What is the Medicare Special Enrollment Period?

Published by Medicare Made Clear®

The two kinds of Medicare Special Enrollment Periods

There are actually two kinds of Medicare Special Enrollment Periods. A Medicare Special Enrollment Period allows you to switch plans or sign up for Medicare outside of the standard Medicare enrollment periods.

  • Special Enrollment Period – Qualifying Life Events: 2 months
  • Special Enrollment Period – Working Past 65: 8 months

If you have Medicare: For people who already have Medicare and who experience a qualifying life event, there is a two-month Special Enrollment Period for switching a Medicare Advantage or Part D plan.

If you don’t yet have Medicare: For people who qualified to delay Medicare because they had creditable coverage – usually from an employer – there is an 8-month Special Enrollment Period for enrolling in Medicare Parts A, B, C and D.

Let’s look at each closely.

What qualifies for a Medicare Special Enrollment Period to switch plans?

People who already have Medicare may qualify for a 2-month Special Enrollment Period with certain qualifying life events. This Special Enrollment Period lets you switch to a different Medicare Advantage or Part D prescription drug plan.

You may qualify for a 2-month Medicare Special Enrollment Period in the following situations:

  • You move out of your plan’s service area.
  • Your plan closes, stops serving the area where you live, significantly reduces its provider network or your plan consistently receives low Medicare star ratings.
  • You want to enroll in a 5-star plan at any time or drop your first Medicare Advantage plan within 12 months of enrolling.
  • You move into or out of a qualified institutional facility, like a nursing home.
  • You are enrolled in or lose eligibility for a qualified State Pharmaceutical Assistance Program.
  • You have Medicare financial assistance such as Medicaid, a Medicare Savings Program or Extra Help, or you gain or lose eligibility for any of these.
  • You enroll in or leave the Program of All-Inclusive Care for Elderly (PACE).
  • You gain or lose eligibility for a Special Needs Plan.

Some situations not listed here may qualify for a Special Enrollment Period as well. If you have questions about your personal situation, call your State Health Insurance Assistance Program for help.

When working past 65: 8-month Special Enrollment Period

For people who work past 65 and qualify to delay Medicare with creditable employer coverage, there is an 8-month Special Enrollment Period that allows you to enroll in Part A (if you haven’t yet), Part B , Part C and Part D without late penalties.

This Special Enrollment Period is tricky though. Why? Because while you have the whole 8 months to get Parts A & B, you only get the first 2 months to enroll in Part C or Part D without penalty. If you enroll after the two-month mark, you’ll face late enrollment penalties for Part D (regardless of whether you end up with a stand-alone Part D plan or a Medicare Advantage plan that includes drug coverage).

To qualify for the Part B Special Enrollment Period, you must have creditable employer or union health coverage based on current employment. Your Special Enrollment Period will begin eight months after your employer coverage ends or you leave your job, whichever happens first.

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