Special Enrollment Period (SEP) for Medicare

The Medicare Special Enrollment Period (SEP) allows people who have had a recent life event that resulted in loss or change of coverage to sign up for Medicare outside of the Medicare General Enrollment Period.

While not every life event will qualify, some common events that generally result in being able to sign up for Medicare outside of the regular enrollment period include loss of coverage or moving. Read on to learn about Medicare SEP qualifying life events, deadlines, start dates, and much more in our expert guide to Medicare enrollment.

To speak with a licensed insurance agent about your Medicare needs, call (855) 634-0435 today. You may also enter your ZIP in our free tool for quotes.

Medicare Special Enrollment Period Explained

The Medicare Special Enrollment Period is a limited-time window outside the standard open enrollment periods for customers who meet the qualifications for a special event.

If you need to sign up for Medicare insurance because of a qualifying life event, you will typically have up to two to eight months after the special event to sign up for coverage (Read More: How to Sign up for Medicare).

Medicare Special Enrollment Periods exist to allow people to adjust or get health insurance coverage after life changes without major penalties.

These special enrollment periods are important because they help people avoid a lapse in health insurance, as being without health insurance for even a month or two could have disastrous financial repercussions.

Special Enrollment Period: Pros & Cons

However, there are some cons to Medicare Special Enrollment Periods, namely that the rules for qualifying can vary and be confusing.

To help ensure you don’t miss the opportunity to sign up for Medicare coverage during a Special Enrollment period, we will review everything you need to know about qualifying for coverage.

When You Qualify for Medicare Special Enrollment

Not every life event that results in someone losing health insurance will qualify for the Medicare Special Enrollment Period (Read More: Medicare Coverage and Eligibility).

Some common events that usually qualify people to enroll in Medicare outside of the standard enrollment period include loss of a job, loss of coverage, and more.

Rules for enrollment can vary based on the life event and the type of Medicare coverage, so we recommend checking Medicare.gov or calling 1-800-MEDICARE for individual cases.

Generally, the most common qualifying events that will result in approval for enrollment outside of Medicare’s standard periods include:

• Moving: This could be a change of residence or facility.
• Coverage Loss: This could be coverage loss from a job, union, COBRA, or Medicaid.
• Eligibility Changes: This could be changes in Medicaid or Extra Help eligibility.
• Plan Changes: This could be because your insurer leaves Medicare, or the contract ends.
• New Coverage: This could be a job, a union, or sometimes VA-related coverage.

A change of address is the most common reason for needing to use the Medicare Special Enrollment Period, accounting for 32% of all cases.

Coverage loss is another common reason, with 26% of Medicare Special Enrollment Period cases being due to loss of health insurance coverage (Learn More: The Complete Guide to Health Insurance).

Medicaid changes and new coverage account for 16% each of cases applying for the Medicare Special Enrollment Period, while plan changes account for 10%.

If you are experiencing any of these major life events that are common for Medicare application cases, then you may qualify for coverage. If you are having trouble affording Medicare coverage, see if you can qualify for Medicare Savings Programs.

Important Medicare Special Enrollment Dates & Deadlines

It is important to note that each qualifying event for Medicare coverage comes with its own stipulations and time constraints.

For example, people who lose their Medicaid coverage only have two months after the loss to apply for Medicare coverage, so it is important to check the Medicare special enrollment period charts to make sure you don’t miss a deadline.

Special Enrollment Period (SEP) Eligibility Details

The timeframe for action varies depending on the event and situation, ranging from two to eight months after a qualifying life event.

It is important to know the applicable deadline for your qualifying life event, as missing the Medicare Special Enrollment Period may mean that you have to wait for the General Enrollment Period. This could leave you without coverage for an extended period, depending on when you lost your health insurance (Read More: How to Finance What Your Health Insurance Won’t Cover).

Typically, Medicare health insurance plans will start on the 1st of the next month after a customer enrolls for coverage. For example, if you sign up for a Medicare plan on October 18, coverage won’t start until November 1.

There may be some exceptions to Medicare coverage starting on the first of the month, although the first of the following month is the most common start date.

It is important to note that, in addition to the regulations on start dates, Medicare Special Enrollment Periods also only allow certain changes to be made to coverage.

As well, not all Special Enrollment Periods apply to every type of Medicare, as some are exclusively special enrollment periods for Medicare Advantage (Read More: What is Medicare Advantage?).

Changes Allowed in Medicare Special Enrollment Periods

For example, with the Medicare Part C and Medicare Part D special enrollment period, you can join, drop, or switch plans.

However, the Special Enrollment Period for Medicare Part A only allows customers to apply for Medicare Part A if they are not auto-enrolled.

As for the Medicare Part B Special Enrollment Period, you can apply online for Medicare Part B during a Special Enrollment Period without penalty.

It is important to note that Medicare’s Special Enrollment Periods help customers avoid the late-enrollment penalties for Part B or Part D that would normally be charged in other situations.

Make Sure You Don’t Miss Medicare Special Enrollment Periods

No one wants to be without health insurance coverage, so making sure you don’t miss your special enrollment period is vital to protecting yourself.

Even if you have months to secure Medicare insurance coverage during a SEP, it is best not to delay enrolling in Medicare coverage.

If you wait until the last minute and have issues signing up, it could result in having to wait for the Medicare General Enrollment Period. You also want to leave yourself time to research coverage options, such as deciding if you want add-ons like Medicare Supplemental Insurance (Medigap).

Some other practical tips to follow when applying for Medicare coverage during a Special Enrollment Period include:

• Keep Event Records: Make sure to keep proof of the qualifying event, such as proof of your move date or loss of coverage.
• Compare Plan Options: Don’t just blindly sign up for coverage; make sure to compare Medicare Parts A, B, C, & D to get the best one for your health insurance needs.

Medicare enrollment can be confusing, but making a plan of action and not waiting until the last minute will help ensure you aren’t left without health insurance coverage.

To speak with a licensed insurance agent about your Medicare needs, call (855) 634-0435 today. You may also enter your ZIP in our free tool for quotes.