In most cases, Medicare enrollment is restricted to specific times of year and dates surrounding the beneficiary’s 65th birthday. However, your Medicare clients may enroll and make changes to their coverage outside of the standard enrollment periods if they qualify for a Special Election Period (SEP).
Coverage obtained during an SEP is effective the first day of the month following the date of the application. While the full list of SEPs is quite long and accounts for some rare circumstances, here are some more common SEPs you may expect to encounter as an agent.
Clients who are Dual-Eligible (qualify for both Medicare and Medicaid) or who maintain Low Income Status can change or drop an MA or PDP plan once per calendar quarter for the first 3 calendar quarters. If Dual-Eligible or Low-Income status changes, they can make one election during the 3 months after their change or after they are notified of the change, whichever is later.
Beneficiaries who relocate to an area with different coverage options are allowed to make one election. The date this SEP begins depends on when the beneficiary notifies the plan of the intended change. Notification before the move begins the SEP on that date, and it lasts until 2 full months after the move. Notification on or after the move date begins an SEP on that date that lasts for the following 2 full months.
From the start of a FEMA-declared emergency or major disaster incident period and for 4 full calendar months after, anyone that had a valid election period but did not use it can make 1 change.
From December 8th to November 30th, anyone living in the service area of a 5-star rated plan can make 1 election to enroll in that plan.
Clients who become residents of a care facility (nursing home, rehabilitation center, psychiatric care facility, etc.) may change their coverage once per month, and have two months after leaving the facility to enroll, disenroll, or switch plans.