How Do I Qualify For A Special Enrollment Period?

When things happen in life, you can’t always predict or prepare for them. Medicare coverage can be greatly affected by changes in your life, so you want to know what options you have. Lots of circumstances can make you eligible for a Special Enrollment Period (SEP) in which you can adjust your Medicare coverage, usually your Medicare Advantage plan or your Part D plan, based on your current or future needs. 

Special Enrollment Periods can look different in length and/or timing depending on the reason you are being granted one. Not all life events grant you the Medicare safety net, but let’s go through the most common ones and what they can mean for you. 

Special Enrollment Period Qualifiers

  • Change in where you are living. Only results in an SEP if you are moving out of your current coverage network, are moving into an area with more network options, returning to the country after living abroad, or moving out of an institution (care facility, jail, etc.).
  • Change regarding employer’s insurance. Whether it is retiree, union, or current employee insurance, some companies offer packages that you can use in replacement for Medicare. Losing this coverage or having the chance to use it instead of/along with Medicare, this can grant you an SEP to add, drop, or change your coverage. 
  • Change regarding Program Of All-Inclusive Care For The Elderly (PACE) coverage. Joining a plan or losing your PACE plan can result in an SEP to change, add, or drop parts of your Medicare coverage.
  • Change regarding your Special Needs Plan. If your condition either becomes included or is no longer included under SNP’s coverage, you are eligible for an SEP to add, drop, or change parts of your Medicare coverage. 
  • Change regarding additional or private drug coverage. Whether it is a private insurance plan that is creditable through Medicare or a federal program like Medicare Cost Plan, losing or gaining this kind of coverage can grant you an SEP to add, drop, or change parts of your Medicare coverage.
  • Losing Medicaid eligibility. An SEP is given to anyone who needs to replace their Medicaid plan with Medicare coverage. 
  • Change in your plan’s standings with Medicare. If your insurance company’s plan is sanctioned, the contract isn’t renewed, or the contract is terminated, you are automatically granted an SEP to avoid a gap in coverage. These periods can look different depending on which of these changes occur.

Are There Other Situations That Can Qualify You?

The other reason you might be granted a Special Enrollment Period could be due to an error made by your provider or Medicare agent. If you were uninformed about parts of your plan, or informed of something incorrectly, you can qualify to change plans. These errors can be found internally and then you are notified, or you can file to report an error if you feel one was made. 

There are always going to be circumstances that don’t fit a category or can’t be predicted, so if you can’t determine whether your situation makes you eligible for a Special Enrollment Period, contact someone at Medicare or your plan provider and ask.

Let Us Get To Know Your Story

We love to help our customers get the most out of their Medicare coverage and make the right decisions for them. Let us listen and provide assistance in your situation and potential Special Enrollment Period changes. Give ReLion Insurance Solutions a call at 858-999-2858.