Reclaim your health with us! This article helps you understand special enrollment periods for Medicare and covers:
- What a special enrollment period for Medicare is
- The most common situations that trigger a special enrollment period
- How long a special enrollment period lasts
- How to enroll in Medicare during a special enrollment period
Just like employer-sponsored or marketplace insurance, Medicare has an open enrollment period, too. Typically, you’re only allowed to enroll in or change your Medicare plan between October 15th and December 7th in any given year.
However, there are special enrollment periods during which the usual rules of Medicare enrollment don’t apply. If you find yourself in a situation that triggers one of these special periods, you don’t have to wait until October to enroll or switch to a new plan if your current plan isn’t working for you.
There are many situations that trigger a special enrollment period, but most of them aren’t very common. (Click here for the full list at medicare.gov). Here’s a list of some of the more common scenarios that allow you some flexibility around enrolling in Medicare or switching your plan:
Your 65th birthday is probably the most common special enrollment period for Medicare, and it lasts for 3 months before and 3 months after your birthday month. You’ll have this period to learn about the different Medicare plans available to you, decide which Medicare plans are right for you, and enroll. Expect to receive paperwork in the mail automatically with more information in the months leading up to your birthday.
The Medicare plan options available to you are highly dependent on where you live. If you move states, it’s likely that the Medicare plans you’re eligible for will change, and in that case, you’ll enter a special enrollment period where you can choose a new plan or combination of plans to suit your health needs and your medical budget.
Entering or leaving a facility
If you’ve just moved into or out of an institution, such as a skilled nursing facility or long-term care hospital, this will trigger a special enrollment period. You’ll have plenty of time to take advantage of it, too; you can join, switch, or drop coverage for as long as you live in the institution and for 2 full months after the month you leave.
The same rules apply if you’re released from prison.
New coverage available
Let’s say you or your spouse decides to go back to work after age 65 and one of you becomes eligible for employer-sponsored health coverage. In that case, or in any other case where non-Medicare coverage becomes available to you, you’ll enter a special enrollment period and be able to change your insurance.
Perhaps you have a chronic condition that you’re managing and a new plan becomes available in your area that caters to your health situation better than your current plan. This will trigger a special enrollment period as well.
Your Medicare plan is no longer available
Sometimes, your Medicare plan will discontinue, in which case, you’ll enter a special enrollment period and be able to enroll in a different one.
Don’t worry: if this happens, Medicare will let you know well in advance and guide you through all of your options. If, for some reason, you miss this communication, they will automatically enroll you in the plan that is most comparable to the one being discontinued.
Your financial situation changes
This can happen, even and especially in retirement. If you find yourself unexpectedly qualifying for Medicaid, you’ll be able to take advantage of a special enrollment period. The same goes for if you qualify for extra help paying for Medicare prescription drug coverage. It is important to note that you can only take advantage of special enrollment one time during each of these periods: January-March; April-June; July-September. Whatever change you make will take effect the first day of the following month.
If you suspect you qualify for a special enrollment period, you can always contact our Reclaim Medicare advisors or visit medicare.gov to learn more about your options. Whether or not you qualify and how long the special enrollment period lasts will depend on your individual situation!