Medicare Special Enrollment Periods (SEP)

Many Medicare beneficiaries will sign up for coverage when they first become eligible for Medicare benefits, during their Initial Enrollment Period.

A Special Enrollment Period (SEP) is an enrollment period that takes place outside of the annual Medicare enrollment periods. They are granted to people who were prevented from enrolling in Medicare during the regular enrollment period for a number of specific reasons.

Special Enrollment Periods exist for Original Medicare (Part A and Part B), as well as for Medicare Advantage (Medicare Part C) and prescription drug plans (Medicare Part D).

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Special Enrollment Periods for Original Medicare

There are a few scenarios that may qualify someone for a Special Enrollment for Original Medicare.

Some of these qualifications include:

#1. Employer coverage

If you did not enroll in Medicare when you turned 65 because you were still employed and were covered by your employer’s health insurance plan, you will be granted a Special Enrollment Period. This allows you to enroll in Medicare once you leave your employer coverage, even if you work past the age of 65, the qualifying age for Medicare.

Beginning the month that follows the end of your employer coverage (whether you retired or your coverage was terminated), you will be given a Special Enrollment Period of eight months to sign up for Part A and/or Part B.

One thing to note: Medicare does not consider COBRA coverage or retiree health plans to be active employer coverage. If you did not enroll in Medicare when you turned 65 because you were covered by COBRA insurance or a retiree health insurance plan, you will not be granted a Special Enrollment Period. You may be subject to late enrollment penalties if and when you do sign up for Medicare.

#2. Foreign volunteer work

If you failed to enroll in Medicare when you first became eligible because you were participating in volunteer work in another country, you may also be granted a Special Enrollment Period. In order to qualify, you must have:

  • Volunteered for at least 12 months outside the U.S.
  • Volunteered for a tax-exempt program
  • Had another type of health insurance for the entire duration that you were volunteering

#3. Disabled TRICARE beneficiaries

TRICARE beneficiaries who are under 65 and qualify for Medicare because of a disability, ALS (Lou Gehrig’s Disease) or End-Stage Renal Disease (ESRD) may be eligible for a Special Enrollment Period if they didn’t sign up for Medicare Part B when they first became eligible.

When does a Special Enrollment Period start?

The beginning and end dates of your Special Enrollment Period will differ from one qualifying scenario to the next.

You may want to explore some additional qualifying Medicare Special Enrollment Period scenarios.

If you have a particular situation that prevented you from enrolling in any type of Medicare coverage for which you were eligible, you are encouraged to call 1-800-MEDICARE and request a Special Enrollment Period.

Learn what to expect when you call 1-800-MEDICARE.

How do I enroll in Medicare?

You can sign up for Original Medicare one of four ways:

Special Enrollment Periods for Medicare Advantage and Medicare Prescription Drug Plans

Many Medicare beneficiaries enroll in a Medicare Advantage plan or a Medicare Part D prescription drug plan during the Medicare Fall Open Enrollment Period.

If you don’t enroll in a Medicare plan during this annual period, you may qualify for a Special Enrollment Period.

There are many ways to qualify for a Medicare Advantage Special Enrollment Period or a Medicare Part D Special Enrollment Period.

Some of the situations that may qualify you for one of these types of Special Enrollment Periods include:

  • You lose drug coverage (through no fault of your own) that was equal to or better than that offered by Medicare, or your drug coverage is reduced to a level that is below that of Medicare’s
  • Your employer or union offers a Part C or Part D plan as part of its benefits, and you wish to either join or drop this non-Medicare coverage
  • You reside in or move in or out of an institutional facility such as a skilled nursing home or other long-term care facility
  • You’re eligible to enroll in a State Pharmaceutical Assistance Program (SPAP), or you lose SPAP eligibility
  • You have Medicaid
  • You’re enrolled in a Medicare Savings Program or Medicare Extra Help
  • You wish to disenroll from your first Medicare Advantage plan within 12 months of signing up for it
  • You enroll in or disenroll from the Program of All-Inclusive Care for the Elderly (PACE)
  • You move to a new residence
  • You were released from prison
  • You are eligible to join a Special Needs Plan, or you lose your Special Needs Plan eligibility
  • The plan in which you enrolled was in violation of marketing, benefits or enrollment rules
  • Your plan does not renew its contract with Medicare
  • You disenroll from a plan during the Medicare Advantage Disenrollment Period
  • You have a disability and are turning 65 and are therefore eligible for new plan options
  • You wish to enroll in a five-star Medicare plan
  • You have been enrolled in a low-performing plan
  • Your plan stops contracting with a number of providers, and Medicare determines that the number of terminations is substantial

The above list does not necessarily include every and all qualifications for a Special Enrollment Period.

How do I enroll in a Medicare Advantage plan during my Special Enrollment Period?

If you are unsure about whether you qualify for a Medicare Special Enrollment Period, or if you qualify and want to compare plans in your area, you can speak with a licensed insurance agent for help.

A licensed insurance agent can answer any questions you have and help you compare benefits, costs, coverage and other details of Medicare Advantage plans that may be available in your area.

Call TTY Users: 711 24 hours a day, 7 days a week to get started.

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.