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Do you qualify for a Special Enrollment Period?

Eligibility

You are Medicare-eligible if you are a legal U.S. resident and one of the following applies to you:

  • You are age 65 or older
  • You are any age and have a qualifying permanent disability


Special Enrollment Period (SEP)

This is a period when Medicare recipients may change medical and prescription drug coverage outside of AEP — if they meet certain requirements and have a qualifying event, such as moving to a new service area or leaving an employer-based plan.

SEPs could include:

  • 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.
  • I have a chance to enroll in other coverage offered by my employer or union.
  • I have or am enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage).
  • I enrolled in a Program of All-inclusive Care for the Elderly (PACE) plan.
  • 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 creditable.
  • 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.
  • Medicare takes an official action (called a "sanction") because of a problem with the plan that affects me.
  • Medicare ends (terminates) my plan's contract.
  • My Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan's contract with Medicare isn't renewed.
  • 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).

What enrollment period do you qualify for?

IEP

Initial Enrollment Period

AEP

Annual Enrollment Period

OEP

Open Enrollment Period

SEP

Special Enrollment Period


Questions about your qualifications? 

Contact our Sales Support team at 1-877-234-0126 (TTY: 711). For more information about Medicare eligibility and enrollment policies and limitations, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

View our Medicare disclaimers.

H8019_wellfirsthealth.com
Updated 1/20/21