare Advantage and moved out of your plan’s service area. In this case you‘ll have to cancel your Medicare Advantage plan coverage as a part of your move.
What Is the Medicare General Enrollment Period?
The Medicare General Enrollment Period (GEP) is for people who don’t sign up for Original Medicare on time. Anyone who fails to enroll during their initial enrollment window can sign up during GEP. GEP runs from January 1 to March 31 of each year. If you enroll during this window, your Original Medicare coverage will begin on July 1. You may also sign up for Medicare Advantage or a prescription drug plan during the General Enrollment Period. Unlike with other enrollment periods, you can’t make changes to your coverage during the General Enrollment Period. You can only enroll for the first time. Because of this, the GEP is a one-time-only enrollment window.
Using Medicare Special Enrollment Periods
If you think you qualify for a Special Enrollment Period, you can call Medicare for confirmation. Another option is to chat with a licensed professional. A licensed agent can walk you through your plan choices, compare quotes, and match you with a plan your doctor accepts that also covers your medications. Each Medicare plan and insurance product we feature has been independently selected and reviewed by the Medicare Expert USA team. If you make a purchase using the links included, Parade.com may be compensated. Next up, here’show to be a good caregiver and take good care of yourself, too.
