There are three primary Medicare Special Enrollment Periods that you could qualify for – whether you’re enrolled in Medicare or not. Discover how you may be eligible for one and the importance of their timing.
A Medicare Special Enrollment Period (SEP) allows you to switch plans or sign up for a Medicare plan outside your standard Medicare enrollment periods. Including outside of the Annual Enrollment Period that occurs October 15th – December 7th annually.
There are three primary reasons why you may qualify for a Special Enrollment Period:
Suppose you have Medicare and experience a Qualifying Life Event. In that case, you have a Special Enrollment Period for switching a Medicare Advantage or a stand-alone Medicare Part D Prescription Drug Plan.
The Centers for Medicare and Medicaid Services rates Medicare plans on a scale of 1 to 5 stars, with 5-stars being excellent. Is a Medicare Advantage, Medicare drug plan, or Medicare Cost Plan with a 5-star rating available in your area? If so, you can use the 5-star Special Enrollment Period to switch from your current plan to a 5-star quality rating plan.
Did you delay Medicare enrollment because you had creditable coverage through an employer or other source? Then you may have an 8-month Special Enrollment Period for enrolling in Original Medicare (Parts A & B), and expanded Medicare coverage, once you lose creditable coverage.
If you have Medicare and experience a Qualifying Life Event, you may qualify for a Special Enrollment Period (SEP). During that time, you can change your Medicare Advantage (Medicare Part C) or stand-alone Medicare Part D Prescription Drug Plan coverage. The changes you can make and when are different for each Special Enrollment Period.
You may qualify for a Medicare Special Enrollment Period if you’ve experienced a Qualifying Life Event. Read more about what Qualifying Life Events are and the timing of their Special Enrollment Periods. If you have a question about eligibility, call to speak with a local licensed agent at no-cost or obligation at (623) 223-8884 (TTY: 711).
If you qualify for a Special Enrollment Period because your primary residence changed, your Special Enrollment Period is typically 60 days after moving. But there is a difference in timing if you inform your plan before versus after your change of residence.
If you tell your plan before you change residence, your chance to switch plans begins the month before your move month, plus 60 days after you move. If you inform your plan after moving, your window to change plans includes the month you tell your plan, plus 60 more days. To confirm the length of your Special Enrollment Period, call and speak to one of Connie Health’s local licensed agents at (623) 223-8884 (TTY: 711).
Qualify for a Special Enrollment Period because you lost your health insurance? Depending on the reason, you could have 60 to 90 days from the date you’re no longer eligible, notified, or after the month your coverage ends. Speak with a local licensed agent to confirm the timing of your Special Enrollment Period. Call (623) 223-8884 (TTY: 711).
Have the chance to get health insurance from somewhere other than Medicare? You can make a plan change whenever your employer or union allows you to make a change to your health plan coverage. If you want to cancel your Medicare Advantage or stand-alone Medicare Part D Prescription Drug Coverage, you can do so at any time. But ensure you have creditable prescription drug coverage from your new source.
If your life event falls under a special circumstance above, speak with a local licensed agent to confirm your Special Enrollment Period. Each Special Enrollment Period has unique timing, and it’s important to know yours. Don’t miss the opportunity to make a change. Call (623) 223-8884 (TTY: 711).
Medicare uses satisfaction surveys and information from plans and health care providers to give performance star ratings to plans. A plan can get a rating between 1 and 5 stars – with 5-stars being excellent. These ratings are updated every fall to help you compare plans based on quality and performance.
Even if a plan has a five-star rating, comparing plans before enrolling is essential. This ensures the plan you choose has the doctors, specialists, and medications that are important to you at a cost that you can afford.
Is a Medicare Advantage, Medicare drug plan, or Medicare Cost Plan with a 5-star rating available in your area? If so, you can use the 5-star Special Enrollment Period to switch from your current plan to a 5 Star Medicare Advantage Plan, 5-Star Medicare Prescription Drug Plan, or 5-Star Medicare Cost Plan available in your area. You can only use this Special Enrollment Period once between December 8 and November 30.
To see if a 5-star plan has become available in your community call to speak with a local licensed agent at (623) 223-8884 (TTY: 711).
Suppose you move from a Medicare Advantage Plan that includes prescription drug coverage (MAPD) to a stand-alone Medicare Prescription Drug Plan (Medicare Part D). In that case, you’ll be returned to Original Medicare.
Suppose you disenroll in a Medicare Advantage Prescription Drug Plan (MAPD) and lose your creditable prescription drug coverage. In that case, you may have to wait until your next enrollment opportunity to get drug coverage. This may cause you to pay a Part D late enrollment penalty.
Did you or your spouse decide to work past the age of 65 and delay Medicare because of your or your spouse’s creditable group health plan coverage? Once you or your spouse decide to retire, leave that job, or lose employer coverage, you have an eight-month Special Enrollment Period. During that time, you can enroll in Medicare Part A (if you haven’t already) and Part B without late penalties.
To be eligible, you must have been continuously covered by your or your spouse’s employer coverage or by Medicare Part B since becoming eligible for Medicare. If you had more than eight consecutive months without employer coverage or Part B, you’re not eligible for the Medicare Part B Special Enrollment Period.
Want to know the next steps for applying for Medicare once you or your spouse have lost employer-sponsored coverage? Visit “How to Apply for Medicare Part B” to learn more.
If you anticipate losing your employer-based health insurance, it’s best to enroll in Medicare before you lose that coverage. This will ensure that you don’t experience any gaps in coverage. If you plan to retire, contact your or your spouse’s employer one or two months in advance to avoid costly gaps in coverage. The human resources department can help you time your Medicare enrollment to start once you lose your employer-based coverage.
During this Special Enrollment Period, you can enroll in a Medicare Advantage or stand-alone Medicare Part D Prescription Drug Plan. However, the timing is slightly different.
You have 8-months to enroll in Medicare Parts A and B during this Special Enrollment Period. But you only have 60 days to enroll in a Medicare Advantage (Part C) or Medicare Part D Prescription Drug Plan. If you don’t enroll in those first two months, you may face late enrollment penalties for Part D coverage.
Read more by David Luna
I am a Spanish-speaking Arizona Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2005. I am a Marine Corps Veteran & former police officer. I enjoy watching football and basketball but hold family time in the highest regard.