Do I Qualify for a Special Enrollment Period?

Medicare Benefits Solutions

Jul 14, 2020

With so many options, many Medicare recipients make an initial choice that just doesn’t meet their long-term needs. Whether you qualified for Medicare a year ago or 10 years ago, you may have experienced changes in your health and well-being. The good news is that you can make changes to your Medicare coverage at certain times during the year.

In most cases, you can get Medicare if you are a United States citizen and reach the age of 65, or if you have a qualifying disability at any age and meet the eligibility requirements. When enrolling in Medicare coverage, you’ll have options, including coverage choices that address generalized needs for medical care, hospitalization, prescription drugs, and more.

This coverage may include:

  • Medicare Part A, which most people get automatically due to taxes they paid while working
  • Medicare Part B, which covers preventive care and medically necessary services and supplies
  • Medicare Part C, which includes Medicare Advantage plans offered by private insurance companies that are approved by Medicare to provide your Part A and B benefits, usually along with other coverage
  • Medicare Part D, which is optional prescription drug coverage
  • Medigap, or Medicare Supplement, which helps cover out-of-pocket costs not covered by Original Medicare

Can I Change My Plan?

After you’ve selected your initial Medicare coverage, you will have the ability to change it during Annual Election Period (AEP) each year, but there may be other circumstances that allow you to change your plan under Special Enrollment Period (SEP) guidelines. If you experience a qualifying event that places you in a Special Enrollment Period, then you will be able to switch plans.

Do I Qualify for a Special Enrollment Period?

In order to qualify for an SEP, you will need to have a qualifying life event. These qualifying life events may include:

  • You lose current employer or union-based group insurance
  • Your plan provider changes its contract with Medicare
  • You move out of your plan’s service area
  • You move back into the country after living abroad
  • You are released from jail
  • You qualify for Medicaid
  • You move into skilled nursing or assisted living
  • You qualify for a Special Needs Plan

Other circumstances could cause SEP eligibility. Although the above listed reasons are the most common for special enrollment period eligibility, your situation is unique, so Medicare also gives consideration to individuals who have experienced things, such as being misinformed about private insurer drug coverage benefits versus Medicare prescription drug coverage. Some people may also qualify if they were previously enrolled in a Special Needs Plan and the condition causing eligibility no longer exists. In order to know whether your circumstances qualify to allow you to take part in a special enrollment period, you will need to contact your Medicare plan manager or your local Medicare administration office to discuss your personal situation.

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