Special Enrollment Periods for Medicare

The Annual Enrollment Period (AEP) for Medicare is October 15 to December 7. During this period, anyone can make changes to their coverage, such as:

  • Switching from one plan to another

  • Switching from Original Medicare to a Medicare Advantage plan

  • Switching from one Advantage plan to another

  • Enrolling or dropping a Prescription drug plan

Changes made during the Annual Enrollment Period become effective the first day of the following year.

Can You Make Changes During Other Times of the Year?

The answer is - yes, under certain circumstances.

Medicare allows changes to your coverage during Special Enrollment Periods (SEP’s). Rules about when you can make changes, and the type of changes allowed, are different for each SEP. See the Medicare website for particulars and the full list, but here are the basic circumstances:

  • Change of Address - you move to an area that’s out of the range of your plan or to where there’s better options, you move back to the U.S. from another country, you move into or out of an assisted living facility, you are released from prison.

  • Loss of Coverage - you become no longer eligible for Medicaid, you lose coverage provided by your employer or union, you lose creditable coverage for drug coverage that’s as good as Medicare, you leave a Medicare Cost plan that provides drug coverage, you drop a Program of All-inclusive Care for the Elderly (PACE) plan.

  • Change of Coverage - you are able to enroll in a plan provided by your employer or union, you enroll in a drug plan such as one offered by TRICARE or the VA, you enroll in a Program of All-inclusive Care for the Elderly (PACE) plan.

  • Your Plan’s Contract with Medicare Changes - Medicare cancels or sanctions your plan’s contract, your Medicare Advantage Plan, Medicare Prescription Drug Plan, or your Medicare Cost Plan's contract with Medicare isn't renewed.

Special Election Period Available for Applicable Individuals Affected by COVID-19

The coronavirus has impacted just about everything in our culture, and Medicare is no exception. Centers for Medicare & Medicaid Services (CMS) has implemented an SEP for Medicare Advantage and Part D beneficiaries affected by COVID-19. The SEP is effective nationwide and runs from March 1, 2020 through June 30, 2020.

To be eligible, beneficiaries must reside in an area that Federal Emergency Management Agency (FEMA) declared an emergency or major disaster due to COVID-19 (see www.fema.gov/disasters for list). Beneficiaries who do not live in an impacted areas, but receive help with healthcare decisions from someone who does, is also eligible.

Need Help with Medicare?

As you can tell, there’s lots of rules with SEP’s, and Medicare in general can be very confusing. I’ll be glad to help if you need it.