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Medicare Special Enrollment Periods

Sonia Ashford

Sonia Ashford

Sonia Ashford is the owner of Ashford Insurance, an independent health insurance agency specializing in Texas Medicare insurance.

You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs). Rules about when you can make changes and the type of changes you can make are different for each SEP.

Medicare Special Enrollment Periods

There are cases where you may enroll in Medicare outside of regular enrollment periods due to extenuating circumstances. This is known as the Medicare Special Enrollment Period (SEP). If you qualify for the Medicare Special Enrollment Period, you can enroll in Medicare outside of your Initial Enrollment Period (IEP) and the General Enrollment Period (GEP).

There are also Special Election Periods (also known as Special Enrollment Periods) for Medicare Advantage and Medicare prescription drug plans.

Common Medicare Special Enrollment Period Reasons

You change where you live
You moved to a new address that isn’t in my plan’s service area.
You moved to a new address that’s still in my plan’s service area, but I have new plan options in my new location.
You moved back to the U.S. after living outside the country.
You just moved into, currently live in, or just moved out of an institution (like a skilled nursing facility or long-term care hospital).
You were released from jail.

You lose your current coverage
You are no longer eligible for Medicaid.
You left coverage from my employer or union (including COBRA coverage).
You involuntarily lose other drug coverage that’s as good as Medicare drug coverage (creditable coverage), or my other coverage changes and is no longer creditable.
You had drug coverage through a Medicare Cost Plan and have left the plan.
You dropped your coverage in a Program of All-inclusive Care for the Elderly (PACE) plan.

You have a chance to get other coverage
You have a chance to enroll in other coverage offered by your employer or union.
You have or am enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage).
You enrolled in a Program of All-inclusive Care for the Elderly (PACE) plan.

Your plan changes its contract with Medicare
Medicare takes an official action (called a “sanction”) because of a problem with the plan that affects you.
Medicare ends (terminates) your plan’s contract.
Your Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan’s contract with Medicare isn’t renewed.

Other special situations
You are eligible for both Medicare and Medicaid.
You qualify for Extra Help paying for Medicare prescription drug coverage.
You are enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility.
You dropped a Medigap policy the first time you joined a Medicare Advantage Plan.
You have a severe or disabling condition, and there’s a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with your condition.
You are enrolled in a Special Needs Plan (SNP) and no longer have a condition that qualifies as a special need that the plan serves.
You joined a plan or chose not to join a plan, due to an error by a federal employee.
You weren’t properly told that my other private drug coverage wasn’t as good as Medicare drug coverage (creditable coverage).
You weren’t properly told that I was losing private drug coverage that was as good as Medicare drug coverage (creditable coverage).
You were a victim of a national disaster, and a SEP was declared.

 

Call Ashford Insurance for assistance navigating any of these SEPs.

 

Photo by Alex Green

 

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Sonia Ashford

Sonia Ashford

Sonia Ashford, “The Medicare Insurance Lady”, has been helping Medicare eligibles in Texas with their Medicare Insurance since 2005.