Special Enrollment Period COVID-19
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To qualify for a Special Enrollment Period (SEP) outside of Open Enrollment Periods, you need special circumstances. For example, you could change your Medicare Advantage or Part D plan if COVID-19 impacted you. Special COVID-19 circumstances include: (Healthcare.gov)
- You or a family member was sick with COVID-19
- The national emergency affected your job and employer-based coverage
Furthermore, you may need to submit documentation to confirm your loss of coverage. These documents must show you lost coverage within the last 60 days or later (not before January 1, 2020).
In addition to COVID-19, the Special Enrollment Period includes other national emergencies, such as hurricanes or wildfires.
To qualify for this special circumstance, you must live (or have lived during the event) in a county of a natural disaster. Moreover, this county must be eligible for assistance by FEMA.
Open Enrollment Periods
Medicare open enrollment periods include the following:
- Annual Election Period – Oct 15 to Dec 7
- Medicare Advantage Open Enrollment – January 1 to March 31
- Your initial Medicare Open Enrollment – 3 months before your 65th birthday, the month of your birthday, and 3 months after your birthday
If you are outside on any of the above open enrollment periods, you will need to qualify for SEP based on special circumstances.
Qualifying Events for Special Enrollment Period (SEP)
You can qualify for SEP if the following applies to you:
- Qualifying Life Event such as marriage, baby, or losing health coverage
- Exceptional circumstance such as unexpected hospitalization, temporary cognitive disability, or you were otherwise incapacitated
- Natural disasters, such as earthquake, flood, hurricane, or wildfire
- You experienced domestic abuse/violence or spousal abandonment
- Qualifying for Extra Help paying for Medicare Part D
Change of Address
Furthermore, you also qualify for SEP when you change where you live. For example, you move to a new address that is not in your plan’s service area. Other reasons for address changes include:
- Moving back to the U.S. after living outside the country
- You moved in or out of an institution such as a skilled nursing facility
- Getting released from jail
Losing Your Credible Coverage
You may qualify for SEP when you lose your current coverage. For example, you left or lost your employer’s group health coverage. When you lose credible insurance coverage, you may qualify for SEP. In this case, you will have 60 days after you lost coverage to join a Medicare Plan.
Lastly, you can qualify for SEP “if you believe you made the wrong plan choice because of inaccurate or misleading information.” (Medicare.gov) If you made the wrong plan choice because of inaccurate information, call 1-800-MEDICARE, and explain your situation.