Special Enrollment Period (SEP)
The Special Enrollment Period (SEP) may allow certain individuals, who are outside other enrollment periods to apply for Medicare Part A or B, enroll or change Part C (Medicare Advantage) or Part D (Prescription Drug Plan).
Whether an individual can enroll or change their plan may depend on their situation.
Why use this period for Part A or B?
Individuals who had employer group health coverage (EGHC) when they became Medicare-eligible at age 65, and opted to continue EGHC, may have delayed enrolling in Part B.
When their EGHC ends, they may use this period to enroll in Part B without incurring a penalty.
Individuals who have EGHC, and an Health Savings Account, to which they want to continue to contribut, may delay both Part A and B until EGHC terminates and they stop contributing to the HSA.
What situations allow for SEP?
Some situations are:
- Moving out of the plan’s service area
- Admission into a skilled nursing facility
- Qualifying for a chronic needs plan
- Qualifying for Medicare & Medicaid, dual-eligible plan
- Opting to enroll in a 5-Star plan
What is the 5-Star Rating SEP?
At any time during the year, a Medicare beneficiary already enrolled in a Medicare Advantage Plan (Part C) or a stand-alone prescription drug plan (Part D) may change their plan to a 5 star rated plan. But, the change has to be to a plan that has a 5-Star Rating.
How long does this period last?
The SEP period can vary depending on the situation.
If an individual delayed Part B do to employee group health coverage, the SEP last