If you’re not very familiar with the Medicare system, you might not understand many of the restrictions that are in place. In particular, you may find that you want to sign up for Medicare or make a change to your current plan, and you can’t do so. Luckily, a Special Enrollment Period (SEP) may be your answer. Keep reading to find out what SEP is, who qualified, and if it’s available in your county.
What is the Special Enrollment Period (SEP) for Medicare?
Typically, you can only make Medicare plan changes during a specific period in the year called the Open Enrollment Period. The Open Enrollment Period varies from state to state, but most states offer it from November 1 to December 15.
The exception to the Open Enrollment Period is if you’re granted a Special Enrollment Period.
The Special Enrollment Period allows you to make changes to your Medicare Part C (Advantage) and Medicare Part D (prescription drug coverage) outside of the regular permissible time periods.
To be granted a Special Enrollment Period, a significant life event usually had to occur. Each SEP type comes with rules around when you can make changes and what those changes are.
Most often, you’re granted 60 days before or 60 days after the life event to make changes to your Medicare plans. If you miss this window, your SEP is over, and you’ll have to wait for the next annual Open Enrollment Period.
For example, if you lose health coverage that you previously had through an employer, you have 60 days from the initial date coverage stopped to sign up for Medicare. After that 60 days pass, you’ll have to wait for the Open Enrollment Period that typically occurs at the end of each year.
Is my County Included in SEP?
Yes, every state and county offers Special Enrollment Periods for qualifying individuals. First, you’ll have to determine if you meet the qualifications for SEP, to understand if you can apply. You can find out if you qualify here.
What Qualifies a Person for a Special Enrollment Period?
The following life events can help you qualify for SEP:
- You got married
- You had a child, fostered a child, or adopted a child
- You got legally separated or divorced and lost health insurance as a result
- Someone on your insurance plan died, which made you no longer eligible for health insurance coverage
- You moved to a new county or ZIP code
- You moved to the U.S. from a foreign country
- You moved to the U.S. from a United States territory
- Students who moved to or from their school
- Seasonal workers moving to or from where they work and live
- Individuals moving to or from transitional housing or a shelter
- You lost health insurance previously offered through a job
- You lost individual health coverage purchased for yourself
- You lost eligibility for CHIP, Medicaid, or Medicare
- You became a member of a federally recognized tribe
- You received official status as an Alaska Native Claims Settlement Act Corporation shareholder
- You became a U.S. citizen
- You left prison
- You started or ended service as an AmeriCorps State and National, VISTA, or NCCC member
Additionally, if a state of emergency on a state or national level is declared, it can sometimes qualify you for SEP. For example, many states opened a new SEP during COVID-19 to help individuals who had been impacted by the pandemic in some form.
If you think you may qualify for SEP, try the online qualification SEP tool. Next, apply for SEP and start doing your research on the coverage that is right for you.