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medicare special enrollment periods

What is the Medicare Special Enrollment Period (SEP)?

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.

What Qualifies You For a Special Enrollment Period?

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.

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Qualifying Life Events: Special Enrollment Periods for Medicare Advantage & Medicare Prescription Drug Plans

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.

What is a Qualifying Life Event & When are Special Enrollment Periods?

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).

Your Primary Residence Changed

  • You moved to a new address outside of your plan’s service area. You can find out if your current plan is or is not offered in your new location by speaking with a local licensed agent.
  • You moved to a new address in your plan’s service area, but now you have new plan options at your new location. You can find out if your plan options have or have not changed at your new location by speaking with a local licensed agent.
  • You’ve moved back to the United States after living abroad.
  • You recently moved into, are currently living in, or just moved out of an institution – such as a skilled nursing facility or long-term care hospital.
  • You’ve been released from jail.

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).

You Lost Your Health Insurance

  • You’re no longer eligible for Medicaid.
  • Your employer or union coverage (including COBRA coverage) has ended.
  • You lost your prescription drug coverage (creditable coverage), or your coverage changed and is no longer creditable.
  • You had prescription drug coverage through a Medicare Cost Plan, but you left the plan.
  • You dropped your coverage in a Program of All-Inclusive Care for the Elderly (PACE) plan.

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).

You Can Get Other Health Insurance

  • You have the chance to enroll in coverage offered by your employer or union.
  • You have or are enrolling in other prescription drug coverage as good as Medicare’s prescription drug coverage.
  • You enrolled in a Program of All-Inclusive Care for the Elderly (PACE) plan.

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.

Additional Special Circumstances

  • Your Medicare plan changes its contract with Medicare.
  • You are eligible for both Medicare and Medicaid.
  • You qualify for Extra Help paying for Medicare Prescription Drug Coverage.
  • You canceled your Medicare Supplement policy the first time you joined a Medicare Advantage Plan.
  • You qualify for a Medicare Chronic Care Special Needs Plan (SNP).
  • You’re enrolled in a Medicare Chronic Care Special Needs Plan (SNP) but no longer have the condition that qualifies you for the plan.

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).

5-Star Medicare Special Enrollment Period for Medicare Advantage, Medicare Prescription Drug, or Medicare Cost Plans

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).

Avoid Medicare Part D Penalties

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.

Working Past the Age of 65: What Is The Special Enrollment Period for Medicare Part B?

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.

How to Avoid Costly Gaps in Coverage When You Retire After 65

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.

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How to Avoid Part D Late Enrollment Penalties When You Retire After 65

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.

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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.

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