Medicare Special Election Period (SEP)
A Special Election Period (SEP) lets you make changes to your Medicare Advantage plan or Medicare prescription drug plan coverage outside of the regular enrollment periods.
The changes you can make during the Special Election Period depend on the situation and can include:
- Switching from Original Medicare to a Medicare Advantage plan.
- Switching Medicare Advantage plans.
- Switching Medicare prescription drug plans.
- Disenrolling from a Medicare Advantage plan and returning to Original Medicare.
Note that the enrollment options available to you in an SEP depend on your situation.
A Special Election Period may apply in, but isn’t limited to, the following situations:
- You move out of your plan’s service area.
- You move to a new location that’s still in your plan’s service area, but now have other Medicare Advantage and Medicare prescription drug plans available.
- You moved back to the United States after living out of the country.
- You were just released from jail.
- You’re no longer eligible for Medicaid.
- You’re eligible for both Medicare and Medicaid benefits (known as “dual eligible”).
- You’re living in a facility such as a long-term care hospital or skilled nursing facility–or you are moving to or from such a facility.
- You left a Program of All-Inclusive Care for the Elderly (PACE) plan.
- You’re in a State Pharmaceutical Assistance Program (SPAP) or lose eligibility to be in the program.
- You’re covered by an employer or union group plan, and that coverage is ending.
- You had other, creditable prescription drug coverage, and that coverage is ending or is no long creditable.
- You left your Medicare Cost plan, which provided prescription drug benefits.
- You’re eligible for the Extra Help (Low-Income Subsidy) program.
- You have a chronic condition and there’s an available Chronic Care Special Needs Plan, or you no longer have the condition required to stay in your Special Needs Plan.
- You’re in a Special Needs Plan, but no longer meet the eligibility requirements for membership.
- Medicare terminates your plan’s contract or doesn’t renew it.
- You’re switching to a Medicare Advantage, Medicare Cost, or Medicare prescription drug plan that has a 5-star rating. You can switch once from December 8 to November 30.
- Your Medicare Advantage plan violated its contract or misrepresented information to you.
- There was an administrative delay, and you weren’t able to enroll in a Medicare Advantage plan when you were first eligible.
The dates and length of your Special Election Period depend on your situation. If you don’t qualify for a Special Election Period, you’ll have to wait until the next Annual Election Period make changes to your Medicare Advantage plan or prescription drug plan coverage. You can also disenroll from a Medicare Advantage plan during the Medicare Advantage Disenrollment Period.
You may not need a Special Election Period if you meet certain requirements. Special Needs Plans, a type of Medicare Advantage plan, have different rules. You may be able to join a Special Needs Plan or switch plans at any time if you live in an institution such as a nursing home or if you have a certain chronic illness or if you qualify for both Medicaid and Medicare.