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What is a Special Enrollment Period?

A Special Enrollment Period (SEP) takes place outside the standard enrollment periods such as AEP and may be granted to people with special circumstances.

You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These changes to make changes are called Special Enrollment Periods (SEPs). Rules about when you can make changes and the type of changes you can make are different for each SEP.

How Can I Qualify For A Medicare Special Enrollment Period?

For most people eligible for Medicare, after their Initial Enrollment Period (IEP) has passed, the only time they can enroll in, change or disenroll from a Medicare Advantage plan (also known as Medicare Part C) or a Part D prescription drug plan is each year during the Medicare Annual Enrollment Period (AEP). This period begins on October 15th and ends on December 7th. Reasons A SEP May Be Granted

During the SEP, you may be able to enroll or make changes to your Medicare Advantage plan or Part D prescription drug plan. A Special Enrollment Period may be allowed for a variety of reasons. Some of the more common reasons may include but are not limited to:

  • Loss of employer coverage
  • Medicare ends its contract with your plan
  • You move out of the service area of the plan
  • You are eligible for both Medicare and Medicaid benefits
  • You live in or move in or out of an institution such as a long-term care hospital or skilled nursing facility
  • You lose drug coverage that was equal to or better than that offered by Medicare (also known as creditable coverage)
  • You want to disenroll from your Medicare Advantage plan within 12 months of joining it
  • You have a disability, are turning 65, and are eligible for new plan options
  • You enroll in or disenroll from the PACE program
  • Your plan stops contracting with a substantial number of providers as determined by Medicare

There are many reasons a SEP may be granted, and the list above does not include all qualifications for a Special Enrollment Period. If you believe you may be eligible, contact CMS at the number below to submit a request.

Requesting A SEP

Suppose you have experienced any of the situations above or another situation that prevented you from enrolling in Medicare once you became eligible. In that case, you are encouraged to call 1-800-MEDICARE and request a Special Enrollment Period.

Special Enrollment Period Timing

The start and end of a SEP and the changes you can make will vary depending on the reason it is granted. If you are granted a SEP, you will be provided with the start and end dates as well as your enrollment options.

What is the 5-star special enrollment period?

Medicare gives overall performance star ratings to Medicare plans on a five-point scale, with five stars being the best. These ratings are based on information from the plans themselves, health care providers and member surveys. They are updated each year.

If you’re not currently in a five-star Medicare Advantage plan, Medicare drug plan (Part D) or Medicare cost plan, and there’s one available in your area, you can switch to a five-star plan during a special enrollment period. Each year the SEP goes from Dec. 8 to Nov. 30 the following year, and you may change only once during that time.

There are some caveats:

If you switch from a Medicare Advantage plan with prescription drug coverage to a stand-alone Medicare prescription drug plan, you’ll be disenrolled from the Medicare Advantage plan and enrolled in Original Medicare for health coverage.

Suppose you switch from a Medicare Advantage plan with prescription drug coverage to a Medicare Advantage plan that doesn’t include prescription drug coverage. In that case, you might lose your drug coverage, and you may have to wait until the next official enrollment window to sign up again. (This may result in late penalties.)

At Senior Benefit Solutions we specialize in Medicare. Represent all major companies and organizations that serve the senior market. Our brokers average over 15 years of experience. They are focused on educating first so you can make an informed decision on your healthcare.

If you are uncomfortable putting your information into the form and would like to receive a phone call, you can, of course, call us at (912) 687-3094.

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