The Annual Enrollment Period (October 15 to December 7) is your once-a-year window. But Medicare has a list of life events that open extra windows called Special Enrollment Periods, or SEPs. If one applies to you, you may be able to switch plans this week, not next October.
What is a Medicare Special Enrollment Period?
A Special Enrollment Period (SEP) is a Medicare rule that lets you change plans outside of the normal yearly window. SEPs exist because life happens. People move, lose jobs, qualify for Medicaid, or have other changes that affect their coverage.
If you qualify for a SEP, you get a set number of days to make a change. Sometimes it is 60 days, sometimes 2 months, sometimes longer. The exact length depends on the type of SEP.
The most common SEPs and how they work
Moving to a new address
If you move outside your plan's service area, you get a 2-month SEP. The clock starts the month you move (if you tell your plan first) or the month after (if you tell your plan after). You can switch to any Medicare Advantage or Part D plan available in your new area.
Losing employer or union coverage
This is a big one. If you delayed Medicare because you had health coverage through work, you get a Special Enrollment Period when that coverage ends. You have 8 months to sign up for Medicare Part B with no late penalty. You also get 2 months to enroll in a Part D plan or Medicare Advantage plan.
For more on this, see our article on Medicare and employer coverage past 65.
Becoming eligible for Medicaid or Extra Help
If you start getting Medicaid, or you start getting the Extra Help program that helps pay for Part D drugs, you get a SEP. You can switch plans once per calendar quarter for the first three quarters of the year. Read more in our guide to Medicare vs Medicaid.
Your plan leaves Medicare
Sometimes a Medicare Advantage or Part D plan stops doing business in your area, or Medicare ends its contract with the plan. When that happens, you get a SEP to pick a new plan.
5-star plan SEP
Medicare rates plans every year using a star system from 1 to 5. If a 5-star Medicare Advantage or Part D plan is available in your area, you get a one-time SEP between December 8 and November 30 to switch to it. Most areas do not have a 5-star plan, but if yours does, this is a perk worth knowing about.
You qualify for or lose a Special Needs Plan
Special Needs Plans (SNPs) are Medicare Advantage plans built around a specific condition (like diabetes), a specific situation (like being in a nursing home), or being dually eligible for Medicare and Medicaid. Becoming eligible for one gives you a SEP. Losing eligibility also gives you a SEP to switch to a regular plan.
You move into or out of a nursing facility
If you live in a skilled nursing facility, rehab center, or long-term care hospital, you get a SEP that lets you change plans once a month for as long as you live there. You also get an SEP for 2 months after you move out.
Your plan's contract is not renewed
If Medicare decides not to renew your plan's contract, you get a SEP that runs from December 8 through the end of February the following year. This SEP gives you a clean way to find a new plan.
The Medicare Advantage Open Enrollment Period
This is not technically a SEP, but it works in a similar way. From January 1 to March 31, anyone on a Medicare Advantage plan can switch to a different Medicare Advantage plan, or go back to Original Medicare. You get one switch. The new plan starts the first of the month after you enroll.
Original Medicare members cannot use this window. Only people who are already on Medicare Advantage on January 1 can use the MA Open Enrollment Period.
What you cannot do with a SEP
Most SEPs let you switch Medicare Advantage plans, Part D plans, or move between Original Medicare and Medicare Advantage. Most SEPs do not let you buy a Medicare Supplement (Medigap) plan without medical underwriting in most states.
There are some narrow exceptions called guaranteed issue rights. The most common one is the trial right, which gives you 12 months to leave your first Medicare Advantage plan and buy a Medigap policy with no health questions. If you switched to Medicare Advantage when you first became eligible for Medicare, this protection may apply to you.
How to use a SEP
- Figure out which SEP applies to your situation
- Gather proof of the qualifying event (a letter from your employer, your new lease, your Medicaid approval letter)
- Call Medicare at 1-800-MEDICARE, your plan, or an independent agent to start the change
- Do not let the SEP window close. Most SEPs are 2 to 8 months, and they are gone when the clock runs out
A simple way to know if you qualify
If something big changed in your life that affected your health coverage, your address, or your income, there is a good chance a SEP applies. The list above is the most common ones, but it is not every SEP. Medicare has more than 30 different SEP types.
If you are not sure whether a SEP applies to you, ask. A 20 minute conversation with an independent agent can save you a year of waiting.