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If I move to another state, will I get a Special Enrollment Period or SEP to join another Medicare Part D plan in my new area?


Yes, in most cases.  When you move out of your Medicare Part D (PDP) or Medicare Advantage (MA or MAPD) plan's service area, you are granted a Special Enrollment Period to join another Medicare plan outside of the annual Open Enrollment Period (AEP that starts October 15th and continues through December 7th).

Your Medicare plan's "Service Area" is either a state (or group of states) for a stand-alone Medicare Part D plan or a ZIP code, region, county, or partial-county (in densely populated areas like Los Angeles) for a Medicare Advantage plan.  You can click on the following link to see how service areas are defined for Medicare Part D plans:  https://q1medicare.com/PartD-Medicare-PartD-Overview-byRegion.php.

Example: Moving from California to Florida = SEP to change PDP or Medicare Advantage plan

If you live in California (PDP Region 32) and move to Florida (PDP Region 11), you would be granted an SEP to join a Medicare plan (Medicare Part D or Medicare Advantage plan) that is available in your new county or ZIP code region.

Example: Moving from West Virginia to Pennsylvania = No SEP to change a stand-alone Medicare Part D plan (PDP)

If you are enrolled in a stand-alone Medicare Part D plan and move from West Virginia to Pennsylvania, you will not be granted a Special Enrollment Period to change Medicare Part D plans (PDPs) since West Virginia and Pennsylvania are in the same PDP service area: CMS PDP Region 6.  However, if you are enrolled in a Medicare Advantage plan and are moving to another county, you will be granted a Special Enrollment Period to join a new Medicare Advantage (MA or MAPD) plan in your new service area.

Example: Moving to another county in Florida = SEP for Medicare Advantage plan

If you are enrolled in a Medicare Advantage plan while living in Saint Johns County, Florida and you move to Lake County, Florida - you will be granted an SEP and allowed to join a Medicare Advantage plan that is available in Lake County.  But, if you are enrolled in a Florida stand-alone Medicare Part D plan, you will not be granted a Special Enrollment Period to change stand-alone Medicare Part D plans since you are still in the same PDP service area of Florida.

The timing of this 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.

Tip:  You can join a Medicare Part D or Medicare Advantage plan in your new area the month before you actually move so there is no break in health and / or drug coverage.

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.
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 plan to live.

You can also review all Medicare Advantage plans in a service area by using our Medicare Advantage Plan Finder https://MA-Finder.com or see all stand-alone Medicare Part D prescription drug plans (PDPs) in your area using our PDP Finder https://PDP-Finder.com.

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)

Further guidance from the Centers for Medicare and Medicaid Services (CMS)

From the Medicare Prescription Drug Benefit Manual, Chapter 3 - Eligibility, Enrollment and Disenrollment, Updated: August 19, 2011 (Revised: November 16, 2011, August 7, 2012, August 30, 2013, August 30, 2014, July 6, 2015, September 1, 2015, September 14, 2015, December 30, 2015, May 27, 2016, August 25, 2016 & June 15, 2017) pp.(23-24)

Section 30.3.1 - SEPs for Changes in Residence

An SEP for changes in residence exists for these scenarios:

1. individuals who are no longer eligible to be enrolled in a PDP due to a change in permanent residence outside of the PDP’s service area;
2. individuals who were not eligible for Part D because they have been out of the U.S. and have now moved back to the U.S.;
3. individuals who were not eligible for Part D because they were incarcerated and have now been released;
4. individuals who will have new Medicare health or Part D plans available to them as result of a permanent move

The SEP permits enrollment elections only; it begins on either the date of the permanent move or on the date the individual provides notification of such move. Since individuals who do not permanently reside in the plan service area are ineligible for the plan and must be disenrolled, a SEP is not needed to effectuate an involuntary disenrollment for that reason (see §50.2.1 [Sponsor Receives Notification of Possible Residence Change]). Individuals who move and have new Medicare health or Part D plans available to them as a result of the move, but continue to reside in the current plan service area, may use this SEP to enroll in any MA or Part D plan for which they are eligible in their new place of residence. It is the individual’s responsibility to notify the organization that he/she is permanently moving.

When the individual notifies the organization of a permanent move out of the plan service area, the SEP begins either the month before the individual’s permanent move, if the individual notifies the organization in advance, or the month the individual provides the notice of the move, if the individual has already moved. The SEP continues for two months following the month it begins or two months following the month of the move, whichever is later.

If the plan learns from CMS or U.S. Post Office (as described in §50.2.1 [Sponsor Receives Notification of Possible Residence Change]) that the individual has been out of the service area for over twelve months and the plan has not been able to confirm otherwise with the individual, the SEP will begin at the beginning of the twelfth month and continues through to the end of the fourteenth month.

The effective date of the enrollment is determined by the date the PDP sponsor receives the enrollment request. The individual may choose an effective date of up to three months after the month in which the PDP sponsor receives the enrollment request. However, the effective date may not be earlier than the date the individual moves to the new service area and the PDP sponsor receives the completed enrollment request.

EXAMPLE 1:
A beneficiary is a member of a PDP in Florida and intends to move to Arizona on June 18. An SEP exists for this beneficiary from May 1 through August 31.

A. If a PDP sponsor in Arizona receives a completed enrollment form from the beneficiary in May and since the individual is not moving to the new service area until June 18th, the beneficiary can choose an effective date of July 1, August 1, or September 1.

B. If the PDP sponsor receives the completed enrollment form from the beneficiary in June (the month of the move) the beneficiary can choose an effective date of July 1, August 1, or September 1.

