Change Your Plan in a Medicare Special Enrollment Period
Medicare Benefits Solutions
Sep 10, 2021
Medicare Special Enrollment Periods let you switch your Medicare Advantage or prescription drug plan outside Annual Enrollment if your life circumstances change.
The Annual Election Period (AEP) and Open Enrollment Period (OEP) aren’t the only two opportunities to make changes to – or switch – your Medicare Advantage Plan. If you experience a major life event that alters your circumstances, you may be eligible for a Special Enrollment Period. In this article, we look at what this is and the situations that can trigger it.
What is a Medicare Special Enrollment Period?
There are two types of Medicare Special Enrollment Periods – one that deals with deferring Part A and/or Part B of Original Medicare, and one which concerns the loss of Medicare Advantage and/or a Prescription Drug Plan. It’s this latter type of special enrollment (or election) period that we’ll talk about here.
If you’re already enrolled in Medicare Advantage but need to switch your plan because of certain major life events, you may qualify for a Medicare Advantage Special Enrollment Period. Circumstances which can lead to eligibility for a Medicare Special Enrollment Period include, but are not limited to:
- You’ve moved out of your current plan’s service area
- You’re entering (or leaving) a long-term care facility
- Your plan no longer accepts Medicare, or is no longer available
- You become ineligible for Medicaid
Several other circumstances could also qualify you for a Special Enrollment Period – one of which is natural disasters.
If your community suffers a major catastrophic event, all of the following need to be true for you to use a Medicare Advantage or Prescription Drug Plan Special Enrollment Period:
- The Federal Emergency Management Agency (FEMA) or a Federal, state, or local government entity has declared an emergency or major disaster in the county where you live
- A valid election (enrollment) period was in effect when FEMA (or other government entity) declared the emergency or major disaster, and you hadn’t yet changed your coverage , and you were unable to make your enrollment request because of the disaster
- The valid Special Enrollment Period announced to address this situation hasn’t expired
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What about switching to a 5-star Medicare Advantage plan?
It’s also possible to use a Medicare Special Enrollment Period to switch to a 5-star Medicare Advantage plan, if one is available in your area. This is the only Special Enrollment Period which has a set duration: from December 8th each year to November 30 the following year.
During the 5-star special enrollment period, you can switch once only from your existing Medicare Advantage plan, Prescription Drug Plan or Medicare Cost plan to a 5-star (Excellent) plan.
How long does a Medicare Special Enrollment period last?
No matter when you qualify for a Special Enrollment Period, you will have a window in which to switch Medicare Advantage plans. For example, if you tell your plan’s provider before you move, you’ll have a chance to switch plans starting the month before you move, and your SEP will continue for two full months after you move.
(NOTE: This period should not be confused with the eight-month Special Enrollment Period for those who choose to defer Part A and Part B of Original Medicare – for example, because they’ve elected to work past 65.)
Need help with your Medicare Special Enrollment Period?
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