When Is the Medicare Special Enrollment Period?

What Events Trigger a Special Enrollment Period for Medicare?

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Medicare is the federal health insurance program designed for people who are 65 years of age or older. It also provides coverage for some younger people with disabilities and people who have end-stage renal disease (ESRD). When you become eligible for Medicare, you need to decide when to enroll.  

You can enroll during the initial enrollment period, which begins near your 65th birthday and lasts for seven months. You can also enroll during the general enrollment period (Jan. 1 to March 31), but you may face late enrollment penalties. If you’re already enrolled, you can make changes to your coverage during designated open enrollment periods each year, depending on the type of coverage you have.

But if you need to add or change your coverage outside of these times, you must qualify for a special enrollment period (SEP). Several different events can create these enrollment opportunities. Below, you’ll find which circumstances make you eligible for a special enrollment period, and what Medicare programs you can enroll in.

Key Takeaways

  • An SEP may allow you to enroll in Medicare Parts A and B, or join or make changes to Medicare Parts C and D, after certain life events or circumstances.
  • Moving, losing your current health insurance, and having your plan end its contract with Medicare are among the events that may trigger an SEP.
  • There are rules about what plan changes you can make, depending on what event caused the SEP. 
  • The amount of time you have to enroll or make changes during an SEP depends on the type of event that triggers your SEP.

The Purpose of Medicare Special Enrollment

Normally, you can only enroll in Medicare or make changes to your plan during specific enrollment windows, including the initial enrollment period, open enrollment, and general enrollment. However, sometimes life’s events require that you make changes outside of these periods. That’s where Medicare's special enrollment comes in.

During a special enrollment period, you can apply for Medicare Part A and/or B, a Medicare Advantage plan (Part C), or a Part D drug plan, or make changes to your Medicare Advantage (MA) plan and your Part D prescription drug coverage. Unlike the other enrollment periods, a specific event or circumstance must occur for you to be eligible.

Here’s how the different enrollment periods, including special enrollment, work:

Type of Enrollment Period How You Qualify When It Happens What You Can Do
Initial Enrollment Based on age Starts 3 months before you turn 65 and lasts until 3 months after you turn 65, for a total of 7 months.  Enroll in Parts A and B, and Part D or a Medicare Advantage (Part C) plan.
Open Enrollment Be enrolled in Medicare  Oct. 15 to Dec. 7 every year Join, switch, or drop a Part D plan; switch or join a Medicare Advantage plan (if you have Parts A and B); or drop your MA coverage and return to Original Medicare.  
General Enrollment You missed your initial enrollment period Jan. 1 to March 31 every year Join Part A (if you have to pay for it) and/or Part B; join an MA plan during April 1 through June 30 (if you have both Parts A and B and enrolled in Part B during general enrollment)
Medicare Advantage Open Enrollment Be enrolled in a Medicare Advantage plan Jan. 1 to March 31 every year Switch to a different MA plan, or drop your MA plan and return to Original Medicare
Special Enrollment Experience a qualifying event  Depends on the type of qualifying event  You may be able to join Part A and/or Part B; join/drop a Part C Medicare Advantage plan or Part D prescription drug plan; switch to a different Part C Medicare Advantage plan or Part D prescription drug plan

Medicare SEPs are available to people who qualify for Medicare coverage and experience an event that triggers an SEP. Once the event happens, you have a limited amount of time to enroll, make changes, or drop your coverage. 

During your special enrollment period, you may be able to: 

The exact actions you’re allowed to take depend on why you qualified for a special enrollment period.

When Is the Medicare Special Enrollment Period?

Below is a closer look at some of the events that can lead to an SEP. 

You Move

Not all Medicare plans are available in every location. If you move, you may need to switch plans to ensure you have medical coverage. Additionally, if you move into or out of a care facility or other institution, you’re also eligible to make changes. 

Here’s a look at the type of changes you can make based on common moves.

