Special Enrollment Period (SEP)

This is a period when one is given a chance to join or even make changes to his/her Medicare coverage based on various life events. Examples of these events include; one moving out of his/her plan’s service area, leaving a job, and many more. The length of SEP or what one can do during the SEP depends on the reason an individual qualifies for the SEP.

When Does One Qualify For a Special Enrollment Period

One may be in a position to use SEP due to many reasons. Some of the reasons include:

Moving. Various movements may give someone a chance to use a SEP. First, moving out of your plan’s service area may enable you to use SEP. Secondly, moving back to the United States after living in a foreign nation may give you a chance to use SEP. Last but not the least, moving into or out of skilled nursing facilities may enhance one’s chances of using SEP.

Loss of the current coverage. The loss includes losing a job that provides health insurance, or a creditable prescription drug coverage. Or even losing Medicaid eligibility.

Having a chance to get other coverage. This includes having a chance to sign up for any private insurance plan that your employer may offer.

If one’s plan changes. Your plan may change when Medicare sanctions your plan or ends your plan’s contract. Hence, enabling you to use SEP.

Change of a person’s eligibility. One can enjoy SEP if he/she becomes eligible for both Medicaid and Medicare. A person who has qualified for Extra Help with Medicare prescription drug coverage has a chance to enjoy SEP. Also if a person enrolled in a special needs plan and the person no longer has the condition that led to him/her signing up for it can enjoy SEP.

The Length of the Special Enrollment Period

The period of the SEP depends on the reason that made an individual qualify for the SEP. Some of the situations that can create a SEP, and the period of the SEP that applies to the situations include:

Moving to a spot out of your plan’s service area
If one alerts the plan before moving, the Special Enrollment Period will start the month before the month he/she moves. The SEP will continue for two months after moving.
If one alerts the plan after moving, the SEP will start the month he/she makes the plan aware. The SEP will continue for another two months after alerting the plan.
If one does not enroll in a new Medicare Advantage plan, the individual gets enrolled in Original Medicare.

Moving back to the U.S.A after living abroad
The SEP begins two months after the month the person returns to the U.S.A.

Moving into a skilled nursing facility
The SEP starts the entire period the person lives there. The SEP will continue for two months after leaving the facility.

Losing Medicaid eligibility
The SEP starts three months from the date a person loses eligibility or the date he/she gets notified. Whichever happens later.

A person ending the health coverage offered by the employer
The person’s SEP to join a prescription drug plan or Medicare Advantage plan lasts two months after the month his/her coverage ends.

His/her Special enrollment program to join Medicare part B lasts eight months after the employment or group health coverage ends.
Medicare ends a person’s plan’s contract

The SEP starts two months before, plus one month after your contract ends.
When a person has eligibility for both Medicaid and Medicare

The person can switch, join or end his/her plan one time during each period from the month of January to March, April to June, or July to September.

The 5-Star Special Enrollment Period
Medicare rates Medicare plans on a 5-star scale. The best plan takes the 5-stars. They give these ratings based on the information given by the plans themselves, members, and health care providers’ surveys. They update the ratings every year.

Individuals not enjoying a 5-star Medicare Advantage plan, Medicare cost plan, or Medicare drug plan (Part D) also have a chance to enjoy a 5-star plan. They can join a 5-star Medicare Advantage plan near them during SEP. Every year the special enrollment period runs from 8th December to 30th November the following year. One can only change once during that time.

However, be aware of the following caveats:

• A person who switches from a Medicare Advantage plan that has prescription drug coverage to a Medicare prescription drug plan, will be disenrolled from the Medicare advantage plan. The person will be enrolled in the Original Medicare for the health coverage.

• What if a person switches from a Medicare Advantage plan that has prescription drug coverage to one that does not have? In such a case, the person might lose his/her drug coverage. He/she may be forced to wait until the next enrollment window and sign up again. Such a person may even suffer late penalties.

What if a Person Gets Extra Help

Some SEPs apply to people who have eligibility for both Medicaid and Medicare. Even to those who have qualified for extra help that pays for Medicare drug coverage. During these SEPs a person can quit, change or join a prescription drug coverage or Medicare Advantage plan.

The person can make changes one time during each of the periods below:
• January- March.
• April- June.
• July- September.

The change takes effect on the 1st day of the following month.

A person can join a Medicare Advantage plan with drug coverage or a Medicare drug plan once a year if:
• The person has enrolled in a state pharmaceutical help program.
• The person has enrolled in SPAP.
• The person has lost SPAP eligibility.