Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community
  • Home
  • Contact
  • MAPD
  • PDP
  • 2020
  • FAQs
  • Articles
  • Search
  • Contact
  • 2020
  • FAQs
  • Articles
  • Latest Medicare News
  • Search


What is a Medicare Special Enrollment Period (SEP)


A Special Enrollment Period (SEP) allows a Medicare beneficiary to join, switch, or drop their Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan (MA or MAPD or SNP) outside of the Annual Open Enrollment Period (AEP).  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 1 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 allowed 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 1 month before the termination and continues for 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:  https://Q1FAQ.com/561.html








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


Browse FAQ Categories


Have a Prescription Not Covered by Your Medicare Plan?
Prescription Discounts are
easy as 1-2-3
  1. Locate lowest price drug and pharmacy
  2. Show card at pharmacy
  3. Get instant savings!
Your drug discount card is available to you at no cost.







Tips & Disclaimers
  • 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.
  • 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.