What is a Medicare Special Enrollment Period (SEP)?

Medicare enrollment can be complicated (or feel overwhelming). You may be familiar with the Annual Enrollment Period (October 15th-December 7th), but what if you need to adjust your coverage for another time? That’s where Special Enrollment Periods (SEP) come in.

A Medicare Advantage SEP means you can drop, switch, or join a Medicare Advantage plan outside of the regular enrollment periods if you have specific life events. These events include:

• Moving. You move out of your plan’s service area, or to a place where new plan options are available.
• Loss of coverage. You lose other credible health coverage (like employer, union, or Medicaid coverage).
• Change to your plan. Your plan leaves Medicare or stops service in your area.
• Changes to eligibility. You qualify or no longer qualify for programs like Extra Help, Medicaid, or a Special Needs Plan.
• 5-star plan access. You may switch into a 5-star Medicare Advantage plan if one becomes available.
• FEMA-declared emergency. If you missed an election window due to a disaster.
• Other unique events. Such as moving into or out of an institution like a skilled nursing facility.

Because each situation is unique, call 1-800-MEDICARE for definitive guidance. [1]

SEP timing varies by event. Many Medicare Advantage and Part D SEPs provide about 60 days [4] from the triggering event to make a change, but some run longer/shorter, and a few allow multiple changes. Always verify the window for your unique SEP before acting.

• Medicare Advantage Special Enrollment Period (Part C)
  You may be eligible for a Medicare Advantage Special Enrollment Period if, for example, you move, lose other coverage, or your plan changes its contract with Medicare. This flexibility ensures you always have access to the providers and coverage you need, including hearing care.
  
  
• Medicare Part D Special Enrollment Period
  Prescription coverage is just as important as medical care. A Medicare Part D Special Enrollment Period allows you to enroll in or change your prescription drug plan if you experience approved qualifying life events. [5]
  
  
• Medicare Part B Special Enrollment Period
  If you delayed enrolling in Medicare Part B because you had employer-sponsored insurance, you may qualify for a SEP for Medicare Part B. The SEP starts the month after employer-sponsored coverage or employment ends, whichever comes first, and lasts for 8 months, so you can sign up without facing late enrollment penalties. [6] 

When it comes to Medicare Enrollment, the time period around 65 is considered an Initial Enrollment Period (IEP), as opposed to a Special Enrollment Period. Your IEP extends 3 months before and after your 65th birthday!

It’s worth noting that many people continue working after the age of 65 and remain on their employer's health insurance coverage. Once that coverage ends, you’ll have 8 months after coverage or employment ends (whichever comes first) to enroll in Part B without incurring penalties. [7]

A Special Enrollment Period is your Medicare safety valve; it lets you adjust your coverage when your life unexpectedly changes. Identify your Medicare-specific trigger, confirm your window, compare plans carefully, and enroll before the deadline so your coverage keeps pace with your needs.

By understanding and using a Medicare Special Enrollment Period, you can start to work towards making sure your plan includes the audiology services and hearing aid benefits you need. Amplifon exists to help you make sure you get the care you deserve.

If you think you qualify for a Medicare SEP or have questions about your coverage, our team can guide you toward more accessible hearing care. Because hearing health is general health.