If you need to enroll in Medicare Advantage or change your plan outside of the usual Medicare enrollment periods, a Special Election Period (SEP) could be the answer.
Here’s a look at the details and qualifications of an SEP.
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
A SEP must be triggered by a qualifying event. Here are some common scenarios:
Changes in residence
- You changed your permanent residence outside of your current MA plan service area
- You’ll have new Medicare health or Part D plans available due to a permanent move
- You were recently released from incarceration
Non-renewals or terminations
- Your plan is not renewing its contract with the Centers for Medicare & Medicaid Services (CMS) or intends to stop providing benefits in your area at the end of the year
CMS has the legal authority to establish SEPs when a person or group of people meet certain exceptional conditions. Some of these 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.
Life happens. Outside of regular enrollment periods, an SEP is your opportunity to update your coverage.