Are You Eligible for One of Medicare's Special Enrollment Periods?

Open Enrollment Is Not Your Only Option

change Medicare plans special enrollment Medicare
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Picking a Medicare plan is like playing chess. You play to win, in this case, for quality affordable health care. That does not mean you will always make the best choices along the way. The good news is you always have the chance to change your strategy when your next turn comes around. Take advantage of these enrollment periods to choose a better Medicare plan.

Medicare's Open Enrollment Period

The Open Enrollment Period is the one time every year when everyone can change their Medicare plan.

From October 15 to December 7, Open Enrollment allows you to:

That being the case, there may be other times during the year that you will want to change your Medicare plan. There are a number of Special Enrollment Periods you need to know about.

Special Enrollment Periods Based on Other Healthcare Programs

You may be eligible for Medicare in addition to with other healthcare programs. If this is the case, you may have certain Special Enrollment Periods available to you.

  • Extra Help. This Medicare Savings Program helps to pay for Part D costs like copayments, deductibles, and premiums. Depending on your income level, your costs may be decreased or even free. When you are eligible for the Extra Help program, you are free to make Medicare plan changes at any time. However, when you lose eligibility to the program, your Special Enrollment Period to change plans extends from January 1 to March 31 only.
  • Medicaid. While Medicare is a program intended to care for the elderly and the disabled, Medicaid aims to care for those with low incomes. People may be eligible for both Medicaid and Medicare. Dual eligibility offers you the opportunity to change between Medicare plans at any time during your enrollment. Losing Medicaid eligibility leaves you with a two-month Special Enrollment Period to change plans.
  • Program of All-Inclusive Care for the Elderly (PACE). This healthcare program is offered to people 55 years and older who qualify as needing a nursing home level of care. Since PACE offers creditable drug coverage, i.e., coverage as good as a Medicare Part D plan, you are unlikely to need to the Medicare drug benefit. You can cancel your Medicare Advantage or Part D plans at any time. Should you leave PACE for any reason, you have two months to re-enroll in either program.
  • State Pharmaceutical Assistance Program (SPAP). While the federal government offers Extra Help, individual states offer their own savings programs for prescription drugs. You can change to a Medicare plan that offers prescription drug coverage one time each calendar year if you qualify for one of these SPAPs.
  • TRICARE or Veteran's benefits. Thank you for your service. If you qualify for healthcare based on military service, you will be given access to creditable drug coverage. You are free to cancel your Medicare Advantage or Part D plan at any time without penalty.

Special Enrollment Periods Based on Changes to Your Medicare or Other Health Plans

Changes to your Medicare plan may be out of your control. If you find yourself in any of these situations, you may be eligible for a Special Enrollment Period.

  • The federal government cancels its contract with your insurance plan. You can change plans starting two months before and ending one month after the contract ends.
  • You lose creditable drug coverage. Whether you have an employer-sponsored plan, union benefits, or another health plan, you need to be informed if that plan offers creditable drug coverage. If for any reason, the plan does not properly notify you of this or if they changed their coverage so that their coverage is no longer creditable, you have two months to change Medicare plans.
  • You lose healthcare access to another plan. You can change your Medicare plan within two months if you lose access to other healthcare coverage you had, including COBRA benefits, employer-sponsored health plans, military benefits, or union benefits.
  • You want to enroll in a Five-Star Plan. If there is a Five-Star Medicare Advantage or Part D plan in your area, you can sign up for one anytime starting December 8 and ending November 30.
  • Your insurance plan is not renewing your Medicare plan for the coming year. You can change your plan from December 8 to February 28/29th.

Special Enrollment Periods Based on Where You Live

Unlike Original Medicare (Part A and Part B) which offers the same coverage wherever you live in the country, Medicare Advantage and Part D plans run on a local network. Moving could change your Medicare service area, prompting a need to change plans.

You are granted Special Enrollment Periods to change plans in the following situations:

  • You move into or out of a skilled nursing facility or long-term care hospital. While you live in an institution, you can change plans at any time. Once you leave that facility, you have two months to change plans.
  • You move to a U.S. address outside of your current plan's network or move to a U.S. address within your current plan's network but where additional plan options are now available. Your Special Enrollment period depends on when you notify your plan about your move. If you tell them before you move, you can change plans one month before and up to two months after your change of address. If you tell them after your move, you are given the month you notified them as well as two months later to make a change.

There may be other times when you are enrolled in Medicare but are unable to make use of the benefit. Your plan options may change by the time you get the opportunity to use Medicare.

You are granted a two-month Special Enrollment Period to change plans in the following situations:

  • You are released from prison. Medicare does not pay for care received during incarceration, even if you are actively enrolled in the program. Instead, the penal system foots the bill.
  • You move back to the United States after living in a foreign country. Medicare does not pay for care in foreign countries, except in rare circumstances and usually only in emergencies.

This does not mean that you should not pay your Medicare premiums when you live outside of the country or if you happen to be incarcerated. Not paying your premiums will result in your being terminated from the Medicare program, leaving you without healthcare options when you return to the United States or when you are released from prison.

A Word from Verywell

Open Enrollment is not the only time you can change Medicare plans during the year. There are a number of Special Enrollment Periods you can take advantage of based on changes to your current Medicare plan, on your eligibility for other healthcare programs, and even on where you live. Know your rights and use these opportunities to choose a plan that best meets your needs. 

Sources:

PACE. Medicare.gov. https://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html.

Special circumstances (Special Enrollment Periods). Medicare.gov. https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances/join-plan-special-circumstances.html.

State Pharmaceutical Assistance Programs. Medicare.gov. https://www.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx.

What Prisoners Need to Know. Social Security Administration website. https://www.ssa.gov/pubs/EN-05-10133.pdf.

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