Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community

Special Election Period (SEP) - Change of Residence -- Timing and Evidence Requirements

Category: Special Enrollment Periods SEP
Published: Feb, 07 2023 05:02:53

The Special Election Period (SEP) for "Change of Residence" becomes available when the beneficiary is permanently relocating outside of their Medicare plan's Service Area.

The Service Area can be a state for a stand-alone Medicare Part D plan or a ZIP Code area for a Medicare Advantage plan.  Please note that some Medicare Part D plans are in a Service Area that includes multiple states (such as West Virginia and Pennsylvania).

The timing of the Special Election Period:
 - begins the month prior to the individual’s permanent move,
 - continues during the month of the move and
 - two months after the move.

The SEP may begin with either the date of the permanent move or with the date the individual provides notification a move. It is the individual’s responsibility to notify their Medicare Part D plan (PDP) or Medicare Advantage plan (MA or MAPD) and inform the plan that they are permanently moving outside of the plan's Service Area.

Usually, you will need some evidence of the SEP and this might include:
  • Voter registration card, driver’s license, tax records, utility bills.
  • Documentation of being outside the plan service area over 6 months.
  • Application or signed statement from the member indicating they have permanently moved into or out of the previous service area.

How do you find the Medicare Part D or Medicare Advantage plans that are available in your area?

We have several online tools to help you get an overview of the Medicare Part D plans in your area.  Here are some good ways to find a new plan for next year:

PDP-Finder - Review all stand-alone Medicare Part D plans (PDPs) available in your state or enter search criteria to narrow the plan list.

MA-Finder - Review all Medicare Advantage plans (MAPDs, MAs, and SNPs) available in your state or enter search criteria to narrow the plan list.

PDP-Wizard - This tool provides you with a little guided help finding a stand-alone Medicare Part D plan.  Just answer the questions and we will show you Medicare Part D plans generally meeting your needs.

Ready to change plans?

When you are ready to move, you can ask a Medicare representative for assistance finding a new Medicare plan in the Service Area where you will live.

To contact a Medicare representative, call Medicare directly toll-free at 1-800-633-4227 (1-800-Medicare), select the prescription drug option, and then choose the option to speak with a Medicare representative or say "representative" several times during the automated menu options.

Once connected, please explain your situation to a Medicare representative and ask the Medicare representative to help you find a Medicare Advantage plan or a Medicare Part D prescription drug plan that most economically covers your health and medication needs - or you can ask specific questions about a particular Medicare plan.

As you review plan options, you can ask the representative to provide you with an estimated annual cost based on your health and medication needs for any particular Medicare plan.

You can also make sure that the Medicare representative knows about the pharmacies you use or have available (and explains to you about the possible cost differences between preferred and non-preferred network pharmacies).

If you are enrolling into a Medicare Advantage plan, please be sure that your healthcare providers are included in the plan's network.

If you have found an acceptable Medicare plan, and you are eligible for enrollment, the Medicare representative can also process your enrollment into any Medicare Part D or Medicare Advantage plan directly over the telephone - and the process only takes a few minutes (with an enrollment confirmation code provided).

View list of other situations creating a Special Election Period (SEP)

Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs

Pets are Family Too!
Use your drug discount card to save on medications for the entire family ‐ including your pets.

  • No enrollment fee and no limits on usage
  • Everyone in your household can use the same card, including your pets
Your drug discount card is available to you at no cost.

Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.