A Special Enrollment Period (SEP) refers to a period of time where it is possible to sign up for a Medicare plan outside of the initial enrollment period or yearly Open Enrollment Period. The initial enrollment period refers to the timeframe when you first become eligible for Medicare, and the yearly Open Enrollment Period (happens from about November through January each year.
The option to enroll in Medicare or change Medicare coverage outside of these windows—known as a Special Enrollment Period (SEP)—is not accessible to everyone but is based on whether you have experienced what is known as a qualifying life event.
What is a qualifying life event?
A qualifying life event is something that triggers a Special Enrollment Period (SEP) and allows you to shop for, buy, or change Medicare coverage outside of your initial enrollment period or yearly Open Enrollment period.
Common examples of qualifying life events include divorce, having a child, a change in Medicaid or CHIP coverage, re-marriage, moving out-of-state, becoming a citizen, death of someone who was providing you coverage, ending COBRA coverage, or an ending of employer-based health coverage. If your employer-based coverage has changed because of COVID-19, there are special laws governing how you can access a new Medicare plan at this time.
What are my options if my situation doesn’t qualify?
If you don’t have a qualifying life event but wish to change Medicare coverage or get onto a Medicare plan, your best option is to wait for the yearly Open Enrollment period that occurs between November and January each year.
While you wait for this window to open, you can get onto a short-term health plan such as COBRA or catastrophe insurance to fill in the gap in coverage until you can get back on Medicare at the start of the next new year.
If you have missed the window of your initial enrollment period after you turn 65 and become eligible for social security, however, it may be possible for insurance companies to deny you coverage. If you believe you fall into this category, consider meeting with an insurance agent to discuss your options. However, this scenario is very rare and most people who qualify for Medicare are able to get onto a plan during one of these enrollment periods.
How long is the Special Enrollment Period?
The Special Enrollment Period (SEP) varies by state, so checking what the window is where you live can give you an exact timeframe.
In general, the SEP occurs in a window of 30-60 days outside of your qualifying life event. For example, if you lose a job where you had employer-based health coverage but now you don’t, you will have 30-60 days after the loss of that job to find a Medicare plan.
In some cases, if there is a qualifying life event in your future that you know the date of—for example, if you know you will be remarried and your eligibility will change on a specific date—you can open the window in advance of your qualifying life event and change before it occurs instead of after.
If you miss the window of your qualifying life event, you will most likely be forced to wait for the yearly Open Enrollment period, so it is generally a good idea to begin looking as soon as your qualifying life event takes place.