If there’s one thing I’ve learned from helping people with Medicare, it’s that life doesn’t always line up neatly with Medicare’s enrollment calendar.
Maybe you’re still working past 65 and have insurance through your employer. Maybe you’re retiring and losing that coverage. Maybe you’re moving to a new area and suddenly your current Medicare plan doesn’t work the same way where you live.
These are exactly the kinds of situations where it’s important to understand Medicare Special Enrollment Periods (SEPs). A Special Enrollment Period may give you an opportunity to enroll in Medicare or make certain changes to your Medicare coverage outside the usual enrollment periods. But not every situation qualifies, and the rules and timing depend on what has actually happened.
What Are Medicare Special Enrollment Periods?
Medicare Special Enrollment Periods are permitted when certain qualifying events or circumstances occur.
For Medicare Advantage and Medicare drug coverage, events such as moving or losing other coverage may allow you to make changes outside the normal enrollment period. What you’re allowed to change and how long you have to make the change depends on the particular event.
That’s why I don’t like giving people a blanket answer without first understanding their circumstances. If you’re weighing this against the enrollment window you get when you’re new to Medicare, take a look at my article on the Medicare Initial Enrollment Period — Special Enrollment Periods work differently and follow their own rules.
Are You Retiring After Age 65?
This is a situation I see people worry about. You’ve continued working past 65, you’ve had health insurance through your employer or your spouse’s employer, and now retirement is approaching.
If you’ve had qualifying group health coverage based on current employment, you may have a Special Enrollment Period for Medicare Part B. The timing matters. Medicare states that the 8-month Special Enrollment Period for Part B generally begins when employment ends or the group health plan coverage based on current employment ends, whichever happens first.
But I would never suggest assuming that your particular employer coverage automatically qualifies. Before you retire or give up employer coverage, find out exactly how your current coverage coordinates with Medicare and when you need to take action.
What If You’re Moving?
Moving can create a completely different Medicare question. Medicare Advantage and Medicare drug plans have service areas. A plan that’s available where you live today may not necessarily be available at your new address.
A move may qualify you for a Special Enrollment Period that allows you to make certain coverage changes. This is where I encourage people to look beyond the name of the insurance company.
- Is your current plan available at the new address?
- Are your doctors in the applicable network?
- What about specialists?
- Which hospitals are in the network?
- Are your prescriptions on the plan’s formulary?
- Is your preferred pharmacy participating?
- What will your estimated costs look like?
Your address is only one part of the picture.
Losing Other Coverage Can Also Matter
If you lose certain other health or drug coverage, you may have an opportunity to make changes to your Medicare coverage. The exact rules depend on the type of coverage you’ve lost and your individual circumstances.
If you know you’re retiring, moving, or losing coverage, start reviewing the situation ahead of time when possible.
Medicare Special Enrollment Periods Don’t Guarantee Every Plan Is Available
Qualifying for Medicare Special Enrollment Periods doesn’t mean every Medicare plan is available to you. Medicare Advantage and prescription drug plan availability can vary by location, including by county and service area. I also don’t represent every Medicare plan available in every area.
My role is to help you understand and compare the options I’m contracted and authorized to offer that are available based on your circumstances and location. If you’re also weighing Medicare Advantage vs. Medicare Supplement, that’s a decision worth thinking through before you use a Special Enrollment Period to switch.
What I Look at When Helping Someone Review Their Options
- Prescription medications
- Doctors and specialists
- Hospitals
- Pharmacies
- Provider networks based on currently available directories
- Premiums and other potential costs
- Medicare Advantage options
- Medicare Supplement options, where applicable; eligibility and enrollment rights for Medicare Supplement coverage are subject to separate federal and state rules
- Prescription drug coverage
- Additional benefits, where available
The goal is to help you compare the available options based on your individual circumstances and priorities.
Don’t Assume You’ve Missed Your Chance
If you’ve experienced a change in your life and think you’ve missed an enrollment deadline, don’t automatically assume there’s nothing you can do. Medicare’s own guidance on Special Enrollment Periods lays out several qualifying situations, and one of them may apply to you depending on your circumstances. At the same time, don’t assume that a life change automatically qualifies you.
If you’re approaching retirement, losing coverage, moving, or dealing with another change that could affect your Medicare coverage, I’m happy to help you review the Medicare options I’m authorized to offer and understand the questions you should be asking.
Need Help With Medicare Special Enrollment Periods?
If you think you might qualify for one of these Medicare Special Enrollment Periods, Contact me and let’s go through your situation together — what’s changed, what deadlines apply, and which options I’m contracted and authorized to offer are worth comparing.
There is no additional fee for my Medicare plan guidance. If you enroll through me, I may receive compensation from the insurance carrier.
Disclosure
We do not offer every plan available in your area. Any information we provide is limited to the plans we offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to obtain information on all of your options.
Availability of plans, benefits, provider networks, premiums, and enrollment opportunities varies by location and individual circumstances and may change from year to year.
