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You’ll need a Special Enrollment Period if you’re enrolling in Medicare after 65 or switching plans outside of the standard enrollment windows. But what exactly are they, how do they work and who qualifies? Let’s break it down.
What’s a Special Enrollment Period (SEP)?
An SEP is a time outside of the usual Medicare enrollment periods when you can enroll in or change your Medicare plan. SEPs are designed to allow flexibility for those who experience certain life events that impact their health coverage needs.
When do you qualify?
You may be eligible for an SEP if you experience a qualifying event, such as:
- Loss of other health coverage (yours or your spouse’s)
- Move to a new area (outside of your current plan’s service area)
- Change in your health status (move in or out of a nursing home or long-term care facility)
- Becoming eligible for or losing Medicaid or Extra Help with drug costs
- Involuntary loss of drug coverage as good as Medicare’s
- 5-Star Medicare Advantage plan available in your area (if you’re not already in a 5-star plan)
- Joined or didn’t join a plan because of false information from a federal employee
Note: Special enrollment opportunities aren’t limited to what’s shown above.
How long do SEPs last?
If you qualify for an SEP, the exact duration and rules of your period depend on the reason for the qualifying event. For example, if you lose employer coverage involuntarily, you have two months from the month your coverage ends to choose a new plan. It’s important to act quickly once you experience a qualifying event to ensure you don’t miss the window to enroll or switch plans.
Need help?
If you have questions about your unique situation or want to learn about other SEP opportunities, a licensed Essence Healthcare advisor can help. Just call 1-866-536-1052 (TTY: 711) from 8 a.m. to 8 p.m., seven days a week.†
Reminder: Standard Medicare Enrollment Windows
Initial Enrollment Period
- Three months before to three months after your 65th birthday.
- Enroll in Medicare for the first time.
Annual Enrollment Period
- October 15 through December 7.
- Switch, drop or join a different Medicare plan once during this yearly enrollment window.
Medicare Advantage Open Enrollment Period
- January 1 through March 31.
- Make a one-time election to change your Medicare Advantage plan.
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