What Are Medicare Special Enrollment Periods?

Most of my clients and others I’ve consulted with believe that there’s only ONE time of year they can change their Medicare Advantage plan – October 15 through December 7. This period is called Annual Enrollment. While this is a valid time to make a change, it’s important to know that there are other times you can make a change to your Medicare Advantage plan, called Special Enrollment Periods, (or SEPs).

Some SEPs are constant and occur every year. But others, like SEPs for natural disasters, may be a one-off. In California, for example, we’ve had wildfires that have affected certain counties during Annual Enrollment. Because such events can affect a Medicare beneficiary’s ability to go out and change their plan, the government will allow for a SEP for a certain period of time within an affected area. These types of one-time SEPs could be created for a number of reasons and last for a defined period of time. I was surprised to discover that, at the time of publishing, a SEP has not been created for COVID-19.

But, other SEPs are related to your geographical or socioeconomic situation. Here’s a few examples of SEPs that may be available to you at any point during the year:

- Moving out of your plan’s coverage area (typically to a different county or state)

- When you have Medicare AND Medi-Cal/Medicaid

- When you lose Medi-Cal/Medicaid eligibility

- When you get “Extra Help” with your prescriptions

- Losing group/employer health insurance

- When you develop a chronic condition and a Plan is available specifically for that condition

I think you get the idea. There are other less common SEPs that also exist. So, if you think that you’re “stuck” in your plan with no options, there’s a fair chance that a SEP may be available to you. It’s always best to check with your friendly neighborhood broker, who can guide you to a great plan that will serve your needs well.


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