What is a Medicare Special Enrollment Period?

A Special Enrollment Period is a time outside of regular enrollment periods when you can sign up for Medicare or change your coverage. You must have a qualifying life event, such as losing employer coverage, moving, or qualifying for Extra Help.

How long does a Special Enrollment Period last?

The length of a Special Enrollment Period depends on the qualifying event. Most SEPs last for two months after the event. Some, like the SEP for losing employer coverage, last for eight months. Certain SEPs, like the Extra Help SEP, are ongoing.

What happens if I lose my employer health insurance?

When you lose employer coverage, you have an eight-month Special Enrollment Period to enroll in Medicare Part B without a late enrollment penalty. You can also join a Medicare Advantage or Part D plan during this time.

Can I change my Medicare plan if I move to a new state?

Yes. If you move outside your current plan service area, you qualify for a Special Enrollment Period. You can switch to a different Medicare Advantage plan or Part D plan available in your new location, or you can return to Original Medicare.

What is the five-star Special Enrollment Period?

From December 8 through November 30 each year, you can switch to a Medicare Advantage or Part D plan that has a five-star quality rating. This allows you to join a top-rated plan outside of the Annual Enrollment Period.

Do I need proof of my qualifying event to use a Special Enrollment Period?

Yes, in most cases. Medicare or the insurance company may ask for documentation of your qualifying event, such as a letter from your previous employer, proof of moving, or notice of Medicaid eligibility. Keep these documents when you enroll.

Medicare Special Enrollment Periods (SEP): Full Guide

Medicare has specific enrollment periods when you can sign up for coverage or make changes. If you miss these periods, you may face penalties or have to wait a full year to enroll.

However, Special Enrollment Periods allow you to enroll or change coverage outside of regular enrollment windows. You must have a qualifying life event to use a Special Enrollment Period.

This article explains every Medicare Special Enrollment Period, what qualifies you, and how long each one lasts.

What Is a Special Enrollment Period?

A Special Enrollment Period is a time when you can enroll in Medicare or change your Medicare coverage outside of the standard enrollment periods. You need a qualifying event to trigger a Special Enrollment Period.

Different types of Special Enrollment Periods apply to different parts of Medicare. Some apply to Medicare Parts A and B. Others apply to Medicare Advantage and Part D plans.

Special Enrollment Periods for Medicare Parts A and B

Losing Employer or Union Coverage

This is one of the most common Special Enrollment Periods. If you are 65 or older and have been covered by employer or union health insurance, you can delay enrolling in Medicare Part B without penalty.

When your employer coverage ends, you have an eight-month Special Enrollment Period to sign up for Part B. This applies whether you or your spouse loses coverage.

The eight months start the month after your employment ends or the month after your coverage ends, whichever happens first. If you miss this window, you may face a late enrollment penalty.

Living or Working Outside the United States

If you did not enroll in Part B when you were first eligible because you lived outside the United States, you may qualify for a Special Enrollment Period when you return.

You have eight months from the month you return to the United States to enroll in Part B without a late enrollment penalty.

Special Enrollment Periods for Medicare Advantage and Part D

Moving to a New Service Area

If you move outside your current Medicare Advantage or Part D plan service area, you qualify for a Special Enrollment Period.

You can switch to a different plan in your new area or disenroll from Medicare Advantage and return to Original Medicare. This SEP lasts for two months after you move.

Even if you move within the same plan service area, you may still qualify for a Special Enrollment Period in some cases. For example, if you move into or out of a nursing home.

Losing Employer, Union, or COBRA Coverage

When you lose employer, union, or COBRA coverage that includes prescription drug benefits, you can join a Medicare Advantage or Part D plan.

You have two months after your coverage ends to enroll. For example, if your coverage ends on June 30, you can enroll through August 31.

Qualifying for Extra Help with Drug Costs

If you qualify for Extra Help, also called the Low-Income Subsidy, you can join, switch, or drop a Part D plan at any time during the year. This is an ongoing Special Enrollment Period.

Extra Help assists people with limited income and resources to pay for prescription drug costs. If you qualify, you have continuous flexibility to change plans throughout the year.

Gaining or Losing Medicaid

If you become eligible for Medicaid or lose Medicaid eligibility, you qualify for a Special Enrollment Period. You have two months from the change to enroll in or switch your Medicare Advantage or Part D plan.

People who are dually eligible for Medicare and Medicaid can also change plans quarterly during the first nine months of the year.

Entering or Leaving an Institution

If you enter or leave an institution, such as a nursing home, long-term care facility, or prison, you can change your Medicare coverage.

You have two months from when you enter or leave the institution to make changes to your Medicare Advantage or Part D plan.

Plan Makes a Material Change

If your plan makes a significant change that affects you, such as no longer covering a drug you take or removing your doctor from the network, you may qualify for a Special Enrollment Period.

You typically have two months from when you receive notice of the change to switch to a different plan.

Plan Leaves Your Service Area

If your Medicare Advantage or Part D plan is no longer offered in your area, you automatically qualify for a Special Enrollment Period.

You can choose a new plan in your area or return to Original Medicare. You have two months from when you receive notice to make your change.

Plan Misrepresented Information or Made a Significant Error

If your plan provided false or misleading information when you enrolled, or if the plan made a significant error that affected your enrollment, you may qualify for a Special Enrollment Period.

