Healthcare Educators


Medicare Enrollment Periods and Special Circumstances

by | Oct 21, 2022

Medicare has a number of different enrollment periods, each serving a different purpose, and each with its own set of rules and timelines. You may be familiar with the enrollment period when you first turn 65, but you may not be aware of Medicare’s Special Circumstances, or Special Enrollment Periods, which allow you to change plans during the year.

Medicare’s Three Main Enrollment Periods

  • Initial Enrollment Period (IEP): For most people this is your first opportunity to sign up for Medicare, occurring during 7-month period around your 65th birthday.
  • Annual Enrollment Period (AEP): From October 15 – December 7 each year, you can join, switch, or drop a Part C Medicare Advantage plan or Part D Prescription plan. Your coverage will begin on January 1.
  • Open Enrollment Period (OEP): From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan). You can only switch plans once during this period. If you failed to sign up for Part A and/or Part B during your IEP when you first became eligible, you can sign up during OEP. You may have to pay a higher premium for late enrollment.

Special Enrollment Periods

It’s important to know that if your circumstances have changed, you have moved, or you picked the wrong plan, there might be a Special Enrollment Period (SEP) that allows you to make a change to your Medicare coverage. Here are just a few of the reasons you might qualify for a SEP.

  • Five Star Special Enrollment
    Medicare recipients are granted a Five-Star Special Enrollment Period from December 8 through November 30. During this SEP you may switch plans once to a 5-Star Medicare Advantage, 5-Star Medicare Cost Plan, or 5-Star Medicare Prescription Drug Plan available in your area. You can use Medicare’s search tool to see if there are 5 star plans available in your zip code.
  • You Enrolled in the Wrong Plan
    If you enrolled in a Medicare Advantage Plan or Part D plan by mistake, or after receiving incorrect or misleading information, you may be able to disenroll and enroll in a new plan that better fits your needs. You can contact 1-800-MEDICARE to request a retroactive disenrollment or request a special enrollment period. A Medicare representatives can help you understand your options for making changes.
  • Your Address Has Changed
    If you move and your plan does not have coverage in your new location, you will have to change plans. Even if your new address is within your current plan’s coverage area, you could switch to a different plan if your move made you eligible for new options that weren’t available at your old address.
  • Coverage From Your Employer Has Changed
    If you left coverage from your employer or union (including COBRA coverage) you would be eligible for a SEP.
  • Your Eligibility for a Special Program Has Changed
    Becoming newly qualified for a special program could make you eligible for a Medicare SEP. This includes drug assistance programs such as Extra Help and state pharmacy programs such as the Texas State Pharmacy Assistance Program (SPAP). Also qualifying for Medicaid or a Special Needs Plan for a chronic health condition will make you eligible for a SEP.
    If you are already enrolled in one of these special programs, and a change in your circumstances means you no longer qualify, you would also be eligible for a SEP to change plans.
  • FEMA Emergency
    If you live in an area where FEMA has declared an emergency or major disaster, and you weren’t able to enroll in a Medicare plan, or switch Medicare plans during an election period that was going on during the emergency period, you could be eligible for a SEP.

These are just some of the Special Circumstances  allowed by Medicare. If you need to know more about whether you qualify for a Special Enrollment Period, contact us today. Our experienced and knowledgeable team of Medicare agents is here to help.