| Tue, Apr 30, 2019 @ 02:17 PM

What is the Medicare Special Enrollment Period?

Posted by Medicare Made Clear

The Medicare Special Enrollment Period allows you to switch plans or sign up for Medicare outside of the standard Medicare enrollment periods. Medicare grants a Special Enrollment Period for certain qualifying situations and life events.

What Qualifies for a Medicare Special Enrollment Period to Switch Plans?

Current Medicare enrollees may qualify for a Special Enrollment Period to switch to a different Medicare Advantage or Part D prescription drug plan in the following situations:

  • You move out of your plan’s service area.
  • Your plan closes, stops serving the area where you live, significantly reduces its provider network or your plan consistently receives low Medicare star ratings.
  • You want to enroll in a 5-star plan at any time or drop your first Medicare Advantage plan within 12 months of enrolling.
  • You move into or out of a qualified institutional facility, like a nursing home.
  • You are enrolled in or lose eligibility for a qualified State Pharmaceutical Assistance Program.
  • You have Medicare financial assistance such as Medicaid, a Medicare Savings Program or Extra Help, or you gain or lose eligibility for any of these.
  • You enroll in or leave the Program of All-Inclusive Care for Elderly (PACE).
  • You gain or lose eligibility for a Special Needs Plan.

Some situations not listed here may qualify for a Special Enrollment Period as well. If you have questions about your personal situation, call your State Health Insurance Assistance Program for help.

What is the Medicare Part B Special Enrollment Period?

The Medicare Part B Special Enrollment Period allows you to enroll in Part B after age 65 without a late enrollment penalty. Some people want to delay Part B enrollment and postpone paying the monthly Part B premium.

To qualify for the Part B Special Enrollment Period, you must have employer or union health coverage based on current employment. You have eight months after your coverage or ends to sign up for Part B. The Part B late penalty may apply if you wait too long.

Note: If you are working past age 65, you can delay enrolling in Medicare Part D prescription drug coverage without penalty as well.

For more information about Medicare, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.