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Signing up for Medicare and making changes to Medicare coverage typically happen during specific enrollment periods — such as when you're turning 65 (your initial enrollment period) or during Medicare’s fall open enrollment period.
But there may be circumstances when you qualify to join Medicare or change Medicare Advantage or prescription drug coverage outside of typical enrollment periods. In those cases, you might be eligible for a special enrollment period.
Here’s what you should know about special enrollment periods.
What is a special enrollment period?
A special enrollment period (SEP) is a period when you’re allowed to sign up for Medicare or make changes to your coverage outside of Medicare enrollment periods. A special enrollment period is triggered by certain life events, such as leaving a job or moving out of your plan’s service area.
The rules about how long a SEP lasts or what you’re allowed to do during the SEP depend on why you qualify for the SEP.
What qualifies you for a special enrollment period?
There are many reasons you might be able to use a SEP. Some include:
- You moved. This includes moving outside your plan’s service area, moving back to the U.S. after living abroad or moving into or out of a skilled nursing facility.
- You lost your current coverage. This includes losing Medicaid eligibility, leaving a job that provided health insurance or losing creditable prescription drug coverage.
- You have an opportunity to get other coverage. This includes having the option to sign up for a private insurance plan offered by your employer.
- Your plan changed. Maybe Medicare sanctioned your plan due to a problem or ended your plan’s contract.
- Your eligibility changed. You’re now eligible for both Medicare and Medicaid, you qualify for Extra Help with Medicare prescription drug coverage or you’re enrolled in a special needs plan and you no longer have the medical condition that led you to sign up for it.
For a complete list of circumstances that would land you a SEP, visit Medicare’s page on special enrollment periods.
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Medicare Advantage is an alternative to traditional Medicare offered by private health insurers. It covers the same benefits as Medicare Part A and Part B.
- States available48 states and Washington, D.C.
- Members in high-rated plansMedium (50% to 84%)
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- States available46 states and Washington, D.C.
- Members in high-rated plansLow (49% or less)
- Member satisfactionAbove average
(855) 432-0512 / TTY 711
M-F 9AM-9PM, Sat 10AM-6PM ET
Speak to a licensed insurance agent on askchapter.org
Get a quote
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How long is the special enrollment period?
The length of your SEP will depend on the reason you qualify. Here are a few of the many situations that will create a SEP and the length of the SEP that applies to them:
| Qualifying SEP event | Length of SEP |
|---|---|
| You move to a spot that isn’t in your plan’s service area. | Two months after the month you move. If you alert your plan before the move, your SEP starts the month before the month you move and continues for two months after. If you alert your plan after the move, your SEP starts the month you tell your plan, plus an additional two months. |
| You move back to the U.S. after time abroad. | Two months after the month you return to the U.S. |
| You move into a skilled nursing facility. | Two months after you leave plus the entire time you live there. |
| You lose Medicaid eligibility. | Three months from the date you’re no longer eligible or the date you’re notified, whichever occurs later. |
| You end employer health coverage. | Two months after the month your coverage ends if you’re joining a Medicare Advantage plan or Part D prescription drug plan. Eight months after you stop working or your coverage ends if you’re joining Medicare Part B. |
| Medicare ends your plan’s contract. | Two months before your contract ends plus one full month after it ends. |
| You’re eligible for both Medicare and Medicaid. | Once each month you can change your Medicare Part D plan or switch from a Medicare Advantage plan with drug coverage to Original Medicare with a stand-alone drug plan. |
For more information on qualifying events and timelines, visit Medicare.gov.
What is the 5-star special enrollment period?
Medicare gives overall performance star ratings to Medicare plans on a five-point scale, with five stars being the best. These ratings are based on information from the plans themselves, health care providers and member surveys. They are updated each year.
If you’re not currently in a five-star Medicare Advantage plan, Medicare drug plan (Part D) or Medicare cost plan, and there’s one available in your area, you can switch to a five-star plan during a special enrollment period. Each year the SEP goes from Dec. 8 to Nov. 30 the following year, and you may change only once during that time.
There are some caveats:
- If you switch from a Medicare Advantage plan with prescription drug coverage to a stand-alone Medicare Part D prescription drug plan, you’ll be disenrolled from the Medicare Advantage plan and enrolled in Original Medicare for health coverage.
- If you switch from a Medicare Advantage plan with prescription drug coverage to a Medicare Advantage plan without prescription drug coverage, you might lose your drug coverage. And you may have to wait until the next official enrollment window to sign up again. (This may result in late penalties.)
» MORE: Best Medicare Advantage plans
What if you get Extra Help?
If you’re eligible for both Medicare and Medicaid or you qualify for Extra Help paying for Medicare drug coverage, there is a special enrollment period that applies to your situation. This is the dual/low-income subsidy (LIS) SEP.
As of Jan. 1, 2025, people who qualify for the dual/LIS SEP can make the following changes once each month:
- Switch your Medicare prescription drug plan.
- Quit your Medicare Advantage plan with prescription drug coverage and sign up for Original Medicare with a prescription drug plan.
Changes take effect on the first day of the following month. You can’t use this SEP if you’re considered an “at-risk” or “potentially at-risk beneficiary.” This applies to members identified as being at risk of abusing or misusing prescription drugs. They receive a letter notifying them of the designation.
If you’re enrolled in a state pharmaceutical assistance program (SPAP) or you lose SPAP eligibility, you can join a Medicare drug plan or Medicare Advantage plan with drug coverage once during the calendar year.
