Special Enrollment Periods (SEPs)

Medicare Advantage SEPs allow you to make changes to your Medicare coverage outside of the standard enrollment windows. They exist to give you flexibility when major life events change your coverage needs or when circumstances—such as natural disasters—may have prevented you from enrolling during your normal enrollment period

What Is a Special Enrollment Period (SEP)?

An SEP is a time outside the standard Medicare enrollment windows when you can switch or join a Medicare Advantage (Part C) or Medicare Supplement plan or return to original Medicare.

SEPs are triggered by specific life events or declared in specific areas for circumstances that may have impeded enrollment. Each SEP has its own rules about when you can enroll and what
types of changes you can make.

Common Reasons You May Qualify for an SEP

Your area was affected by a disasters or other emergency:

• If a federal, state, or local government declares an emergency or disaster, CMS may offer an SEP for affected individuals. This gives you more time to make changes to your coverage if you were unable to during a regular enrollment window.

You’re not in a 5-star plan:

• You can switch to a plan that has earned a 5-star quality rating from Medicare once per calendar year, between January 1 and November 30 or December 8 and December 31. It’s a great opportunity to upgrade to a top-rated plan without waiting for the annual enrollment period.

Here are some real-world examples of how a Special Enrollment Period (SEP) can be used.

1. Moving to a New Area

Example: Mary moves from Michigan to Arizona. Her current Medicare Advantage plan doesn’t operate in her new ZIP code, so she qualifies for an SEP to enroll in a new plan available in her area.

2. Losing Employer Coverage

Example: Jerry retires and loses his employer-sponsored health insurance. This triggers an SEP allowing him to enroll Medicare coverage.

3. Gaining/Losing Medicaid Eligibility

Example: Nancy becomes newly eligible for both Medicare and Medicaid (a dual-eligible). She can use an SEP to enroll in a plan like a Dual Eligible Special Needs Plan (D-SNP).

4. Plan Termination

Example: Milton’s current MA plan is discontinued by the insurer for the upcoming year. He would be eligible for an SEP to switch to a different Medicare Advantage plan or return to Original Medicare (Parts A & B).

5. Leaving Jail, Prison, or Other Detention Facility

Example: Sally is released from jail and becomes eligible again for a Medicare health insurance plan.

6. Enrolling or Disenrolling from Programs like PACE

Example: Fred decides to disenroll from a PACE program (Program of All-Inclusive Care for the Elderly). He gets an SEP to enroll in a Medicare plan.

How Long Do SEPs Last?

The timing varies depending on your qualifying event. In many cases, your SEP starts the month the event occurs and lasts up to two months after. Some SEPs may have shorter or longer windows, so it’s important to act quickly.