C. If the PDP sponsor receives the completed enrollment form in July, the beneficiary can choose an effective date of August 1, September 1, or October 1.

EXAMPLE 2:
A beneficiary resides in Florida and is currently in Original Medicare and not enrolled in a PDP. The individual intends to move to Maryland on August 3. An SEP exists for this beneficiary from July 1 through October 31.
At the time the individual enrolls in a PDP, the individual must provide the specific address where s/he will permanently reside upon moving into the service area, so that the PDP sponsor can determine that the individual meets the residency requirements for enrollment in the plan.

Disenrollment from Previous PDP
Please keep in mind that a member of a PDP who moves permanently out of the service area must be involuntarily disenrolled from the plan. A member of a PDP who resides out of the service area for over twelve months must be involuntarily disenrolled from the plan. CMS has established an SEP that allows an individual adequate time to choose a new PDP, given the fact that the individual will no longer be enrolled in the original PDP after the month of the move or after the twelfth month (whichever is appropriate). Unless an individual elects new coverage during a valid enrollment period, he/she will be enrolled in Original Medicare without Medicare prescription drug coverage. If the individual does not elect new prescription drug coverage for an effective date immediately after the termination of the old coverage, he/she may be subject to a Part D late enrollment penalty (LEP). See Chapter 4 of the Medicare Prescription Drug Manual for more information.


And from the Medicare Managed Care Manual, Chapter 2 - Medicare Advantage Enrollment and Disenrollment - 

Section 30.4.1 - SEPs for Changes in Residence

An SEP for a change in residence exists for these scenarios:

1) individuals who are no longer eligible to be enrolled in an MA plan due to a change in permanent residence outside of the MA plan service area;

2) individuals who were not eligible for MA because they were incarcerated and have now been released, or;

3) individuals who will have new Medicare health or Part D plans available to them as a result of a permanent move.

The SEP permits enrollment elections only; it begins on either the date of the permanent move or on the date the individual provides notification of such move. Since individuals who do not permanently reside in the plan service area are ineligible for the plan and must be disenrolled, a SEP is not needed to effectuate an involuntary disenrollment for that reason (see §50.2.1 [Members Who Change Residence]). Individuals who move and have new Medicare health or Part D plans available to them as a result of the move, but continue to reside in the current plan service area, may use this SEP to enroll in any MA or Part D plan for which they are eligible in their new place of residence. It is the individual’s responsibility to notify the MA organization that he/she is permanently moving.

When the individual notifies the organization of a permanent move out of the plan service area, the SEP begins either the month before the individual’s permanent move, if the individual notifies the organization in advance, or the month the individual provides the notice of the move, if the individual has already moved.  The SEP continues for two months following the month it begins or the two months following the month of the move, whichever is later.

If the organization learns from CMS or another source (as described in §50.2.1.3 [Researching and Acting on a Change of Address]) that the individual has been out of the service area for over six months and the organization has not been able to confirm otherwise with the individual, the SEP starts at the beginning of the sixth month and continues through to the end of the eighth month.

The enrollment effective date is determined by the date the MA organization receives the enrollment request. The individual may choose an effective date of up to three months after the month in which the MA organization receives the enrollment request. However, the effective date may not be earlier than the date the individual moves to the new service area and the MA organization receives the enrollment request.

EXAMPLE 1
A beneficiary is a member of an MA plan in Florida and intends to move to Arizona on June 18. A SEP exists for this beneficiary from May 1 - August 31.
A. If an MA organization in Arizona receives an enrollment request from the beneficiary in May, the beneficiary can choose an effective date of July 1, August 1, or September 1.

B. If the MA organization receives the enrollment request from the beneficiary in June (the month of the move), the beneficiary can choose an effective date of July 1, August 1, or September 1.

C. If the MA organization receives the enrollment request in July, the beneficiary could choose an effective date of August 1, September 1, or October 1.

EXAMPLE 2
A beneficiary resides in Florida and is currently in Original Medicare and not enrolled in an MA plan. The individual intends to move to Maryland on August 3. An SEP exists for this beneficiary from July 1 through October 31.

At the time the individual makes the enrollment request into an MA plan, the individual must provide the specific address where the individual will permanently reside upon moving into the service area, so that the MA organization can determine that the individual meets the residency requirements for enrollment in the plan.

Disenrollment from Previous MA Plan
Please keep in mind that a member of an MA plan who moves permanently out of the service area must be involuntarily disenrolled from the plan, unless continuation of enrollment applies. A member of an MA plan who is out of the service area for over six months must be involuntarily disenrolled from the plan.

CMS has established an SEP that allows an individual adequate time to choose a new MA plan, given the fact that the individual will no longer be enrolled in the original MA plan after the month of the move or after the sixth month (whichever is appropriate). Unless an individual enrolls in a new MA plan with an effective date of the month after the move or the beginning of the seventh month (e.g., the individual moves on June 18 and enrolls in a new plan effective July 1), he/she will be enrolled in Original Medicare until he/she elects the new MA plan during a valid enrollment period. If the individual had Part D coverage and lost it due to the involuntary disenrollment, s/he may be subject to a Part D late enrollment penalty (LEP). See Chapter 4 of the Medicare Prescription Drug Manual for more information.

Source: Medicare Managed Care Manual, Chapter 2 - Medicare Advantage Enrollment and Disenrollment
Updated: August 19, 2011, (Revised: November 16, 2011, August 7, 2012, August 30, 2013, August 14, 2014, July 6, 2015, September 1, 2015, September 14, 2015, December 30, 2015, May 27, 2016, August 25, 2016 & June 15, 2017)  (pp.32-34)





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