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Medicare Special Enrollment Period

Medicare has an annual enrollment period for Part D (drug coverage) and Part C (Medicare Advantage health plans). This annual enrollment period is October 15th through December 7th of each year. At this time, Medicare beneficiaries can enroll in a Part D or a Part C plan, or switch plans. However, there are circumstances when a Medicare enrollee can enroll in (or switch) a Part D or Medicare Advantage plan outside of the normal Medicare enrollment period. Perhaps the most basic exception to the normal enrollment period applies to people who are newly eligible for Medicare. The normal Initial Enrollment Period for Medicare begins three months before the month in which a person turns 65 and continues three months after the month in which a person turns 65.

Medicare Special Enrollment Period

Medicare has an annual enrollment period for Part D (drug coverage) and Part C (Medicare Advantage health plans). This annual enrollment period is October 15th through December 7th of each year. At this time, Medicare beneficiaries can enroll in a Part D or a Part C plan, or switch plans. However, there are circumstances when a Medicare enrollee can enroll in (or switch) a Part D or Medicare Advantage plan outside of the normal Medicare enrollment period. Perhaps the most basic exception to the normal enrollment period applies to people who are newly eligible for Medicare. The normal Initial Enrollment Period for Medicare begins three months before the month in which a person turns 65 and continues three months after the month in which a person turns 65.

Initial Enrollment Period: 7-Months

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However, there are additional conditions under which a person may qualify for enrolling in, or switching between, Medicare insurance plans. These are known as “Special Enrollment Periods (SEP).” Special Enrollment Periods often last two months from the time of a qualifying event. If you are a dual eligible that qualifies for both Medicare and Medicaid and you have coverage through a special needs plan, you qualify for a special enrollment period which gives you the option to change your plan at the beginning of each month. Dual eligibles can also change their Part D plan at any time during the year.

Medicare Advantage & Medicare Part D Special Enrollment Period

There are a variety of situations that trigger a Special Enrollment Period for someone with a Medicare Advantage and/or a Medicare Part D plan. For your convenience these events have been grouped into three categories: Living Changes, Coverage Changes & Other Changes. The following list is not exhaustive and additional information on Special Enrollment Periods can be found at Medicare.gov or by calling 1‑800‑MEDICARE (1‑800‑633‑4227). If you are hearing impaired and use TTY you should call 1‑877‑486‑2048.

Living Changes

SituationOptionsDeadline Information
You move and your plan’s network does not cover your new area.

You move and your plan’s network does cover your new area but you have new plan options.
Switch to a new Medicare Advantage or Medicare Prescription Drug Plan.If you tell your plan before you move you can switch plans from one month before you move until two full months after you move.

If you tell your plan after you move you can switch plans the month you tell your plan, plus two additional full months.
You move back to the US after living outside of the country.Join a Medicare Advantage or Medicare Prescription Drug Plan.You have two full months to enroll after the month you move back.
You currently live in, move into, or move out of an institution such as a long-term care hospital or a skilled nursing facility.
  • Join a Medicare Advantage or Medicare Prescription Drug Plan.
  • Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan.
  • Drop your Medicare Advantage Plan and return to Original Medicare (Parts A & B).
  • Drop your Medicare prescription drug coverage.
As long as you live in the institution you qualify for a special enrollment period and can switch or drop coverage at any time.

If you move out of the institution you have two full months to enroll after the month you move out.
You are released from jail.Join a Medicare Advantage or Medicare Prescription Drug Plan.You have two full months to enroll after the month you were released.

Coverage Changes: Lost Current Coverage

SituationOptionsDeadline Information
You no longer qualify for Medicaid.
  • Join a Medicare Advantage or Medicare Prescription Drug Plan.
  • Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan.
  • Drop your Medicare Advantage Plan and return to Original Medicare (Parts A & B).
  • Drop your Medicare prescription drug coverage.
You have two full months after the month you find out you are no longer eligible for Medicaid to change your plan.
You find out you no longer qualify for Extra Help next year.
  • Join a Medicare Advantage or Medicare Prescription Drug Plan.
  • Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan.
  • Drop your Medicare Advantage Plan and return to Original Medicare (Parts A & B).
  • Drop your Medicare prescription drug coverage.
You can change your plan from January 1st to March 31st.
You no longer have coverage through your employer or union.Join a Medicare Advantage or Medicare Prescription Drug Plan.You have two full months after the month your coverage ends.
You lose your other creditable drug coverage (meaning the plan is just as good as a Medicare drug coverage plan) or your other coverage changes and becomes no longer credible.Join a Medicare Advantage plan that includes drug coverage or join a Medicare Prescription Drug Plan.You have two full months after the month you lose creditable coverage or you are notified of the loss of coverage, whichever is later.
You drop your coverage in a Program of All-inclusive Care for the Elderly (PACE) plan.Join a Medicare Advantage or Medicare Prescription Drug Plan.You have two full months after the month you drop your PACE plan.

