Special Enrollment Information for Medicare

Sometimes big life changes or extenuating circumstances can impact everything from your daily routine to your health care coverage. Fortunately, this is why Medicare offers something called Special Enrollment Periods — segments of time only applicable to one person, allowing them to modify their Medicare coverage. Special enrollment periods can happen for a variety of reasons but are often because of a major life change that impacts your ability to get healthcare. During these times, you can enroll in a Medicare Advantage Plan, a Medicare Part D Prescription Drug Plan or return to Original Medicare.

You should know that Special Enrollment Periods are different from Initial Enrollment Periods, which come around only one time in your life when you are first eligible for Medicare benefits. If you are ready to sign up for Medicare for the first time, you should pay attention to the dates for your Initial Enrollment Period instead of looking for a Special Enrollment Period.

Special enrollment periods are helpful because like most private insurance companies, you cannot simply adjust your Medicare health coverage throughout the year. Generally speaking, you can only make changes to your Medicare coverage:

  • During the Annual Enrollment Period (also called Open Enrollment) that runs from October 15 to December 7.
  • During the Medicare Advantage Disenrollment Period from January 1 to February 14, which lets you drop Medicare Advantage and return to Original Medicare.

Sometimes you need to make changes outside of these times because of a big life change, and Medicare acknowledges that can happen. That’s why Special Enrollment Periods exist. This chunk of time allows you to make changes that help you get the best benefits possible.

Kinds of Special Enrollment Periods

There are a handful of reasons you may qualify for a Special Enrollment Period. The most common reasons are:

You have moved and your new plan is not available in your area. Often times moving to a new home, city or state can affect your healthcare coverage. Because plans vary by region, your plan may not extend to your new place of residence. If that is the case, Medicare will allow you to switch to a new plan so that you can maintain health benefits.

You have lost your current form of health insurance outside of Medicare. Many people are enrolled in Medicare Part A but not the rest of Original Medicare because they still have health insurance benefits from an employer or union. If those benefits are lost or you retire and can no longer use them, Medicare will grant you a Special Enrollment Period to get signed up for either Original Medicare or a Medicare Advantage plan.

 You can enroll in a different kind of health coverage outside of Medicare. Sometimes benefits from a private insurer can come along and Medicare will not penalize you if you want to use them. If your employer or union offers another form of health insurance, you can request a Special Enrollment Period to drop your current Medicare coverage.

Your health plan changes its contract with Medicare. Medicare Advantage plans are provided through private insurance companies. Each company creates a contract with Medicare to ensure you get the benefits and coverage you need. But on occasion, Medicare may drop a contract with an insurance provider because of sanctions or problems. If this is the case, you are able to switch to another plan. Medicare will notify you if this happens and you will have time to enroll in a new plan.

There are alternative reasons why you may qualify for a Special Enrollment Period, too. These are less common, but if they happen, you can become eligible to modify your healthcare coverage:

  • You are released from jail
  • A federal employee makes an error with my enrollment
  • You qualify for the Extra Help financial assistance program to pay for prescription drug coverage
  • You become eligible for both Medicare and Medicaid
  • You were enrolled in a Special Needs Plan but no longer have a qualifying condition

If you do not see your particular situation mentioned here, you may still qualify since there are many reasons people use them. In many cases, contacting Medicare and explaining your situation can help you become eligible for a Special Enrollment Period.

What Kinds of Changes Can I Make?

Each kind of Special Enrollment Period will allow you to make different changes to your healthcare benefits. For example, if you move to a new address outside of your insurance plan’s service area, you can switch to a new Medicare Advantage Plan or Part D Prescription Drug Plan. Additionally, you have the option of returning to Original Medicare. In most situations, you will be able to enroll in either a new Medicare Advantage plan, a new prescription drug plan or return to Original Medicare. But you should always confirm your options with Medicare before attempting to sign up for a new form of insurance.

How Long Do Special Enrollment Periods Last?

In most cases, a Special Enrollment Period will run about two months. This is the same amount of time as other enrollment events, so you won’t be rushed to switch to a new plan or drop certain kinds of coverage in a short period of time. But it remains important that you make changes promptly during your Special Enrollment Period. If you miss the deadline for making adjustments, you could be stuck with your current insurance plan until the Annual Election Period in October.

How Do I Get a Special Enrollment Period?

To qualify for a Special Enrollment Period and get the process started, you will need to contact Medicare. Only Medicare can say for sure if you are eligible to update or change your plan through Special Enrollment Period, but applying for one does not have to be scary. In many cases a Medicare representative can help determine if you qualify and what kinds of changes you are allowed to make to your current coverage depending on your unique situation.