Special Enrollment Period

For some who do not enroll during their Initial Enrollment Period, Medicare will extend a Special Enrollment Period (SEP). However, Special Enrollment Periods are not given to everyone, and there are certain qualifications that must be met in order to be eligible. If you need to make a change in your plan and are wondering if you qualify, reach out to an insurance agent who can answer your questions.


Enrolling in Medicare when you first become eligible is important to avoid late enrollment penalties. However, circumstances happen, and sometimes enrolling during the Initial Enrollment Period is not always ideal. Even if you are already enrolled in Medicare, a Special Enrollment Period can give you a chance to find new coverage if you need it.

But how exactly can someone qualify for a Special Enrollment Period? Well, here’s how:


  • You move outside of your plan’s service area.
  • You moved to a new address that’s still in your plan’s service area, but you have new plan options available.
  • You lived outside the country but moved back to the United States.
  • You moved into, moved out of, or currently live in an institution, such as a skilled nursing facility.
  • You were released from jail.

Losing Coverage

  • You are no longer eligible for Medicaid.
  • You no longer have coverage through your employer or union.
  • You involuntarily lose drug coverage that’s not as good as Medicare prescription drug coverage.
  • Your current coverage makes changes and is no longer credible.
  • You had drug coverage with a Medicare Cost Plan but you left the plan.
  • You dropped your coverage in a PACE plan.

Getting Other Coverage

  • You have a choice to enroll in coverage offered by your employer or union.
  • You have or will enroll in prescription drug coverage that’s as good as Medicare prescription drug coverage.
  • You enrolled in a PACE plan.

Changes in Contract

  • Medicare takes an official action because of an issue with the plan that affects you.
  • Medicare ends your plan’s contract.
  • Your Medicare Advantage Plan, prescription drug plan, or Medicare Cost Plan’s contract is not renewed with Medicare.

Other Situations

  • You are eligible for Medicare and Medicaid.
  • You qualify for Extra Help.
  • You are enrolled in a SPAP or lose eligibility.
  • You dropped a Medicare policy when you first joined a Medicare Advantage Plan.
  • You have a chronic condition, and there is a C-SNP (Chronic Care Special Needs Plan) that is available.
  • You are enrolled in a Special Needs Plan but no longer have a condition that qualifies you for it.
  • You weren’t told your other prescription drug coverage was not as good as Medicare’s drug coverage.
  • You weren’t told you were losing prescription drug coverage that was as good as Medicare’s drug coverage.

Get a free medicare Consultation

Do You Qualify for a SEP?

If you’re wondering whether your circumstance could be granted a SEP, our professionals are here to answer your questions. You can make an appointment by calling us at 402-740-5505.