What Other Opportunities Do I Have To Change My Medicare Health and Drug Coverage?There are times when you may be able to change your Medicare health or drug coverage. The length of the Special Enrollment Period (SEP) and the effective date of the new SEP vary depending on the circumstances that trigger your SEP. The plan and, in some cases, the Centers for Medicare and Medicaid Services (CMS) determine whether you qualify for an SEP.

Note that while some SEPs allow you to enroll in Part D outside of a standard enrollment period, you may still owe a premium penalty for late Part D enrollment.

Some of the circumstances in which you may be able to access an SEP to change your Medicare coverage include:

  • You have creditable drug coverage (coverage that is as good as or better than the Medicare prescription drug benefit) or lose creditable coverage through no fault of your own.
  • You choose to change employer/union coverage (through either current or past employment).
  • You move into, reside in, or move out of a qualified institutional facility
    • Qualified facilities include a skilled nursing facility, nursing home, psychiatric hospital or unit, Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/ID), rehabilitation hospital or unity, long-term care hospital, or swing-bed hospital.
    • You are enrolled in a qualified State Pharmaceutical Assistance Program (SPAP) or lose SPAP
      • You can learn if your state has an SPAP and if you may qualify by contacting your SHIP. If you do not know how to reach your SHIP, call 877-839-2675 or visit www.shiptacenter.org.
    • You have Medicaid, a Medicare Savings Program (MSP), and/or Extra Help (see What is the Extra Help Special Enrollment Period (SEP)?)
    • You gain, lose, or have a change in your Medicaid, MSP, or Extra Help status.
    • You want to disenroll from your first Medicare Advantage
    • You enroll in/disenroll from PACE (Program of All-Inclusive Care for the Elderly)
    • You move (permanently change your home address)
    • You have had Medicare eligibility issues. For example:
      • You have received retroactive enrollment into
      • You do not have premium-free Part A and you enroll in Part B during the General Enrollment Period with your Part B coverage beginning July 1.
      • You lost Part B but still have Part A and are involuntarily disenrolled from your Medicare Advantage
    • You are eligible to join a Special Needs Plan (SNP) or you lose SNP
      • SNPs are Medicare Advantage Plans that are designed to meet specific care needs, and you can only join a SNP if you fit the special needs category the plan
    • You are passively enrolled into a Part D plan or Dual-eligible SNP (D-SNP).
    • You experience contract violations (such as misleading marketing) or enrollment errors.
    • Your Medicare Advantage Plan or Part D plan no longer offers Medicare coverage.
    • You had Medicare due to disability before turning 65, and you qualify for a new Part D initial enrollment period when you turn 65.
    • You want to enroll in a five-star Medicare Advantage Plan or Part D
    • You have been in a consistently low-performing Medicare Advantage or Part D
    • Your Medicare Advantage Plan stops contracting with many of its providers.
    • You experience an “exceptional circumstance”
      • If your circumstances do not fit into any of the other SEP categories, you have the right to ask CMS to grant you an SEP based on your particular exceptional circumstances.

     

    Read More: When Can I Enroll in Medicare Part A and/or Part B?
    Learn About: If I Delayed Enrollment in Part B Because I Had Insurance Through Current Employment, When Can I Enroll in Part B?
    Return to: Medicare In-Depth

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