Coverage Changes: Opportunity to Get Other Coverage

SituationOptionsDeadline Information
You have a chance to get employer or union sponsored coverage.Drop your current Medicare Advantage or Medicare Prescription Drug Plan to enroll in the private plan sponsored by your employer or union.Inquire with your employer or union to see when you can make changes to your plan.
You have the chance to enroll in other creditable drug coverage such as TRICARE or VA coverage.Drop your current Medicare Advantage plan with drug coverage or your Medicare Prescription Drug Plan.No deadline, can drop at any time.
You enroll in a Program of All-inclusive Care for the Elderly (PACE) plan.Drop your current Medicare Advantage or Medicare Prescription Drug plan.No deadline, can drop at any time.
You live in an area with one or more Medicare Advantage or Medicare Prescription Drug Plans with a CMS 5-star quality rating.Join a 5-star Medicare Advantage, Medicare Cost, or Medicare Prescription Drug Plan.One time between December 8th and November 30th.

Coverage Changes: Your Current Plan’s Contract With Medicare Changes

SituationOptionsDeadline Information
Medicare sanctions (takes an official action) your plan because of a problem with it that affects you.Switch from your current Medicare Advantage or Medicare Prescription Drug Plan to another plan.Your chance to switch is determined on a case-by-case basis by Medicare.
Your plan’s contract is terminating during the contract year.Switch from your current Medicare Advantage or Medicare Prescription Drug Plan to another plan.You can switch from two months before until two months after your contract ends.
The contract for your current Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan is not renewed for the next contract year.Join another Medicare Advantage or Medicare Prescription Drug Plan.You can enroll between October 15th and February 28th/29th (depending on if it is a Leap Year).

Other Changes Due to Special Situations

SituationOptionsDeadline Information
You are eligible for both Medicare and Medicaid (dual eligible).Join, switch, or drop a Medicare Advantage Plan or Medicare Prescription Drug coverage.No deadline, can join, switch, or drop at any time.
You qualify for Extra Help.Join, switch or drop Medicare Prescription Drug coverage.No deadline, can join, switch, or drop at any time.
You are enrolled in a State Pharmaceutical Assistance Program (SPAP) or you lose SPAP eligibility.Join a Medicare Prescription Drug Plan or a Medicare Advantage Plan that includes prescription drug coverage.One time during the calendar year.
When you joined a Medicare Advantage plan you dropped your Medigap (Medicare Supplemental Insurance) policy.Drop your Medicare Advantage Plan & enroll in Original Medicare (Parts A & B). Then you can buy a Medigap policy.You can drop your Medicare Advantage Plan within 12 months after you join the plan for the first time.
You have a severe or disabling condition and a Medicare Chronic Care Special Needs Plan (SNP) is available in your area.Join the SNP which serves people with your condition.You can join the SNP at any time but once you join your chance to make changes using this special enrollment period ends.
Due to error by a federal employee you joined a plan or chose not to join a plan.
  • Join a Medicare Advantage or Medicare Prescription Drug Plan.
  • Switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan.
  • Drop your Medicare Advantage Plan and return to Original Medicare (Parts A & B).
  • Drop your Medicare prescription drug coverage.
You have two full months after the month you receive notice of the error from Medicare.
You were not properly notified that your private drug coverage is not as good as Medicare drug coverage (creditable coverage).Join a Medicare Advantage plan that includes drug coverage or join a Medicare Prescription Drug Plan.You have two full months after the month you receive notice of the error from Medicare.
You were not properly notified that you are losing your current creditable private drug coverage.Join a Medicare Advantage plan that includes drug coverage or join a Medicare Prescription Drug Plan.You have two full months after the month you receive notice of the error from Medicare.

Every year there is also a Medicare Advantage Disenrollment Period (MADP) from January 1st through February 14th. At this time, Medicare Advantage enrollees can disenroll and return to Original Medicare Parts A and B (along with a stand- alone Medicare prescription drug plan if their former Medicare Advantage plan had drug coverage).

Understanding Medicare Part C & D Enrollment Periods (October 2012) http://www.medicare.gov/Pubs/pdf/11219.pdf

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