What are Medicare Special Enrollment Periods?
Special Enrollment PeriodsEnrollment periods are designated time periods to enroll or disenroll from the various parts of Medicare. There are six Medicare enrollment periods. (SEPs) allow beneficiaries to change their Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). or Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plans due to a special circumstance. Common reasons for a SEP include moving, losing employer coverage, and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. eligibility, to name a few.1Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021
Key Takeaways
- Special Enrollment Periods allow a person to enroll in a Medicare plan outside the normal enrollment periods.
- Moving to a new area may qualify for a Special Enrollment Period.
- Losing healthcare coverage may qualify a beneficiaryA person who has health care insurance through the Medicare or Medicaid programs. for a Special Enrollment Period.
- Qualifying for a secondary coverage plan may allow for a Special Enrollment Period.
- Medicare Advantage or Part D plans being discontinued may qualify a beneficiary for a Special Enrollment Period.
- Being diagnosed with a severe medical condition may qualify for a Special Enrollment Period.
- Many more circumstances can allow for a Special Enrollment Period, check the full list at Medicare.gov.
Special Enrollment Periods (SEPs) are enrollment periods for Medicare Advantage and Part D plans that are only available under certain circumstances1Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021. Listed below are the most common SEPs and their timeframes for enrolling in Medicare plans.
What if I Lost My Current Coverage Plan?
If a beneficiary moves and their new area has different Medicare Advantage or Medicare Part D plans available, they have two months to enroll in a new plan or three months if they notify Medicare before they move. If a beneficiary is moving into a long-term healthcare facility, they can switch Medicare Advantage plans and Part D plans at any time during their stay and up to two months after they leave. Beneficiaries can also switch from Advantage to Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. coverage during their stay, but cannot switch back.1Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021
Beneficiaries may have been delaying enrollment because they had creditable employer coverage. If so, they can enroll in a Medicare Advantage or Medicare Part D up to two months after that coverage ends. Beneficiaries should check with Medicare to confirm their employer’s coverage is creditable before delaying enrollment.1Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021
A beneficiary might be a Medicare Advantage or Medicare Part D plan member and that plan becomes unavailable through Medicare. Medicare will notify them when a plan will be discontinued. They will have three months to enroll in a new plan, starting two months before their old plan is discontinued and ending one month afterward.1Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021
What if I Qualify for a New Coverage Plan?
Beneficiaries might be enrolled in Part D or an Advantage plan with drug coverage and suddenly qualify for a secondary creditable drug plan like Medicaid or Veteran Affairs. If this happens beneficiaries can drop their Medicare drug plan at any time to enroll in that secondary creditable drug plan. Beneficiaries can use that secondary payer in conjunction with Medicare as their primary payer for their healthcare services.1Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021
A severe chronic condition may require a beneficiary to enroll in a Special Needs Plan (SNP) available through Medicare Advantage. If there is an SNP that requires having that condition, they can enroll at any time. Once a beneficiary is enrolled, they cannot make changes to the SNP until the Annual Enrollment PeriodThe Annual Enrollment Period is when Medicare beneficiaries can join, drop or change Medicare Advantage and Medicare Part D prescription drug plans. AEP begins on 15 October and ends on 7 December..1Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 20212Medicare.gov, “Joining a health or drug plan“, Accessed September 25, 2021
Citations
- 1Medicare.gov, “Special circumstances (Special Enrollment Periods)“, Accessed September 25, 2021
- 2Medicare.gov, “Joining a health or drug plan“, Accessed September 25, 2021