A Special Enrollment Period (SEP
) allows a Medicare beneficiary a special time to join, switch, or drop their
Medicare Part D prescription drug plan (PDP
) or Medicare Advantage plan (MA or MAPD
outside of the annual Medicare Open Enrollment Period (AEP) that starts each year on October 15th and continues through December 7th.
If you are eligible for an
SEP, your coverage will be effective on the first day of the month
following your new Medicare plan enrollment.
Making Medicare plan changes during the annual Open Enrollment Period (AEP).
Most Medicare beneficiaries
can only change their Medicare Part D or Medicare Advantage plan
coverage during the annual Open Enrollment Period (AEP or Annual
Enrollment Period or Annual Coordinated Election Period
) that starts every year on
October 15th and continues through December 7th with coverage starting
on January 1st. After the close of the AEP, most people are "locked"
into their Medicare plans for the entire calendar year (even when their prescriptions or health-needs change).
Making Medicare plan changes during the Medicare Advantage Open Enrollment Period (MA OEP).
The Medicare Advantage Open Enrollment Period (MA OEP
) is another enrollment period (outside the AEP) allowing people currently enrolled in a Medicare Advantage plan (MAPD or MA) an opportunity to change plans or drop their Medicare Advantage plan, return to Original Medicare Part A and Part B coverage, and join a stand-alone Medicare Part D prescription drug plan (PDP). The MA OEP starts on January 1st and continues through March 31st of each year - with plan coverage starting the first day of the month after the plan change.
Making Medicare plan changes outside of organized enrollment periods - Special Enrollment Periods (SEPs).
In certain situations, Medicare beneficiaries may be eligible
for a Special Enrollment Period and have an opportunity to change Medicare Part D or Medicare Advantage plan coverage outside of the AEP or MA OEP. Some of the most common SEPs are:
- SEP for people moving outside of their Medicare plan's Service Area.
The Service Area for a stand-alone Medicare Part D plan is a state or multi-state area and the Service Area for a Medicare Advantage plan (MA or MAPD) is a county, partial-county, or ZIP code area.
For example, if you are enrolled in a Colorado Medicare Part D plan (PDP) and move to Florida, you will be granted this SEP to join a Medicare Part D or Medicare Advantage plan that is available in your new area. If you are enrolled in a Medicare Advantage plan and live in Saint Johns County, Florida and then move to Lake County, Florida you will be granted this SEP to join a Medicare Advantage plan in your new county or you can return to original Medicare Part A and Part B and join a stand-alone Florida Medicare Part D plan.
Reminder: When you move to another Service Area, you may not find the exact same Medicare Part D or Medicare Advantage plans – and even plans with the same name may not provide the exact same coverage as the plan in your previous location – please be sure to carefully evaluate your plan options before enrollment.
- SEP for people qualified for both Medicare and Medicaid - or the Medicare Part D Extra Help program.
If you are eligible for both Medicare and Medicaid, you are granted a Special Enrollment Period (SEP) and can change Medicare plans once per quarter (once every 3 months) through September with coverage starting on the first day of the month after you enroll in a new plan. If you are not qualified for full-Medicaid benefits, but still qualify for the Medicare Part D Low-Income Subsidy (LIS) or Extra Help program – you are also granted the same SEP.
- SEP for people enrolled in a Medicare plan that is being terminated by CMS
CMS provides a Special Enrollment Period (SEP) for members of a Medicare Part D (PDP) or Medicare Advantage plan (MA, MAPD, or SNP)
who are enrolled in Medicare plan when CMS terminates the plan's
contract. The SEP begins one (1) month before the termination and continues
for two (2) months after the Medicare plan's contract termination.
CMS Reminder: "Approved [Medicare] plan consolidations are neither terminations nor non-renewals. Thus individuals affected by plan consolidations are not eligible for the SEP for non-renewals or terminations." Medicare plan consolidations occur most years when Medicare plans merge or just reorganize plans and members are moved from one discontinued plan to another one of the company's Medicare plans.
For more common Special Enrollment Periods allowing you to change Medicare plans during the year (or outside scheduled enrollment periods), please see our Special Enrollment Period Frequently Asked Question: Q1FAQ.com/561