You can enroll during the initial enrollment period, which begins near your 65th birthday and lasts for seven months. You can also enroll during the general enrollment period (Jan. 1 to March 31), but you may face late enrollment penalties. If you’re already enrolled, you can make changes to your coverage during designated open enrollment periods each year, depending on the type of coverage you have. But if you need to add or change your coverage outside of these times, you must qualify for a special enrollment period (SEP). Several different events can create these enrollment opportunities. Below, you’ll find which circumstances make you eligible for a special enrollment period, and what Medicare programs you can enroll in.
The Purpose of Medicare Special Enrollment
Normally, you can only enroll in Medicare or make changes to your plan during specific enrollment windows, including the initial enrollment period, open enrollment, and general enrollment. However, sometimes life’s events require that you make changes outside of these periods. That’s where Medicare’s special enrollment comes in. During a special enrollment period, you can apply for Medicare Part A and/or B, a Medicare Advantage plan (Part C), or a Part D drug plan, or make changes to your Medicare Advantage (MA) plan and your Part D prescription drug coverage. Unlike the other enrollment periods, a specific event or circumstance must occur for you to be eligible. Here’s how the different enrollment periods, including special enrollment, work: During your special enrollment period, you may be able to:
Sign up for Part A of Original Medicare Sign up for Part B of Original Medicare Join or switch to a different Medicare Advantage plan (Part C) Drop a Medicare Advantage plan and return to Original Medicare Join or switch to a different Medicare prescription drug plan (Part D) Drop your Part D prescription drug coverage
The exact actions you’re allowed to take depend on why you qualified for a special enrollment period.
When Is the Medicare Special Enrollment Period?
Below is a closer look at some of the events that can lead to an SEP.
You Move
Not all Medicare plans are available in every location. If you move, you may need to switch plans to ensure you have medical coverage. Additionally, if you move into or out of a care facility or other institution, you’re also eligible to make changes. Here’s a look at the type of changes you can make based on common moves.
You Lose Your Current Health Coverage
If you have some other types of health coverage when you turn 65, such as employer-provided group health insurance, you can delay enrolling in Medicare without having to pay a penalty later. Once you lose this coverage (or while you have it), you can enroll in Part A (if you’re required to pay a premium), Part B, Part C, and Part D plans without penalty until the end of your SEP. Part A and Part B If you qualify for premium-free Part A, you can enroll in Part A at any time without penalty. If you don’t but were covered under a group health plan, you have eight months from the date you lose your coverage or your job ends, whichever comes first, to enroll in Part A. The same rule applies to Part B coverage (if you didn’t enroll when first eligible because you were covered by a group health plan). Your coverage will start anywhere from the first day of the month you sign up or, if you choose, during any of the three months after you sign up. Medicare Advantage and Part D You have two full months to enroll in a Medicare Advantage or Part D plan after the month your “creditable” drug coverage ends. If you don’t have creditable drug coverage for 63 or more days once you’re eligible for Medicare, you may owe a late enrollment penalty that permanently increases your Part D premium if you decide to get it.
You’re Eligible for Other Coverage
Sometimes, you may become eligible for other insurance coverage after you’ve already enrolled in Medicare Advantage and/or Medicare Part D if you:
Get a different job and have qualifying coverageEnroll in a Program of All-Inclusive Care for the Elderly (PACE) planQualify for another kind of prescription drug coverage (such as from Tricare)
During this type of SEP, you can drop your Medicare Advantage and drug coverage at any time or whenever your employer or union allows you to change your plan. Other circumstances can trigger special enrollment periods for Medicare. Here are some of the most common:
Your plan changes its contract with Medicare and is no longer eligibleYou enroll in a State Pharmaceutical Assistance Program (SPAP)You’re eligible for both Medicaid and MedicareYou have a severe disability, and you’re eligible for a Medicare Special Needs Plan (SNP) A federal employee made an error with your enrollment
If you think you’re eligible for a special enrollment period, you can contact Medicare via phone or live chat to ask for help.
What if You Miss Special Enrollment?
If you miss special enrollment, you’ll have to wait for another enrollment period to make changes to or enroll in a plan. You can make changes to your coverage during the open enrollment period, during the Medicare Advantage open enrollment period (if you have Medicare Advantage), and you can enroll in Part B and a Medicare Advantage plan during general enrollment. However, you may have to pay a late penalty for failing to enroll on time.
