Medicare Special Enrollment Periods (SEP's)


Enrolling in Medicare coverage is very much like enrolling in an employer sponsored health insurance plan in many ways. Just like with employer sponsored health insurance, you must wait for an open enrollment period to sign up for the program. With Medicare, that open enrollment period is alternatively referred to as Annual Enrollment.

In 2012, Medicare Annual Enrollment is October 15th through December 7th. Those dates may change in subsequent year, but the general time-frame will be the same. Most people will have to wait until Annual Enrollment in order to sign up for coverage beginning January 1st of each year.

However, some people can enroll at other times. Special Enrollment Periods will allow some people to enroll in Medicare outside of the Annual Enrollment Period in certain unique situations (qualifying events), the following qualifying events apply:

Extra Help (Medicare Financial Assistance)

If you are receiving the low income subsidy (low income assistance) known as Extra Help, you can make a change to your Medicare prescription drug coverage at will. Your new coverage will begin the following month after you make the change.

Generally, with Medicare Extra Help programs, they have pre-selected the most cost effective plan for you, but you are free to change your plan if you would like.

If you are losing your Extra Help coverage, you will only have one time Special Enrollment Period in which to select new coverage; this begins the month of the loss of assistance and lasts for two months following the loss.

*State Pharmacy Assistance Programs (SPAP) qualify as well

Moving In or Out of Coverage Area

If you move out of the service area of your current prescription drug plan or Medicare Advantage Plan, you will be given a Special Enrollment Period in which to enroll in a new plan.

This SEP begins the month of and 60 days after the time you notify your organization of a permanent move out of the plan service area.

Loss of Coverage

If you lose creditable drug coverage from an employer, a retiree plan, or any other source through no fault of your own, you will qualify to enroll under an SEP.

Long Term Care

If you live in a long term care facility and you move or move out of that facility, you will be granted an SEP. Long term care facilities include the following:

  • Nursing Homes
  • Skilled Nursing Facilities
  • Intermediate Care Facilities for the Mentally Disabled
  • Psychiatric Hospitals
  • Rehabilitation Hospitals
  • Long Term Care Hospitals

Aging Into Medicare

If you are just becoming qualified to receive Medicare according to your 65th birthday, your SEP is called the Initial Enrollment Period (IEP). Your IEP will give you a full seven month window in which to enroll.

The IEP period is three months prior to the effective date, the month of the effective date, and the three months following your effective date (effective date = the date you become eligible for Medicare enrollment).

Medicare can often be a puzzle for most people to solve. If you still have questions about Medicare basics, please read the hub Medicare Summarized to help you become more familiar with the program.

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