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.

What is a Medicare Special Enrollment Period?

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

How do I qualify for a Medicare SEP?

A SEP must be triggered by a qualifying event. Here are some common scenarios:2

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

Exceptional conditions for Medicare SEPs

CMS has the legal authority to establish SEPs when a person or group of people meet certain exceptional conditions. Some of these conditions include:3

  • 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. Outside of regular enrollment periods, an SEP is your opportunity to update your coverage.

Sources

  1. “Medicare Managed Care Manual: Chapter 2 - Medicare Advantage Enrollment and Disenrollment: Section 30.4 Special Election Period (SEP),” Centers for Medicare and Medicaid Services, last accessed August 18, 2020, https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/CY_2019_MA_Enrollment_and_Disenrollment_Guidance.pdf, PDF opens new window.
  2. “Medicare Managed Care Manual: Chapter 2 - Medicare Advantage Enrollment and Disenrollment: Section 30.4 Special Election Period (SEP).”
  3. “Medicare Managed Care Manual: Chapter 2 - Medicare Advantage Enrollment and Disenrollment: Section 30.4.4 - SEPs for Exceptional Conditions.”

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