Special Election Periods: What to know

Medicare Advantage and prescription drug plans are regulated by the government. Thus, the government provides a window of time for seniors on Medicare Advantage or Prescription Drug plans to change their plan. Medicare Beneficiaries are allowed to make one change per year the Annual Enrollment Period. The Annual Enrollment Period, also know as, AEP is during the Fall of each year, October 15 - December 7. Changes made during this enrollment period will not take effect until the following January. For example, if a senior of a Medicare Advantage plan changes their plan during the Annual Enrollment Period (October 15 - December 7), their new plan will not begin until January 1.

Some exceptions to the Annual Enrollment Period rule exist. These exceptions are formally known as Special Election Periods (SEPs). We’ll dive into the top 5 most used exceptions which qualify seniors for a Special Election Period.

1. Initial Enrollment Period

   The Initial Enrollment Period is first made available when an individual turns 65. This enrollment period lasts for a period of 7 months. These 7 months include the 3 months prior to an individual’s 65th birth month, the month of their 65th birthday, and the 3 months following their 65th birth month.

2. General Enrollment Period

   The purpose of the General Enrollment Period is to provide Medicare Beneficiaries with a season to enroll in Medicare Part B if you missed signing up when first eligible. The General Enrollment Period is from January 1 - March 31 of each year.

   If your Medicare Part B was suspended or terminated, you may re-enroll in Medicare Part B only during the General Enrollment Period.

3. Loss of Creditable Coverage

   What about seniors who work past 65 and who do not enroll in Medicare during their Initial Enrollment Period? If you’ve had creditable coverage and are losing coverage, you may enroll in Medicare during the Special Enrollment Period: Lost of Creditable Coverage.

   Scenario:

   Bob is 65 and recently eligible for Medicare A & B. He declines to enroll in Medicare Part B due to having creditable coverage through his employer for an affordable price. Five years later, Bob decides to retire. Bob missed his Initial Enrollment Period to enroll in Medicare, but due to Loss of Creditable Coverage, Bob will be able to enroll in Medicare Part B along with a Prescription Drug Plan or Medicare Advantage plan. Bob only has 8 months after losing creditable coverage to apply for Medicare Part B. Furthermore, he only has two months after losing creditable coverage to enroll in a Prescription Drug Plan.

4. Moved out of Service Area

   Prescription Drug and Medicare Advantage plans are based upon your specific zip code. If you move out of your county, you may lose your coverage and be required to enroll in a new Prescription Drug Plan or Medicare Advantage Plan in your new area.

   Note: the same plan may be offered in your new service area, but you still will be required to submit a new application.

   Pro Tip: Loss of coverage due to moving out of your service area opens a 60-day window to apply for a Medicare Supplement with no questions asked. This opportunity is known as a Guarantee Issue.

5. Open Enrollment Period

   The Open Enrollment Period is specifically designed to allow Medicare Beneficiaries who are already on a Medicare Advantage Plan one opportunity to change their plan during quarter one (January 1 - March 31) of each year. Although the Open Enrollment Period may sound similar to the General Enrollment Period, the two SEPs should not be confused as their purposes are separate.

   Pro Tip: The Open Enrollment Period is only for individuals who are on a Medicare Advantage plan at the beginning of the year. This SEP does not apply to individuals on Prescription Drug Plans. Individuals on Prescription Drug Plans may only change their plan once a year during the Annual Enrollment Period.

If your specific scenario does not fall into the top 5 categories, feel free to read more about Special Enrollment Periods at Medicare.gov or reach out to our office for a complimentary consultation.

We’d love to answer your questions at no cost to you!