Special Enrollment Period california wildfires

Special Enrollment Period

Special Enrollment Period COVID-19

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 

Estimated reading time: 4 minutes

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.

Special Enrollment Period senior man in hospital COVID-19 test
COVID-19 testing with an oral swap.

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:

If you are outside of any of the above open enrollment periods, you may qualify for a Special Enrollment Period. Otherwise, you must wait for the next open enrollment period.

Open Enrollment Periods - senior ladies birthday cake
Celebrate Medicare Open Enrollment on your 65th birthday.

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
Special Enrollment Period (SEP) california wildfires

Change of Address

Senior man and woman moving boxes

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 Creditable 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 creditible 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.

Senior African American Speaking on Phone

2021 Special Election Period

For people not yet eligible for Medicare, you can get affordable healthcare through the 2021 Special Enrollment Period. Discover how to lower your monthly premium and save money

Thank you for reading this article. We publish new articles every week. Share your email and choose the Medicare topics you what to read, and we will send you new articles.

Medicare Reader Survey african american man

Last Updated on September 1, 2021 by Brian Kondas