Special Enrollment Periods
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Special Enrollment Period Cheatsheet
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Special Enrollment Periods Cheat Sheet
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Examples of eligibility for an Special Enrollment Period
You change where you live
- I moved to a new address that isn’t in my plan’s service area.
- I moved to a new address that’s still in my plan’s service area, but I have new plan options in my new location.
- I moved back to the U.S after living outside the country.
- I just moved into, currently live in, or just moved out of an institution (like a skilled nursing facility or long-term care hospital).
- I’m released from jail.
You lose your current coverage
- I’m no longer eligible for Medicaid.
- I left coverage from my employer or union (including COBRA coverage).
- I involuntarily lose other drug coverage that’s as good as Medicare drug coverage (creditable coverage), or my other coverage changes and is no longer credible.
- I had drug coverage through a Medicare Cost Plan and I left the plan.
- I dropped my coverage in a Program of All-inclusive Care for the Elderly (PACE) plan.
You have a chance to get other coverage
Your plan changes its contract with Medicare
Other special situations
- I’m eligible for both Medicare and Medicaid.
- I qualify for Extra Help paying for Medicare prescription drug coverage.
- I’m enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility.
- I dropped a Medigap policy the first time I joined a Medicare Advantage Plan.
- I have a severe or disabling condition, and there’s a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with my condition.
- I’m enrolled in a Special Needs Plan (SNP) and no longer have a condition that qualifies as a special need that the plan serves.
- I joined a plan, or chose not to join a plan, due to an error by a federal employee.
- I wasn’t properly told that my other private drug coverage wasn’t as good as Medicare drug coverage (creditable coverage).
- I wasn’t properly told that I was losing private drug coverage that was as good as Medicare drug coverage (creditable coverage).
Source: Special Enrollment Periods
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