Are you eligible for a Special Enrollment Period? While annual open enrollment has come to a close, that does not necessarily mean that you missed your opportunity to make changes to your Medicare Advantage plan or your Medicare part D prescription drug plan.

If you have Medicare Part C, also known as Medicare Advantage, meaning your Medicare benefits are offered through a private company, you will have a second opportunity to make changes. During the Medicare Advantage Open Enrollment period, running from January 1, 2022, through March 31, 2022, you can switch to a different Medicare Advantage Plan or go back to Original Medicare.

Additionally, some Medicare recipients, based on certain triggering life events, may qualify for a Special Enrollment Period (or SEP), which allows you to make changes to your Medicare Advantage and/or Part D prescription drug coverage throughout the year. Certain situations or life changes that may trigger a Special Enrollment Period include:

  • Your living situation changes; you move outside of your plan’s service area, or you move to an area that offers new plan options, you just moved back to the U.S. or, most commonly, you just moved into, currently live in, or just moved out of an institution, such as a skilled nursing facility.
  • You lost your current coverage by losing your Medicaid eligibility, leaving your employer, union, or retiree coverage (including COBRA), you lost other creditable drug coverage, or you dropped your PACE plan coverage.
  • You have a chance to enroll in other coverage offered by your employer or union, you are enrolling in other creditable drug coverage, such as TRICARE, or you recently enrolled in a PACE plan.
  • Your plan changes or loses its contract with Medicare.
  • You are dually eligible (both Medicare and Medicaid eligible).
  • You qualify for Extra Help paying for Medicare prescription drug (Part D) coverage or are enrolled in another State Pharmaceutical Assistance Program, such as PAAD or PACE.
  • You dropped a Medigap policy to join a Medicare Advantage plan for the first time.

Special Enrollment Periods can also be triggered if you selected your plan based on a federal employee’s incorrect advice. For example, if a federal employee did not tell you that your current coverage does not qualify as creditable coverage.

The above circumstances generally create a SEP ranging from two to three months, depending on the type of situation. Some SEPs can only be used once per calendar year to make a change, so it is important to select the proper SEP when making changes and ensure that you are reading and accounting for all of the restrictions. Your Care Coordinator or Public Benefits Specialist at Rothkoff Law Group can help determine whether you qualify for a SEP and can put you in touch with a trusted health insurance broker to ensure that all of your needs are being met.