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Medicare - What is a Special Enrollment Period?

January 15, 2024

A Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period during which individuals can sign up for or make changes to their Medicare coverage. Medicare, the federal health insurance program for people who are 65 or older, as well as certain younger individuals with disabilities, typically has an annual Open Enrollment Period from October 15 to December 7 each year.
 
However, Special Enrollment Periods are designated times when you can make changes to your Medicare coverage due to specific life events or circumstances. Some common examples of events that may trigger a Special Enrollment Period include:
 
1. Moving:
If you move to a new location that is not in your current plan's service area.
 
2. Losing other health coverage:
If you lose other health insurance coverage, such as employer-sponsored coverage or Medicaid.
 
3. Qualifying for Extra Help:
If you qualify for Extra Help with Medicare prescription drug costs.
 
4. Becoming eligible for other coverage:
If you become eligible for other types of health coverage, such as through an employer or Medicaid.
 
5. Changes in your current plan:
If your Medicare Advantage plan or Medicare Part D prescription drug plan is terminated, you move out of the plan's service area, or other circumstances arise that affect your plan.
 
It's important to note that the specific rules for Special Enrollment Periods can vary, and eligibility criteria may differ depending on the circumstance. If you think you qualify for a Special Enrollment Period, it's advisable to contact Medicare or visit the official Medicare website to get accurate and up-to-date information based on your specific situation.