Throughout your time benefitting from Medicare, it’s normal to change your plans. You might try out Medicare Advantage and find it unsuitable, or experience a change in circumstances that makes some care redundant. Medicare offers two open enrollment periods where you can change your plans no questions asked, but sometimes you can’t or don’t want to wait until these periods roll around. In this case, you should ask the Medicare Health Experts, “Do I qualify for SEP?”

Do I Qualify for SEP?

SEP is short for the Medicare Special Enrollment Period. If you’re looking to change plans outside the annual occasions where this is possible, then qualifying for SEP is your best bet.

What is the Medicare Special Enrollment Period?

The Special Enrollment Period refers to an array of exceptions wherein you can change your care plans throughout the year. If you qualify, then you’re able to switch plans within Medicare without any penalty. Without the SEP, you’ll have to wait. When you’re wondering whether or not you qualify for SEP, consider if any of these conditions apply to you.

Qualifying Factors for the Medicare Special Enrollment Period

You Gain Alternative Care Options

There are a handful of cases where gaining additional care entitles you to a special enrollment period. For instance, gaining additional coverage via an employer or union or qualifying for Medicaid works. If you have an existing Medicare Part D drug plan, then gaining equal or better prescription drug coverage via programs such as TRICARE is also acceptable.

You Lose Existing Coverage

Conversely, losing coverage often means that you qualify for SEP. Leaving the aforementioned coverage plans such as union healthcare is one set of applicable conditions. If you lose eligibility for Medicaid, then you should look into requesting an SEP to update your coverage through Medicare.


While Medicare mostly functions on a national level, Medicare Advantage plans exist on a statewide level. When you move, you’ll lose access to existing plans, but you’ll also gain new options. As a result, moving will qualify you for an SEP so that you can pursue the right coverage for your medical needs.

Contractual Changes

There are many occasions where the contracts between private companies and the Medicare Administration might change. These changes might result in differences in cost and coverage, or your old plan might cease to be available altogether. Either way, a change in the contract that governs your existing plans will entitle you to a special enrollment period.

Other Special Situations

Many other life changes and conditions will allow you to request an SEP. Some of these qualifying grounds include evidence that your private provider failed to properly inform you of their coverage quality, or application for a Special Needs Plan. There are too many exceptions and special situations to list here, so you should get in touch with the Medicare Health Experts to see all of your questions answered.

Call the Medicare Health Experts

Here at the Medicare Health Experts, we understand all the inner workings of this program. If the above conditions don’t apply to you, you might still qualify for SEP. Find out right now by getting in touch with our team.