Medicare Special Enrollment Periods

  1. Move outside service area.
  2. Lose employer coverage or creditable coverage. Ends 2 months after the month coverage ends.
  3. Move back to US.
  4. Leave Jail.
  5. Eligible for Medicare and Medicaid.
    1. Part A and Part B can enroll in or disenroll from an MA and/or Part D plan once, for change in Medicaid or LIS.
    2. Those entitled only to Part B can only do so for PDPs.
    3. SEP begins the later of the change or notification of the change and continues for 3 months.
    4. Full Benefit Dual Eligible have SEP to make a one-time per month election into a fully integrated dual eligible special needs plan,
    5. A highly integrated duel eligible special needs plan, or an applicable integrated plan. This SEP is only available to facilitate aligned enrollment.
  6. Eligible for special needs plan for health condition., Severe or disabling chronic conditions and with to enroll in a SNP designed to serve their Specific condition have an SEP during which they can enroll in a chronic condition SNP (C-SNP). The SEP last as long as the qualifying condition and ends once the enrollment in a C-SNP.
  7. Eligible for Extra Help or low income subsidy.
  8. Five Star plan available in area. Those who live in the service area of a 5 star plan have a SEP during which they can disenroll from an
    1. MA plan, PDP, or Cost plan or leave Original Medicare to enroll in a 5 Star MA plan, PDP, or a Cost plan.
    2. The SEP is available each year beginning on December 8 and may be used once through November 30 of the following year.
  9. Natural Disaster www.fema.gov/disaster
  10. Nursing Home resident or Dual Eligible have continuous special enrollment period, may change once per month.
  11. Any Medicare Beneficiary who dropped a Medigap Policy when they enrolled for the first time in an MA plan
    1. Has a SEP during the first 12 months of their enrollment in the MA plan during which they can elect to disenroll from their first MA plan to Original Medicare. They also have a guaranteed Eligibility period to rejoin a Medigap plan.
  12. Low Performing Plan SEP, plan that has been identified with the low performing icon have a SEP that exits as long as the beneficiary is enrolled in the Performing MA plan.
  13. Loss of Special Needs SEP. Begins month special needs changes/ends when they make an enrollment request or three calendar months after the effective date of involuntary disenrollment from the SNP, whichever is earlier.
  14. Medicare Part A and or B and receive any type of assistance from Medicaid and those who qualify for a low income subsidy but who do not receive Medicaid Benefits have a SEP that allows them to make a one-time per month election into a standalone PDP.
  15. Significant Changes in Provider Network SEP: CMS will establish and SEP, on a case by case basis, when it determines that changes to an MA plan's provider network
    1. Are significant based on the affect, or potential to effect on current plan enrollee's. SEP begins the month enrollees are notified and continues for a 2 months.
  16. MA OEPI Individual /Part D SEP for Institutionalized Individuals:
    1. Move into, reside in, or move out on an institution. (Skilled Nursing, Nursing Facility, intermediate care facility for intellectual disabilities, psychiatric hospital/unit or long term care hospital.)
    2. NOT available for institutional-equivalent, who meet the institutional level of care but do not reside in one of the above facilities, i.e. Assisted Living Facility.
    3. The OEPI is a continuous open enrollment period as long as an individual is in an institution.
    4. Ends 2 months after the month a person moves out of the institution.
    5. May make unlimited number of MA enrollment requests and may disenroll form an MA plan.
    6. Enroll or disenroll from a Part D plan.
    7. Return to Original Medicare.