Medicare Special Enrollment Periods (SEP)

If you’re enrolled in Medicare (or will be soon) and you experience a significant life change, such as moving, losing other coverage, or getting assistance through Medicaid, you might qualify for a Special Enrollment Period (SEP). These SEPs allow you to join, switch, or drop certain Medicare plans outside the usual enrollment windows. Medicare

Here’s a breakdown of what SEPs are, when they apply, what you can do during one, and what you should keep in mind. Think of this as your cheat sheet for making the most of your coverage when life happens.

1. You Move

Examples:

• Move to a new address that’s outside your plan’s service area

• Move where new plan options are available

• Return to the U.S. after living abroad

• Move into, out of, or remain in an institution (like a nursing home)

What You Can Do:
Join, switch, or drop a Medicare Advantage (MA) or Prescription Drug (Part D) plan.

How Long You Have:

• If you tell your plan before you move: SEP starts 1 month before and lasts 2 months after your move.

• If you tell your plan after you move: SEP starts the month you notify them and lasts 2 months after.

What to Gather:
Proof of new address or move date (lease, utility bill, etc.).

2. You Lose Other Coverage

Examples:

• Employer/union group coverage ends

• Lose Medicaid eligibility

• Lose other drug coverage that was considered “creditable”

• End coverage through COBRA

What You Can Do:
Join an MA or Part D plan, or return to Original Medicare.

How Long You Have:
Usually 2 full months after coverage ends or you’re notified.
If losing Medicaid, you may have 3 full months after losing eligibility or being notified.

What to Gather:
Letter or documentation showing coverage end date.

3. Your Plan Changes or Ends

Examples:

• Medicare ends its contract with your plan

• Your plan stops serving your area

• You get misleading or incorrect information during enrollment

• Your plan has received a low rating (under 3 stars for 3 consecutive years)

What You Can Do:
Join a new MA or Part D plan, or return to Original Medicare.

How Long You Have:

• Contract ends: From 2 months before through 1 month after the contract ends.

• Low-rating plan: You can switch anytime while enrolled in the low-rated plan.

What to Gather:
Notice from Medicare or your plan confirming the change.

4. You Gain or Lose Medicaid or “Extra Help”

Examples:

• Become eligible for both Medicare and Medicaid (“dual eligible”)

• Gain, lose, or change level of Extra Help with drug costs

What You Can Do:
Change your MA or Part D plan once per calendar quarter (for duals or Extra Help beneficiaries) or when eligibility changes.

How Long You Have:
Typically continuous (monthly or quarterly depending on eligibility).

What to Gather:
Medicaid or Social Security letter confirming change in status.

5. You Qualify for a Special Needs Plan (SNP)

Examples:

• Have a chronic or disabling condition (e.g., diabetes, heart disease)

• Move into or out of an institution

• Lose eligibility for your SNP

What You Can Do:
Join, switch, or leave a Special Needs Plan.

How Long You Have:
Usually 2 months after the qualifying event.

What to Gather:
Medical documentation or plan notice verifying eligibility or loss of it.

6. You Gain Coverage Through Employer, Union, or Other Source

Examples:

• Start a new job that offers health benefits

• Join a union plan that includes drug coverage

What You Can Do:
Drop your Medicare plan to take employer or union coverage (and re-enroll later when it ends).

How Long You Have:
2 months after new coverage starts.

What to Gather:
Proof of new employer or union coverage.

7. You Made an Enrollment Mistake or Were Misled

Examples:

• Chose a plan based on incorrect or incomplete information

• Experienced a marketing violation or plan error

What You Can Do:
Request a Special Enrollment Period through Medicare to switch or drop your plan.

How Long You Have:
Varies — determined by Medicare on a case-by-case basis.

What to Gather:
Documentation or correspondence showing the error.

8. You Want to Try or Leave a 5-Star Plan

Examples:

• A plan in your area has a “5-Star” rating from Medicare

What You Can Do:
Switch once per calendar year to a 5-Star MA, MA-PD, or Part D plan.

How Long You Have:
From December 8 – November 30 of the following year.

What to Gather:
None required; enrollment handled directly through the 5-Star plan.

Key Tips for Consumers

• Act quickly: Most SEPs are short windows (e.g., 2 full months) after a qualifying event. Delaying could mean missing your chance.

• Document the event: Keep proof of the event (moving address, loss of coverage notice, plan notification) in case you need to show you’re eligible.

• Check your area: Even if you qualify for an SEP, the specific plans available might vary depending on where you live. A move might change your options.

• Be careful with combinations: For example, switching from one type of plan to another (especially if prescription drug coverage is involved) could trigger penalties or loss of benefits if you don’t follow rules.

• Talk to someone: Contact Platinum Benefit Advisors, and we can put you in touch with an independent licensed agent to review your options.

  If you’re unsure whether you qualify or when your window begins/ends, call Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227). TTY users: 1-877-486-2048