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?

There are situations that may allow an individual to enroll or change their Medicare Advantage or Prescription Drug Plan.

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

To learn more, you can contact Medicare at 1-800-Medicare, visit Medicare website, or Contact Jean Enyeart.

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.

The change must be a like plan change, which. means the beneficiary wanting to change can only move from a Part C plan to another Part C plan, not from a Part C plan to a Part D plan.

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

Additional Questions? Submit here.