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FAQs on Special Enrollment Periods (SEPs)



Browse the Medicare Part D "Special Enrollment Periods (SEPs)" FAQs
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Category: Special Enrollment Periods (SEPs)

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What are the Medicare Part D Special Enrollment Periods (SEP)?
Usually, most seniors or other Medicare beneficiaries can only change their Medicare Part D or Medicare Advantage plan coverage during the annual Open Enrollment Period (AEP or Annual Enrollment Perio...

What is the 5-star Special Enrollment Period?
If a Medicare Part D or Medicare Advantage plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period (SEP) for a once-a-year opportunity to switch from yo...

Is there any risk associated with using the 5-star Special Enrollment Period?
Maybe.  The key is that you must be aware of the type of Medicare plan you currently have and what type of 5-star Medicare plan you are choosing (read more below) as part of the 5-star Special En...

We just moved from North Carolina to Florida and our Medicare plan was cancelled because of our relocation. Can we enroll back into our same Medicare plan now (July) or do we have to wait until November/December?
No need to wait - you can enroll now into a new Medicare plan.  Most people are not allowed to change Medicare Part D prescription drug or Medicare Advantage plans outside of the annual Ope...

If I change my Medicare prescription drug plan during the year, will my initial deductible transfer to the new Part D plan?
Yes.  When you transfer Medicare Part D prescription drug plans, the total retail value of your drug purchases (monthly gross covered drug costs) and the total value of your out of pocket exp...

When a Non-Renewing Medicare Part D or Medicare Advantage plan reassigns members to another plan does the SEP through February apply?
No.  The Special Enrollment Period through end of February for Service Area Reduction or Medicare plan cancellation Special Enrollment Period (SAR SEP) would NOT apply....

If I change Medicare Advantage plans during the year, will the amount that I have already spent out-of-pocket for Medicare Part A and Part B coverage transfer to the MOOP of my new plan?
Maybe.  If you are able to change or transfer to another Medicare Advantage plan offered by the same company during the plan year, you will be able to transfer the amount that you have person...

I plan to move from Miami to New Orleans next month and I don't want to get a penalty for being without a Medicare plan. What is the Special Enrollment Period when moving outside of my current Medicare Advantage plan's service area?
The Special Election Period (or SEP) for "Change of Residence" becomes available when the beneficiary is moving out of his/her Medicare plan's service area,  What is the timing of th...

Can I get a Special Enrollment Period if my Medicare Advantage plan drops my doctor from the plan's network?
Maybe. This particular Special Enrollment Period (SEP) is exceptional, and will only be granted if the changes to your provider network are considered as "significant".   You also cannot jus...

Where can I learn about Medicare Part D special enrollment periods.
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 Coordina...

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What is the 5-star Special Enrollment Period?
If a Medicare Part D or Medicare Advantage plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period (SEP) for a once-a-year opportunity to switch from yo...

Can I get a Special Enrollment Period if my Medicare Advantage plan drops my doctor from the plan's network?
Maybe. This particular Special Enrollment Period (SEP) is exceptional, and will only be granted if the changes to your provider network are considered as "significant".   You also cannot jus...

I turned 65 this year and joined a Medicare Advantage plan with drug coverage, can I now get a Special Enrollment Period to leave my Medicare plan since I have been enrolled for less than a year?
Yes.  Since you joined your Medicare Advantage plan (MAPD) during your Initial Coverage Election Period (ICEP) (similar to your Medicare Part D Initial Enrollment Period (IEP)) surrounding you...

If I move to another state, is there a Special Election Period or SEP to join another Medicare Part D plan in my new area?
Yes.  When you move outside of your Medicare Part D or Medicare Advantage plan's Service Area, you are granted a Special Enrollment Period to join another Medicare plan outside of the annual Ope...

If I change my Medicare prescription drug plan during the year, will my initial deductible transfer to the new Part D plan?
Yes.  When you transfer Medicare Part D prescription drug plans, the total retail value of your drug purchases (monthly gross covered drug costs) and the total value of your out of pocket exp...

If I change Medicare Advantage plans during the year, will the amount that I have already spent out-of-pocket for Medicare Part A and Part B coverage transfer to the MOOP of my new plan?
Maybe.  If you are able to change or transfer to another Medicare Advantage plan offered by the same company during the plan year, you will be able to transfer the amount that you have person...

Special Enrollment Period for Service Area Reduction (SAR SEP): When your Medicare Part D or Medicare Advantage plan is cancelled or not offered next year.
If you are enrolled in a Medicare Advantage plan or Medicare Part D plan that is not offered next year (and you are not "cross-walked" or transferred  to another Medicare plan), you will be wit...

What is the Medicare Part D Special Enrollment Period (SEP) when a Medicare beneficiary loses their healthcare coverage through an employer or union
Up to two months after the end of employer health coverage to join a Medicare Part D or Medicare Advantage plan.  Medicare beneficiaries who did not enroll in Medicare Part D or Medicare Part B...

Is there a Special Enrollment Period (SEP) so we can leave a consistently low-rated Medicare Part D or Medicare Advantage Plan?
Yes.  If you are enrolled in a Medicare Part D or Medicare Advantage plan identified by the Centers for Medicare and Medicaid Services (CMS) as consistently low-performing, CMS will inform you ...

When a Non-Renewing Medicare Part D or Medicare Advantage plan reassigns members to another plan does the SEP through February apply?
No.  The Special Enrollment Period through end of February for Service Area Reduction or Medicare plan cancellation Special Enrollment Period (SAR SEP) would NOT apply....


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