Special enrollment periods (SEPs) describe when a person can sign up for Medicare outside the yearly Open Enrollment Period. People can qualify for Medicare SEPs due to life changing circumstances.
Medicare is a government program that can provide medical and other health-related services to specific individuals in the U.S. Some people get Medicare automatically, while others will need to enroll to receive it. Generally, people will apply for Medicare during an enrollment period. These are timeframes that allow a person to join, switch, or drop a Medicare plan.
SEPs help people get Medicare coverage without penalty outside of normal signup windows when they have certain life circumstances. Because SEPs vary in different parts of Medicare, it is important to understand how they work in order to avoid penalties or avoid gaps in medical coverage.
Medicare SEPs refer to a portion of time where an individual can switch Medicare plans, or sign up for Medicare outside of the standard Medicare Enrollment Periods. A person may qualify for an SEP following certain life events that change their circumstances. These can include losing coverage, moving, marriage, having a baby, or changes in income.
Most people can sign up for Medicare during their Initial Enrollment Period (IEP). This period starts 3 months before a person turns 65 and ends 3 months after the month they turn 65.
If a person then wishes to join, drop, or switch to another Medicare plan, they usually will need to wait until an Open Enrollment Period. These windows are either October 15 to December 7, or January 1 to March 31, depending on the plan a person wishes to change.
However, if a person qualifies to SEPs, they can make changes to their Medicare plans outside of these Open Enrollment Periods.
Additionally, if a person does not sign up for Medicare coverage during their IEP, they may need to pay an extra amount, called a late enrollment penalty. However, if a person is eligible for an SEP, they can avoid late fees.
Not everyone qualifies for SEPs, so a person should make sure they have qualifying circumstances before their Initial Enrollment Period ends so they can sign up if necessary.
Several qualifying circumstances allow a person to sign up for coverage past their Initial Enrollment Period. For example, a person can make changes to Medicare Advantage and Medicare drug coverage when certain life events occur. These can include:
- changing residence
- losing coverage
- getting married
- having a baby or adopting a child
- a divorce or legal separation
- a death of someone on the plan
- if household income is below a certain amount
A person should contact Medicare directly by calling 800-633-4227 if they think they may have a SEP or to ask about their eligibility.
Like the Initial Enrollment Period, SEPs vary based on the person’s situation and when a person becomes eligible.
SEPs for signing up for Part A or Part B following missing the IEP varies between 6 to 12 months following eligibility. The majority require enrollment within 6 months of the qualifying event.
A person can sign up for Part C or Part D within 2 months of signing up for parts A or B following a special circumstance.
Making changes to plans for parts C or D can vary greatly and also need to occur typically within a few months of any qualifying event.
SEPs for parts A and B are available for certain groups of people that miss the IEP.
SEPs for parts A and B include the following:
- lost Medicaid coverage on or after 1/1/2023
- missed a chance to sign up due to a natural disaster or an emergency declared or started on or after 1/1/2023
- missed a chance to sign up because of inaccurate or misleading information from a health plan or employer on or after 1/1/2023
- released from incarceration on or after 1/1/2023, causing a person to miss the Initial Enrollment Period during incarceration
- missed a chance to sign up due to other exceptional conditions (must contact Social Security directly to ask for this period)
- have or had health insurance through personal employment, spouse’s employment, or family member’s employment (if disabled)
- have TRICARE (insurance through active military service)
- volunteer and serve in a foreign country
SEPs for part C and D either help a person avoid penalties associated with missing the IEP or allow a person to switch plans mid-year due to special circumstances.
People typically need to join Part D when they sign up for Part A, Part B, or both. Failing to do so, without adequate drug plan coverage or Extra Help, will result in the penalty. A person who misses this period without a SEP can add a Part D plan during Open Enrollment from October 15 to December 7 each year, though they will likely receive a penalty fee for the duration of coverage.
A person can sign up for Part C with a private insurance agency during their IEP. They can also switch plans during the year either during the Open Enrollment period each year or during the Medicare Advantage Open Enrollment Period (January 1 – March 31) each year.
SEPs for Parts C and D can include special circumstances, such as moving or changes to providers in the area as well as a variety of other situations.
As of January 1, 2024, a person will have two months following signing up for Part A or Part B due to an exceptional situation to sign up for either Part C (with or without drug coverage) or Part D.
Medicare Special Enrollment Periods (SEPs) refer to timeframes where a person can make changes to their Medicare plan due to certain life circumstances.
Typically, a person would need to wait until an Open Enrollment Period to make these changes. However, if certain life changes occur, a person may qualify for an SEP. In some cases, qualifying for an SEP may also help a person avoid late penalty fees.