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.
What is a Medicare Special Enrollment Period?
A Medicare SEP is a limited window that allows you to enroll in or make changes to certain parts of Medicare outside the standard enrollment periods. Depending on your qualifying event, you may be able to:
- Join, drop, or switch a Medicare Advantage (Part C) plan
- Enroll in or change a Medicare Part D prescription drug plan
- Enroll in Medicare Part B (if you delayed it due to employer-sponsored coverage)
The changes you’re allowed to make and how long you have to act depend on your qualifying event.
What Triggers a Medicare Advantage Special Enrollment Period (Part C)?
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]
Important Dates to Remember
Keep these in mind as you’re thinking about changing your Medicare plan.
- Annual Enrollment Period (AEP). October 15 – December 7. Anyone with Medicare can make changes to Medicare Advantage and/or Part D coverage for the following year. [2]
- Medicare Advantage Open Enrollment. January 1 – March 31. If you’re already in an MA plan, you can switch to another MA plan or go back to Original Medicare (with or without Part D). One change is allowed. [3]
How Long Is a Special Enrollment Period?
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.
How to Apply for a Medicare Special Enrollment Period
To apply for a Medicare Special Enrollment Period, follow these steps.
- Identify your Medicare qualifying event.
- Confirm your election window and allowed actions. Your event determines when you can change and what you can change. Mark your deadline.
- Gather documentation. This could be proof of address change, a FEMA notice, Extra Help approval, or other relevant documents. Plans usually request evidence of eligibility.
- Compare plans using the Medicare Plan Finder.
- Enroll via the plan you choose or through Medicare.gov. Be precise and complete. Coverage typically begins on the first day of the month following the plan's receipt of your request, although this varies by SEP.
- Save records (confirmation numbers, plan documents) in case you need to verify your election later.
Need help? Call 1-800-MEDICARE (1-800-633-4227) or your State Health Insurance Assistance Program (SHIP).
Medicare Advantage vs. Medicare SEPs: What You Can Do
- 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]
Medicare Special Enrollment Period After Age 65
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]
Medicare Special Enrollment Period FAQs
Using Hearing Health Insurance With Amplifon
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.
Take control of your hearing health
Request a hearing evaluation
Request an appointment at a hearing care provider near you.
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Our hearing care advocates will call you shortly and help answer all your questions.Sources
1. Medicare. “Special Enrollment Periods.” Retrieved from https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods
2. Medicare. “Joining a Plan.” Retrieved from https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan
3. Medicare. “Joining a Plan.” Retrieved from https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan
4. Medicare. “Special Enrollment Periods.” Retrieved from https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods
5. National Council on Aging. “Medicare Part D Special Enrollment Periods.” Retrieved from https://www.ncoa.org/article/medicare-part-d-special-enrollment-periods/
6. Social Security Administration. “How to Apply for Medicare Part B (Medical Insurance) During Your Special Enrollment Period.” Retrieved from https://www.ssa.gov/pubs/EN-05-10012.pdf
7. Social Security Administration. “Special Enrollment Period (SEP)” Retrieved from https://www.ssa.gov/help/iClaim_medSEP.html
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