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.
- You no longer qualify for Extra Help paying for your Medicare prescription drug coverage.
- You recently involuntarily lost your creditable prescription drug coverage (creditable means as good as standard Medicare prescription drug coverage).
- You get Extra Help to pay for Medicare prescription drug coverage but do not have Medicaid.
- In the last 12 months, you left a MediGap policy to enroll in a Medicare Advantage Plan with prescription drug coverage for the first time.
- In the last 12 months, you turned 65 and enrolled in a Medicare Advantage Plan with prescription drug coverage.
- You are leaving/losing/joining an employer or union.
- You belong to a State Pharmacy Assistance Program (SPAP).
- You are losing or have lost participation in 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.
- You are disenrolling from a Medicare cost plan that you had prescription drug coverage from.
- You are being disenrolled from a Medicare Special Needs Plan (SNP) because you no longer have special needs status.
- 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 disenrolling from your Medicare Advantage Plan between January 1 and February 14 to enroll in original Medicare.
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 (Phone Number1-800-633-4227). TTY users call Phone Number1-877-486-2048, 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.