Medicare Special Enrollment Periods

If you need to sign up for a Medicare Advantage plan outside of the usual Medicare enrollment periods, a Special Election Period, also called a Special Enrollment Period or SEP, could be the answer. Let’s explore how SEPs work.

What is a Medicare Special Enrollment Period?

A Medicare SEP offers an eligible Medicare member a chance to change their plan outside of their Initial Coverage Election Period (ICEP) or Medicare’s Annual Election Period (AEP).

How do I qualify for a Medicare SEP?

There are specific rules about who may qualify for an SEP. Here are some common scenarios:

You’ve moved to a new home

If you’re moving to another city or state where your current Medicare plan isn’t available, you may qualify for an SEP.
If you’ve recently been released from jail and you’re eligible for Medicare, you may qualify.

Your Medicare Advantage plan is no longer available from your insurance company

Your insurance company is going to stop offering your current plan at the end of the year. This is sometimes called a non-renewal or termination.

How long is the Special Enrollment Period?

If you have or had health insurance through your job or your spouse’s job, your Special Enrollment Period starts the first month after your Initial Enrollment Period ends. It ends 8 months after either your group coverage or your employment ends – whichever comes first. A late enrollment penalty may be applied if you wait longer than 63 days after your SEP ends to enroll in a new plan. (It’s important to know that COBRA isn’t considered group health plan coverage. Signing up for COBRA doesn’t change when this Special Enrollment Period ends.)

A Medicare SEP is a period of time to enroll or change a Medicare Advantage plan outside of the Initial Coverage Election Period (ICEP) or Medicare’s Annual Election Period (AEP). There are various types of SEPs that would allow you to enroll in a Medicare Advantage plan outside of these periods.¹

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Exceptional conditions for Medicare SEPs

The Centers for Medicare and Medicaid Services (CMS) has the legal authority to establish SEPs when a person or group of people meet certain exceptional conditions. Some of those conditions include:

Individuals making MA enrollment requests into or out of employer-sponsored MA plans
Individuals disenrolling from an MA plan to enroll in the Program of All-inclusive Care for the Elderly (PACE)
Individuals who dropped a Medicare Supplement insurance plan when they enrolled for the first time in an MA plan and are still in a trial period
Individuals enrolled in a Special Needs Plan (SNP) who are no longer eligible for the SNP because they no longer meet the specific special needs status
Non-U.S. citizens who become lawfully present in the U.S.

A special opportunity

Life happens. Whether the next big change represents an exciting adventure or a challenge, we’re here to help keep you covered. Take some time now to explore your Medicare Advantage options with Humana.

Frequently Asked Questions

Do I need to enroll in Medicare every year?

The short answer is no. If you’re enrolled in Original Medicare or a Medicare Advantage plan that you want to keep and your plans are still available, you don’t have to do anything, and your coverage will renew automatically. Learn more about how annual Medicare plan renewal works.

What is a Medicare late enrollment penalty?

Depending on your choices, if you don’t enroll in certain plans when you’re first eligible, and you don’t have what’s called “creditable coverage” from another source, like an employer, you may pay a penalty to sign up for Medicare later. Take a few minutes to learn more about how to avoid Medicare late enrollment penalties. Here’s an overview based on the different parts of Medicare coverage:

Most people who have worked and paid taxes have a $0 premium for Medicare Part A (hospital coverage). If you’re not eligible for premium-free Part A based on your work history, your monthly premium may increase if you don’t purchase Part A coverage when you’re first eligible.
In most cases, if you don’t sign up for Medicare Part B (medical coverage) when you’re first eligible, you’ll have to pay a penalty—and not just upon enrollment. You’ll continue to pay that penalty for as long as you’re enrolled in Medicare Part B.
The same applies to Medicare Part D prescription drug plans. If you don’t enroll when first eligible, you’ll pay more for as long as you’re enrolled in a Part D plan.