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Special Enrollment Periods for Medicare Advantage

The Medicare program is littered with different enrollment periods. They can be quite a bit to keep track of, but they’re also vitally important for Medicare beneficiaries to pay attention to. One type of enrollment period that often goes unnoticed is the Special Enrollment Period.

What Is a Medicare Special Enrollment Period?

Many beneficiaries know about the Initial Enrollment Period (around your 65th birthday) and the Annual Enrollment Period (every year from October 15 through December 7), but not many people know about Special Enrollment Periods.

Special Enrollment Periods (SEPs) are available for people who have had a life-changing event. This might include losing other coverage, moving to a new service area, becoming eligible for Medicaid, being admitted to an institution, and other things. Not everyone will qualify for an SEP, but for those that do, they allow them to change their current Medicare plans.

Special Enrollment Periods for Medicare Advantage

Each kind of Medicare health plan - Medigap plans, Medicare Advantage plans, and Part D prescription drug plans - can qualify for an SEP. Today, we’re going to focus on qualifying events that would allow someone to change their existing Medicare Advantage (Part C) plan.

Change in Residence

You moved to an address that is not in your current plan’s service area. In this case, you can switch your Medicare Advantage and/or Part D plan to a different one or move back to Original Medicare. You have two full months to make this change. It’s important to understand that if you move back to Medicare, you may not be eligible to enroll in a Medigap (Medicare Supplement) plan.

You moved to a new residence, and your new address is within the plan’s service area, but now you have more plan options. As in the scenario above, you have two full months to switch your Medicare Advantage or Part D plans or move back to Original Medicare.

You moved back to the United States after living abroad. You have two full months to enroll in a Medicare plan.

You moved into or out of an institution such as a long-term care hospital or skilled nursing facility. In this case, you can switch plans for a full two months after moving into or out of an institution. You may also qualify for a special kind of Medicare Advantage plan called an I-SNP (Institutional-Special Needs Plan) if one is available in your area.

You were released from jail. If you were already enrolled in Original Medicare (Parts A and B), you have two months to enroll in additional coverage.

Loss of Current Coverage

You lost your coverage from an employer. You have two full months from your plan’s termination date to enroll in other coverage.

You are no longer eligible for Medicaid. If you are no longer eligible for Medicaid due to a change in your income, you can join a Medicare Advantage or Part D plan. If you are currently enrolled in a D-SNP (Dual-Eligible Special Needs Plan), you will need to select a different kind of plan. You have three months from your last day of Medicaid eligibility or when you were notified, whichever occurs later.

Your existing prescription drug coverage is no longer creditable. You can join a Part D plan or a Medicare Advantage plan within two months of being notified or the coverage termination date, whichever is later.

You left drug coverage in a Medicare Cost Plan. You may join a Part D plan within two months of terminating the Medicare Cost Plan.

You dropped your coverage in a PACE plan. You can join a Part C or Part D plan within two months of leaving the PACE plan.

Opportunity for Other Coverage

You gain access to a creditable, employer-sponsored plan. If you or your spouse has decided to enroll in a creditable health insurance plan, you can disenroll from your current Medicare plans and move to the employer plan whenever the employer allows for enrollment.

You enrolled in a PACE plan. You can drop your current Medicare plans at any time.

You enrolled in creditable drug coverage. This happens most frequently when a beneficiary has VA or TRICARE benefits. You can drop your Medicare coverage at any time in this scenario.

Change in Medicare Contracts

Medicare terminated your current plan’s contract. You may switch Medicare plans beginning two months before the contract ends and must make changes no later than one full month after the contract’s termination date.

Your current plan was not renewed by Medicare. If your current plan is not renewed for the upcoming year, you can change plans from December 8 through the last day of February.

Other Special Circumstances

There are a number of other circumstances that would allow you to change your Medicare Advantage or Part D plan. Some of those circumstances include:

  • Gaining eligibility for Medicaid (in addition to Medicare)
  • Qualifying for the Extra Help program
  • Enrolling or losing eligibility for a State Pharmaceutical Assistance Program (SPAP)
  • Deciding to enroll in a Medigap plan within the first 12 months of your first time in a Medicare Advantage plan (Trial Right)
  • Developing or being cured of a chronic condition covered under a C-SNP (Chronic-Special Needs Plan)
  • Joining or terminating coverage under a plan due to a mistake made by a federal employee

If you’ve recently had a significant change in your life, you may qualify for an SEP to change your Medicare plan. Call the experts and Local Medicare Specialists to learn more about your unique situation.

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