Do I qualify for a Medicare Special Enrollment Period?

Medicare is a great way to get health coverage as you get older, but the timing for enrolling or changing plans can be tricky. Opportunities to sign up for Medicare or switch to a Medicare Advantage (MA) plan are usually limited to very specific and standard enrollment periods called Medicare Initial Enrollment Period (IEP) or Annual or Open Enrollment Periods (AEP or OEP). But we all know that “life happens” and can change our circumstances without warning. People move, lose jobs, need skilled nursing care, and more.

Is there a way to get Medicare coverage outside the regular enrollment periods? Yes—and that’s where a Special Enrollment Period (SEP) comes in. SEPs allow you to get covered if something happens or if you’d like to enroll in an MA plan outside the normal enrollment periods. Do you qualify for an SEP? Find out by answering these questions.

Has your employment ended?

If you are 65 and over and your employment is ending, you may qualify for an SEP to enroll in Medicare. When you turned 65, you likely signed up for Medicare Part A (hospital coverage), but you probably didn’t sign up for Medicare Part B (medical coverage) because you were still working. Now, you have up to eight months after you stop working and your employer health insurance coverage ends to add Medicare Part B without a penalty.

Have you lost coverage from another provider?

If so, you qualify for an SEP to join an MA Plan or a Medicare Prescription Drug Plan. The Centers for Medicare and Medicare Services (CMS) allows you to change your coverage for certain life events, such as losing other insurance coverage. First, you’ll need to enroll in Parts A and B, then you’ll have two months after losing coverage to join an MA Plan with drug coverage or a Medicare Prescription Drug Plan.

Did you lose your prescription drug coverage?

If you involuntarily lost creditable prescription drug coverage (coverage that’s at least as good as Medicare Part D), you have a two-month special enrollment period to enroll in a Medicare Part D plan. Many people delay enrolling in a Medicare Part D plan because they have better prescription coverage through a current or former employer or a spouse. However, if that coverage ends or changes and is no longer creditable, you may qualify for an SEP. If you miss the two-month SEP, you can enroll in a Part D plan only during the AEP (October 15- December 7) for coverage that will start on January 1.

If you have a gap in creditable prescription drug coverage for more than 63 days, you will be charged a late enrollment penalty which is added to your monthly Part D premium for as long as you are covered by a Part D plan.

Have you moved?

If you’re moving to a new address not covered in your current plan’s service area (or if your address is still in your MA plan’s service area but there are new plan options based on your location), then you have one month after you notify your plan about the move plus two more full months to switch your coverage. If you recently moved to Monterey County and are looking to make a change, we are here to make the transition easier. Our Health Plan Advisors can be reached at (855) 378-9680. (TTY users call 711.)

Are you in a skilled nursing facility?

You may also qualify for an SEP if you move into, out of, or reside in a skilled nursing facility (SNF) or long-term care (LTC) hospital. You can join an MA plan for two full months after you leave the institution. Learn more about the role Aspire Health plays in the recovery of our members who have had hospital or SNF stays.

These are just some of the situations that may qualify you for an SEP. For a complete list, visit the special circumstances page of Medicare.gov. Remember the length of time you have to make changes and the type of changes you can make may be different for each SEP.

Our Aspire Health team wants to help you find the best coverage whenever you want to enroll or change MA plans. Call our Aspire team at (866) 798-1530 to talk with our Sales team if you’d like more information on switching to our plan. TTY users can call 711.

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