Medicare offers Special Enrollment Periods (SEPs) for people who suddenly find themselves in certain circumstances that may affect their previous insurance coverage. You must understand what SEPs are and how you qualify for them to ensure that you have the correct coverage that you need for both you and your family.
What Is a SEP?
A SEP is a designated period of time in which you can make changes to your Medicare Advantage Plan and or Medicare Prescription Drug Plan. SEPs are granted with certain life events; if you qualify for one, you are given the opportunity to either change your current coverage or switch to a different Medicare plan that better suits you and your family’s needs. If you miss the Open Enrollment Period for health insurance, qualifying for a SEP is the only other way to enroll in a new plan or change your current plan during the year. As long as you submit an enrollment request or application within the designated period that your SEP gives and you are approved, your new health insurance coverage will begin shortly after. The exact length of time before your coverage begins again will depend on the situation.
How Do You Qualify for a SEP?
A Special Enrollment Period (SEP) for Medicare only occurs under certain circumstances, such as changes to your housing, family, or insurance. Below are some of the most common situations that qualify people for a SEP.
Housing Circumstances
- Moving to a new residence that is located in an area that your current plan no longer services or an area that offers new plan options.
- Moving to the United States from another country.
- Moving to or from a school, institution, or shelter.
- Being released from prison.
Family Circumstances
- Getting married.
- Welcoming a baby through birth or adoption or putting a child up for adoption.
- Divorce or legal separation in which you lose your insurance.
- The death of someone on your plan leaves you ineligible for your current insurance.
Insurance Circumstances
- Losing eligibility for your current insurance coverage because of your job or your age.
- Getting other coverage via employment or other qualifying programs.
- Your plan is either terminated or not renewed by Medicare.
- You want to apply to a 5-star Medicare Advantage Plan or Medicare Prescription Drug Plan.
Other Circumstances
- If you were impacted by the coronavirus pandemic and you either have lost or are going to lose your health insurance.
- An error occurred when you were enrolling or unenrolling from an insurance plan.
- Becoming a United States citizen and qualifying for Marketplace coverage.
- You were told misleading or improper information that affected your decision regarding health insurance coverage.
These are some but not all of the circumstances that can qualify you for a SEP. If you believe that you qualify for a SEP but your situation does not fit under any of the qualifying categories, you can still request a SEP based on your “exceptional circumstances.” If you are denied for a SEP but believe that you qualify with your current circumstances, you have the option to file an appeal.
The rules and lengths for SEPs change according to the circumstances, so make sure that you are receiving the right information that fits your situation. Also, ensure that you act quickly and accordingly when it comes to filing all the necessary documentation during the SEP. The period of time that they give you to make the necessary changes can go fast, especially when you are dealing with the life changes that qualified you for a SEP in the first place. If you have questions about SEPs and whether or not you qualify for one, consult Medicare’s website or talk to someone via live chat or phone at 1-800-MEDICARE (1-800-633-4227).