Qualifying Event Changes You Can Make When You Can Make Changes 
Move to a new home Switch to a new Medicare Advantage plan or Medicare prescription drug plan (Part D)
 
 
The month before you move, or up to two months after your move. 
Move back to the U.S. from another country Join a Medicare Advantage plan or Medicare prescription drug plan.
 
 
Up to two full months after the month you move back. 
Move into or out of an institution such as a care facility  Join a Medicare Advantage plan, switch Medicare Advantage plans, return to Original Medicare, drop your Medicare Part D drug coverage As long as you’re living in the institution, and up to two full months after the month you move out. 

You can trigger a special enrollment period if you get released from jail. In that case, you have two full months to sign up for a Medicare Advantage or a Medicare prescription drug plan.

If you move to a new address that’s outside of your Medicare Advantage plan’s service area, you can choose a new Medicare Advantage plan or drop your MA plan and return to Original Medicare.

You Lose Your Current Health Coverage

If you have some other types of health coverage when you turn 65, such as employer-provided group health insurance, you can delay enrolling in Medicare without having to pay a penalty later. Once you lose this coverage (or while you have it), you can enroll in Part A (if you’re required to pay a premium), Part B, Part C, and Part D plans without penalty until the end of your SEP.

Part A and Part B

If you qualify for premium-free Part A, you can enroll in Part A at any time without penalty. If you don’t but were covered under a group health plan, you have eight months from the date you lose your coverage or your job ends, whichever comes first, to enroll in Part A. The same rule applies to Part B coverage (if you didn’t enroll when first eligible because you were covered by a group health plan). Your coverage will start anywhere from the first day of the month you sign up or, if you choose, during any of the three months after you sign up.

Medicare Advantage and Part D

You have two full months to enroll in a Medicare Advantage or Part D plan after the month your “creditable” drug coverage ends. If you don’t have creditable drug coverage for 63 or more days once you’re eligible for Medicare, you may owe a late enrollment penalty that permanently increases your Part D premium if you decide to get it.

Creditable drug coverage refers to coverage that is expected to pay on average what a Medicare prescription drug plan would pay.

You’re Eligible for Other Coverage

Sometimes, you may become eligible for other insurance coverage after you’ve already enrolled in Medicare Advantage and/or Medicare Part D if you: 

  • Get a different job and have qualifying coverage
  • Enroll in a Program of All-Inclusive Care for the Elderly (PACE) plan
  • Qualify for another kind of prescription drug coverage (such as from Tricare)

During this type of SEP, you can drop your Medicare Advantage and drug coverage at any time or whenever your employer or union allows you to change your plan. 

You can drop your Part B and Part A coverage (if you’re required to pay a premium) at any time without penalty. You can’t drop premium-free Part A.

Other circumstances can trigger special enrollment periods for Medicare. Here are some of the most common: 

  • Your plan changes its contract with Medicare and is no longer eligible
  • You enroll in a State Pharmaceutical Assistance Program (SPAP)
  • You’re eligible for both Medicaid and Medicare
  • You have a severe disability, and you’re eligible for a Medicare Special Needs Plan (SNP) 
  • A federal employee made an error with your enrollment

If you think you’re eligible for a special enrollment period, you can contact Medicare via phone or live chat to ask for help.

What if You Miss Special Enrollment?

If you miss special enrollment, you’ll have to wait for another enrollment period to make changes to or enroll in a plan. You can make changes to your coverage during the open enrollment period, during the Medicare Advantage open enrollment period (if you have Medicare Advantage), and you can enroll in Part B and a Medicare Advantage plan during general enrollment. However, you may have to pay a late penalty for failing to enroll on time.

Frequently Asked Questions (FAQs)

How many times can you change Medicare plans during a special enrollment period?

During a special enrollment period, you can make the changes allowed by that type of SEP. Once you make the changes, you’ll need to wait until the next applicable enrollment period to change plans again. 

How long does it take to get Medicare with special enrollment?

Your Medicare coverage usually starts the month after you enroll.