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Is there a list of Medicare Special Enrollment Periods?
Here is a list of several common situations that can result in a Special Enrollment Period (SEP) in Medicare:
1. Moving: If you move out of your Medicare Advantage plan's service area, you may be eligible for an SEP to enroll in a new plan available in your new location.
2. Loss of Creditable Coverage: If you lose creditable prescription drug coverage (e.g., employer-sponsored coverage or union coverage) through no fault of your own, you may qualify for an SEP to enroll in a Medicare Part D Prescription Drug Plan.
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3. Loss of Employer/Union Coverage: If you lose coverage from your employer or union, you may be eligible for an SEP to enroll in Medicare Part B and/or Part D. <4>4. Loss of Medicaid or Extra Help: If you lose eligibility for Medicaid or the Extra Help program, you may qualify for an SEP to enroll in or change your Medicare Advantage plan or Medicare Part D plan.
5. Dual-Eligible Beneficiary: Dual-eligible beneficiaries (eligible for both Medicare and Medicaid) have ongoing opportunities for SEPs to enroll, switch, or disenroll from Medicare Advantage plans or Medicare Part D plans.
6. Institutional Status Change: If you enter, reside in, or leave an institution (such as a skilled nursing facility or long-term care facility), you may be eligible for an SEP to change your Medicare coverage.
7. Plan Non-Renewal: If your Medicare Advantage or Part D plan is discontinued or will no longer be available in your area, you have an SEP to select a new plan.
8. 5-Star Special Enrollment Period: If you are currently enrolled in a Medicare Advantage plan or Part D plan with a 5-star rating, you may be eligible for a 5-Star SEP to enroll in a different 5-star plan at any time of the year.
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9. Medigap SEP: Any Medicare beneficiary who dropped a Medigap (Supplement) policy when they enrolled for the first time in a Medicare Advantage plan can elect to disenroll from their first MA plan and return to Original Medicare. They will have a guaranteed eligibility period to rejoin a Medigap plan. MA plan.
10. Severe or Disabling Chronic Conditions SEP: Beneficiaries who have severe or disabling chronic conditions and wish to enroll in a SNP (Special Needs Period) designed to serve individuals with their specific condition have a SEP during which they can enroll in a chronic condition SNP (C-SNP) designed to serve individuals with their condition. The SEP lasts as long as the individual has the qualifying condition and ends once the individual enrolls in a C-SNP.
11. Low-Performing Plan SEP: Beneficiaries enrolled in a plan that has been identified by CMS with the low-performing icon have a SEP that exists as long as the beneficiary is enrolled in the low-performing SEP.
12. Loss of Special needs SEP: Beneficiaries enrolled in a SNP because they feel they no longer meet the needs status have a special SEP that begins the month the individual's special needs status changes and ends when they make an enrollment request or three calendar months after the effective date of involuntary disenrollment from the SNP, whichever is earlier.
13. Disaster-Emergency SEP: Beneficiaries affected by an emergency or major disaster declared by a federal, state, or local government entity are eligible for a SEP to make a Medicare Advantage enrollment or disenrollment election. The SEP starts on the day the declaration is made, the incident starts, or, if different, the date the end of the incident is announced, whichever is later. it applies where an individual was eligible for another election period at the time of the emergency or major disaster and did not make an election during that other election period due to the emergency or major disaster.
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14. PACE SEP: Beneficiaries may disenroll from an MA or prescription drug (PDP) at anytime in order to enroll in PACE. In addition, beneficiaries who disenroll from PACE have a SEP to elect a Medicare Advantage (MA) plan, or PDP. The SEP ends two months after the effective date of PACE disenrollment.
MedHelpCenter.us recommends that you call the Senior Health Insurance Agency at 813-592-8568 for further help and explanation.
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