Contact Medicare to report the issue. They will review your case and determine if you qualify for a Special Enrollment Period.

Five-Star Special Enrollment Period

From December 8 through November 30 each year, you can switch to a Medicare Advantage or Part D plan that has received a five-star quality rating from Medicare.

You can only use this Special Enrollment Period once per year. Five-star plans represent the highest quality ratings based on member satisfaction and plan performance.

Chronic Condition Special Needs Plan SEP

If you are newly diagnosed with a chronic condition and qualify for a Chronic Condition Special Needs Plan, you can enroll in that type of plan at any time.

Chronic conditions that may qualify include diabetes, heart failure, chronic lung disorders, and certain neurological conditions.

Disaster-Related SEP

If you are affected by a federally declared disaster, you may qualify for a Special Enrollment Period. This allows you to make changes to your Medicare coverage if the disaster disrupted your access to care or your plan services.

The length and specific terms of disaster-related SEPs vary depending on the situation.

How Long Do Special Enrollment Periods Last?

The duration of a Special Enrollment Period depends on the qualifying event. Here is a summary:

Losing employer or union coverage (Parts A and B): Eight months
Moving to a new area: Two months
Losing other creditable coverage: Two months
Gaining or losing Medicaid: Two months
Entering or leaving an institution: Two months
Plan makes a material change: Two months
Extra Help: Ongoing, anytime during the year
Five-star SEP: December 8 through November 30, once per year

When Does Coverage Start After Using a SEP?

When you enroll using a Special Enrollment Period, your coverage start date depends on when you enroll and the type of coverage.

For Medicare Parts A and B, coverage usually begins the first day of the month after you enroll. In some cases, such as when losing employer coverage, you can request retroactive coverage.

For Medicare Advantage and Part D plans, coverage typically starts the first day of the month after the plan receives your enrollment request. However, if you enroll between the 1st and 15th of the month, coverage may start that same month.

How to Use a Special Enrollment Period

To use a Special Enrollment Period, you need to enroll in coverage during the SEP timeframe. The process depends on which type of Medicare coverage you are enrolling in.

Enrolling in Parts A and B

To enroll in Medicare Part A or Part B using a Special Enrollment Period, you can apply online at the Social Security Administration website, call Social Security at 1-800-772-1213, or visit a local Social Security office.

You will need to provide documentation of your qualifying event. For example, if you are enrolling after losing employer coverage, you need a letter from your employer stating when your coverage ended.

Enrolling in Medicare Advantage or Part D

To join or change a Medicare Advantage or Part D plan using a Special Enrollment Period, you can enroll online at Medicare.gov, call 1-800-MEDICARE, or contact the insurance company directly.

You will need to indicate the qualifying event that makes you eligible for the Special Enrollment Period. The plan or Medicare may ask for proof of the qualifying event.

Documentation You May Need

When using a Special Enrollment Period, you may need to provide documentation of your qualifying event. Keep these documents ready:

Letter from employer showing when coverage ended
Proof of new address, such as utility bills or lease agreement
Notice of Medicaid eligibility or termination
Documentation of entering or leaving an institution
Notice from your plan about changes or termination

Common SEP Mistakes to Avoid

Missing the Deadline

Special Enrollment Periods have strict deadlines. If you miss the window, you may have to wait until the next Annual Enrollment Period to make changes. Mark your calendar and enroll as soon as possible after your qualifying event.

Not Keeping Documentation

Always keep proof of your qualifying event. Even if you enroll without submitting documentation initially, Medicare or the plan may request it later. If you cannot provide proof, your enrollment may be canceled.

Assuming All SEPs Are the Same

Different Special Enrollment Periods have different rules and timeframes. Make sure you understand which SEP applies to your situation and how long it lasts.

Not Comparing Plans

Just because you qualify for a Special Enrollment Period does not mean you should rush into the first plan you see. Take time to compare your options and choose the plan that best meets your needs.

What to Do If You Miss a Special Enrollment Period

If you miss a Special Enrollment Period, your options depend on what type of coverage you need.

For Medicare Parts A and B, you generally have to wait until the General Enrollment Period, which runs from January 1 through March 31 each year. Coverage would start July 1. You may also face late enrollment penalties.

For Medicare Advantage and Part D plans, you typically need to wait until the Annual Enrollment Period from October 15 through December 7. However, if you qualify for a different Special Enrollment Period before then, you may be able to enroll earlier.

Getting Help with Special Enrollment Periods

Understanding Special Enrollment Periods can be complex. If you need help determining if you qualify or how to enroll, several resources are available:

Call Medicare at 1-800-MEDICARE for free assistance
Contact your State Health Insurance Assistance Program (SHIP) for free local counseling
Work with a licensed Medicare insurance agent
Visit Medicare.gov for information and enrollment tools

Final Thoughts

Special Enrollment Periods provide important flexibility to enroll in or change your Medicare coverage when life circumstances change. Understanding which SEPs exist and how to use them can help you avoid coverage gaps and late enrollment penalties.

If you experience a qualifying event, act quickly. Most Special Enrollment Periods are time-limited. Keep documentation of your qualifying event and compare your coverage options carefully before enrolling.