Healthcare Educators


What Are Medicare SEPs?

by | Jul 14, 2021

If you need to enroll in Medicare or change your plan, you probably want to do it ASAP – but that’s not always possible. Medicare enrollments and plan elections are restricted to certain periods. Outside of these defined periods, you may not be able to make changes to your enrollment.

That’s the bad news. The good news is that you might qualify for a Special Enrollment Period, or SEP, that will allow you to enroll in a plan immediately.

When Are the Regular Medicare Enrollment Periods?

Before diving into the Special Enrollment Periods, it’s useful to understand the regular enrollment periods.

Medicare has several enrollment periods.

  • The Initial Enrollment Period occurs around an individual’s 65th birthday and lasts for seven months. This is when Medicare enrollees first become eligible for Medicare and make their initial plan selections.
  • The General Enrollment Period happens every year between January and March. This is when people who missed their Initial Enrollment Period can get another chance to enroll in a plan. Watch out, though – people who enroll during the General Enrollment Period may be hit with late enrollment penalties. Also, coverage won’t start until July, so there may be a coverage gap.
  • The Annual Election Period happens every year between October 15 and December 7. This is when beneficiaries who are currently enrolled in Medicare can review their coverage and decide if they want to change their plan selection for the coming year.

SEPs Based on SNP or Extra Help Eligibility

Medicare Special Needs Plans, or SNPs, are Medicare Advantage plans specially designed for specific groups. Enrollment in a Special Needs Plan is restricted to people who meet the criteria of that SNP.

There are three types of SNPs:

  • D-SNPs serve people who are eligible for both Medicare and Medicaid.
  • C-SNPs serve people with chronic conditions.
  • I-SNPs serve people who need nursing care or institutional care.

If you qualify for a Special Needs Plan, you may also qualify for a Special Enrollment Period to select a plan.

People who qualify for both Medicare and Medicaid are given three additional enrollment periods each year: between January and March, between April and June and between July and September. You can make one plan change per period. People who qualify for Medicare’s Extra Help can also take advantage of these additional enrollment periods.

SEPs Based on Other Personal Circumstances

Many personal circumstances can affect coverage. If your coverage needs have changed because of a change in your life, you may qualify for a Special Enrollment Period.

Here are a few common events that can trigger SEPs:

  • You move out of your plan’s coverage area.
  • You lose your employer-based coverage.
  • You no longer qualify for Medicaid.

You can also qualify for a Special Enrollment Period if your plan loses its contract with Medicare, or if you weren’t properly informed that you were losing private drug coverage, or other issues related to your plan. For more information on various situations, see Medicare’s page on special circumstances.

SEPs Based on Disasters and Emergencies

In some cases, people may miss enrollment opportunities because of a hurricane, wildfire, or other emergency. According to CMS, if FEMA declares an emergency or major disaster, individuals in the affected area will qualify for a Special Enrollment period if they missed another enrollment opportunity during that time. This period will last for four full calendar months, and individuals will be able to enroll in, disenroll from or switch plans during this time.

Do I Qualify for a Special Enrollment Period in Texas?

Texans may qualify for a Special Enrollment Period based on their eligibility for a Special Need Plan or Extra Help or based on other personal circumstances. Additionally, a FEMA-declared emergency in Texas will create a Special Enrollment Period for people who missed other enrollment opportunities as a result.

Special Enrollment Periods are usually limited. If you think you qualify for one, act quickly to avoid missing your chance. Contact PTT Financial to learn more.