Enrolling in Original Medicare is a key part of taking care of your health, so it's important to know when and how to sign up. Enrollment windows can be broken into three separate periods: Initial, Annual and Special. Initial Enrollment is the first time you become eligible for Medicare because of age and begins three months prior to the month you turn 65 and continues until three months after you turn 65. Annual Enrollment is meant for individuals who missed the Initial Enrollment window.
Finally, we get to Special Enrollment. The Medicare Special Enrollment Period (SEP) is the time outside the Initial Enrollment Period when you can make changes to your coverage. This is usually opened because of a life-changing event, like moving to a new area or losing your drug coverage. The SEP gives you the flexibility to adapt your Medicare Advantage or Medicare Part D (Prescription Drug Coverage) plans to more readily fit your needs.
Here’s what you need to know to make the most of this bonus enrollment opportunity.
Scenarios That Qualify You for the Special Enrollment Period
Usually, you can qualify for the Special Enrollment Period because of events that happen in your life. Moving and losing coverage are both instances that allow you to make changes to your Medicare Advantage or your Part D plans. Let’s look at some of the more common situations that will open the SEP for you:
- You move to a new address that isn’t in your current plan’s service area
- You change where you live, including a move to or from a nursing home or long-term care facility
- You no longer qualify for Medicaid
- You lose your current coverage, whether it was from an employer or union
- You have the option to enroll in other coverage that’s offered from an employer or union
- Your current plan’s contract is either changed or terminated by Medicare
In addition to these life events, there are also special situations that give you a chance to make changes during the Medicare SEP. They include:
- You become eligible for both Medicaid and Medicare
- You qualify for Extra Help in paying for your Medicare prescription drug coverage
- You’re enrolled in a State Pharmaceutical Assistance Program (SPAP)
- You joined a plan (or chose not to join a plan) because of a federal employee error
- You’re enrolled in a Special Needs Plan (SNP) but no longer have a condition that qualifies for the plan
- You weren’t properly told about Creditable Coverage (i.e. coverage that’s at least as good at what Medicare can provide)
Beginning January 1, 2024, people who sign up for Medicare Part A and/or Part B because of a life-changing event will have two months to join a Medicare Advantage (with or without drug coverage) or Medicare Part D (Prescription Drug Coverage) plan. Benefits start the first day of the month after you sign up.
Length of the Special Enrollment Period
The length of a Special Enrollment Period depends on the event that opened it. For people who are past Medicare’s qualifying age of 65, there is an eight-month period to enroll without any penalties. But if the SEP is due to a qualifying life event (like the ones we’ve discussed here) the window to sign up is only two months.
Available Plans During Enrollment
During enrollment, there are several types of Medicare plans that are available for you to consider.
Original Medicare (Part A and Part B)
Medicare Part A (hospital insurance coverage) and Part B (medical insurance coverage) are plans provided by the federal government and include coverage for hospital stays, doctor visits and certain medical services.
Medicare Advantage (Part C)
Private insurance companies approved by Medicare offer Medicare Advantage plans. These bundled plans combine the coverage of Part A and Part B. Often, these plans include additional benefits such as prescription drug coverage, dental, vision and wellness programs.
Medicare Part D (Prescription Drug Coverage)
Medicare Part D benefits are prescription drug plans that private insurance companies provide and help cover the cost of prescription medications. They can be added to Original Medicare or some Medicare Advantage plans.
Medigap Policy
A Medigap Policy is extra insurance from a private company and helps pay your share of costs in Original Medicare. These policies are standardized, so the basic benefits of each remain the same.
What if I Missed the Initial Medicare Enrollment Period?
If you miss the Initial Medicare Enrollment Period, you will still be able to enroll. (The initial enrollment period starts three months before the month you turn 65 and ends about three months after.) However, you may have to wait to sign up for coverage and pay a late enrollment penalty – a cost that not only gets added to your monthly premium but also increases the longer you wait to sign up.
Frequently Asked Questions
What is the eight-month special enrollment period for Medicare?
Some people choose to delay Medicare coverage past the qualifying age of 65 because they already have credible coverage through an employer. The eight-month Special Enrollment Period applies to Original Medicare. It’s the period of time for those individuals working past 65 to enroll outside of the Initial Enrollment Period without penalty.
What are three scenarios that qualify you for a special enrollment period?
- You can qualify for a Special Enrollment Period during any month that involves a life-changing event. These reasons include:
- A change in your permanent residence
- A recent move to a new service area
- A desire to switch to a higher-quality plan with a better rating
What is the eight-month SEP for Medicare Part B?
The eight-month Special Enrollment Period for Medicare Part B allows individuals to delay their enrollment past the age of 65 without penalty as long as they have credible coverage through an employer.
What is an example of a special election period?
A special election period, also known as a Special Enrollment Period (SEP), applies to Medicare Advantage. It’s the time outside annual enrollment when you can change your Medicare Advantage or Part D coverage. This period is caused by a qualifying life event. Some common examples are a move in your residence, a loss of current coverage or a termination of your plan’s contract by Medicare.
Can patients enroll in Medicare Part D anytime or only during open enrollment?
Your first chance to sign up for Medicare Part D is during the Initial Enrollment Period when you turn 65. But you may be able to enroll during the Medicare Advantage Open Enrollment Period, as well.
Which Medicare Advantage Plan is right for you?
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Disclaimers
Sources
Medicare.gov Special Enrollment Periods
SSA.gov Special Enrollment
How to enroll in Medicare if you missed your Initial Enrollment Period
