Special Enrollment Period (SEP)

In certain circumstances, Medicare will allow you to change your Part D prescription drug plan outside of your Medicare Initial Enrollment Period (IEP) (when you first become Medicare-eligible), and the Annual Enrollment Period (AEP) that begins in October. Below are many (but not all) of those circumstances:

  • You recently returned to the United States after living permanently outside of the U.S.
  • You have both Medicare and Medicaid (or your state helps pay for your Medicare premiums) or you get Extra Help paying for your Medicare prescription drug coverage, but you haven’t had a change.
  • You recently had a change in your Extra Help paying for Medicare prescription drug coverage (newly got Extra Help Program, had a change in the level of Extra Help, or lost Extra Help).
  • You recently involuntarily lost your creditable prescription drug coverage (creditable means as good as standard Medicare prescription drug coverage).
  • You recently had a change in your Medicaid (newly got Medicaid, had a change in level of Medicaid assistance, or lost Medicaid).
  • You are leaving/losing/joining an employer or union.
  • You belong to a State Pharmacy Assistance Program (SPAP).
  • You recently moved outside the service area for your current plan, or recently moved and this plan is a new option for you.
  • Your plan is ending its contract with Medicare, or Medicare is ending its contract with your plan.
  • You recently left a PACE program (Program of All-Inclusive Care for the Elderly).
  • You live in, are moving into, or recently moved out of a nursing home or Long-term Care Facility.
  • You are enrolled in a Medicare Advantage plan and you want to make a change during the Medicare Advantage Open Enrollment Period (MA OEP).
  • You are enrolled in plan by Medicare (or your state), and you want to choose a different plan.
  • You are affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency (FEMA). One of the other statements here applied to you, but you were unable to make your enrollment because of the natural disaster.
  • You were recently released from incarceration.
  • You recently obtained lawful presence status in the United States.

Remember that even if you do qualify for a SEP, you still must meet the eligibility requirements of the Part D plan you wish to join for your enrollment to be valid. To learn more about circumstances that may qualify you for a Special Enrollment Period (SEP) and the rules that govern other important Medicare enrollment periods such as your Initial Enrollment Period (IEP) and the Annual Enrollment Period (AEP), call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048, 24 hours a day, 7 days a week.

Return to the Medicare FAQ section to view more answers to other commonly asked questions about Medicare prescription drug coverage. Contact us if you'd like more information about when to enroll in a Medicare prescription drug plan.