What Is a Medicare Special Enrollment Period (SEP)?
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A special enrollment period (SEP) is a time when you can sign up for, leave or switch Medicare Advantage, Supplement or Part D plans outside of open enrollment in the fall.
Special enrollment periods typically occur when you undergo a major life change like moving, becoming a U.S. citizen or losing Medicaid eligibility. It's important to sign up for Medicare quickly because special enrollment periods tend to be short. Many last for just two or three months.
What is a Medicare special enrollment period (SEP)?
A Medicare special enrollment period, or SEP, is a window of time in which you can sign up for or switch Medicare Supplement, Advantage and Part D plans outside of the normal open enrollment period. Open enrollment runs from Oct. 15 to Dec. 7 each year. There are two ways you can get a Medicare special enrollment period.
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Qualifying life events such as moving or losing your Medicaid eligibility
- Late retirement
When a qualifying event occurs, you typically have two to three months to sign up or switch plans. If you continue working past 65 or if you're covered by a working spouse's health insurance, then an eight-month special enrollment period starts after that coverage ends.
The eight-month window that opens up when you continue to work past 65 only exists for Medicare Part A and Part B. If you want to sign up for a Part C plan or a Part D plan, you must do so within two months of the end of your employer-provided care.
You have to pay a late enrollment penalty if you wait until after your eight-month special enrollment period to sign up for Medicare. This penalty will be part of your monthly bill as long as you're enrolled in Medicare. This likely means you'll pay more for the rest of your life.
Missing a special enrollment period could restrict your coverage options until the next open enrollment period.
Medicare special enrollment qualifying events
Special enrollment periods are typically triggered by events that interfere with your existing health coverage. For example, moving to a new area triggers a special enrollment period because companies usually only offer their plans in certain locations.
Qualifying SEP events and lengths
- Moving outside your current plan's coverage area: One month before the move and two months after
- Returning to the U.S. after living abroad: Two months from your return date
- Losing Medicaid eligibility: Three months after your eligibility expires or after you receive an expiration notice (whichever is longer)
- Joining or leaving the Program of All-Inclusive Care for the Elderly (PACE): One month before and two months after
- Moving to a skilled nursing facility: While you live there and two months after you leave
- Becoming a U.S. citizen: Two months after receiving citizenship
- Leaving jail or prison: Two full calendar months from the end of incarceration
- Medicare canceling your plan: One month before and two months after
Understanding which events qualify you for a special enrollment period can help you avoid coverage gaps. In some cases, you can use an SEP to upgrade your coverage or plan quality.
Virtually any event that can disrupt or end your existing Medicare coverage will result in a special enrollment period. If you're unsure whether your particular circumstances qualify you for an SEP, check Medicare.gov or call the Social Security Administration at 800-772-1213 to see if you qualify for an exceptional condition special enrollment period.
You can switch coverage up to three times a year if you have dual Medicare and Medicaid eligibility.
Nonqualifying events
You must sign up for Medicare during your initial enrollment period even if you're still covered by COBRA or individual insurance. Failure to do so will result in a late-enrollment penalty, which will be part of your Medicare bill for the rest of your life.
Switching to a higher-rated plan
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage and Medicare Part D plans on a one-to-five-star rating scale with five being the best. Star ratings are awarded based on customer service, health care access and preventive care treatment rates.
You can switch to a five-star plan from your existing policy once each year at any time except for Dec. 1 through 7.
You can get five-star plans in 36 states and Washington, D.C. Roughly 75% of all Medicare Advantage plan holders do not have access to a five-star plan.
Frequently asked questions
What is a Medicare special enrollment period (SEP)?
A Medicare special enrollment period (SEP) lets you sign up for Medicare or switch Medicare plans outside of the normal initial and open enrollment periods. A special enrollment period is triggered by a qualifying event, such as a move, losing your primary health insurance or returning to the U.S. after living overseas.
What is the eight-month special enrollment period?
If you continue to work past the age of 65, you can delay Medicare enrollment without penalty until eight months after you retire. This eight-month period only covers Original Medicare (Parts A and B).
How does an SEP work in Medicare?
Normally, you must wait until open enrollment to switch Medicare Advantage, Medicare Supplement and Medicare Part D plans. However, if you qualify for a special enrollment period (SEP), you can change coverage outside of open enrollment.
Sources and methodology
Information on special enrollment periods was compiled from Centers for Medicare & Medicaid Services (CMS) documents.
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