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Medicare End-of-Year To-Do List


Understanding the Medicare Special Enrollment Period

There are several Medicare enrollment periods throughout the year.

By Clover Health

These include the Annual Enrollment Period, the Open Enrollment PeriodInitial Enrollment Period, and Special Enrollment Periods. Here’s all the information you need to understand the Medicare Special Enrollment Period.

What Is a Special Enrollment Period?

Special Enrollment Periods are times when you can join, switch, or drop your Medicare drug coverage if you meet certain requirements. Generally you must stay enrolled in your Medicare drug plan for the entire year, but you may be able to change your coverage mid-year if you qualify for a Special Enrollment Period when certain events happen in your life.

Qualifying for a Special Enrollment Period

When life takes an unexpected turn, you may be eligible for a Special Enrollment Period and make changes to your Medicare coverage. During this period, you can enroll in Medicare coverage for the first time or make changes to your current coverage. You’ll also be able to join, switch, or drop a Medicare Advantage plan.

You may qualify for a Special Enrollment Period if certain events in your life disrupt your current Medicare coverage. You can qualify for a Medicare SEP if you:

  • Miss the Initial Enrollment Period.
  • Retire or other special circumstances and no longer have employer sponsored health benefits.
  • Permanently move to a new home that’s outside the coverage area of your current plan.
  • Move into or out of a nursing home.
  • Are eligible for both Medicare and Medicaid health insurance.
  • Enroll in or disenroll from a Program of All-Inclusive Care for the Elderly (PACE) plan.
  • Lose drug coverage due to changes in your health insurance plan’s coverage.
  • Experience a FEMA-declared weather-related emergency or major disaster.

These are just some of the circumstances that qualify you for an SEP. If you experience one or more of these life events you may qualify for a Special Enrollment Period.

Who Is Eligible for a Medicare Special Enrollment Period?

If you are currently enrolled in a Medicare plan or if you recently became eligible for Medicare, you may qualify for a Medicare SEP. Also, any of the life events listed above may make you eligible for a Special Enrollment Period. A Medicare SEP gives you flexibility with your health coverage so you can choose the right coverage for your current circumstances.

How to Apply for Medicare During a Special Enrollment Period

To apply for Medicare during a Special Enrollment Period, start by reviewing the complete list of eligible circumstances to see if you qualify for an SEP. You can also find out if you’re eligible for a Medicare SEP by contacting Medicare directly at 1-800-MEDICARE (1-800-6334227) or TTY 1-877-486-2048 and asking about your unique circumstances. You may also contact the health plan you are interested in joining for more information.

To enroll in Original Medicare, fill out a CMS 40B form to request Original Medicare Part B coverage. Return the form to your local Social Security office, and they’ll enroll you in Original Medicare.

To enroll in a Medicare Advantage plan, contact us at Clover Health. Learn more about our plans and coverage options to find a plan that matches your healthcare needs. We’ll take care of the rest and make sure you get the care that you deserve.

Learn about our coverage areas here:

Get the Most Out of Your Medicare Special Enrollment Period

At Clover Health, we make your health coverage options easy to understand. Whether you’re enrolling during your Initial Enrollment Period or during a Special Enrollment Period, we’ll help find the right health insurance plan for you.

If you qualify for a Special Enrollment Period, consider the coverage you’d like to add and make a list of all your current healthcare expenses. All our plans include Original Medicare coverage and drug coverage. Our plans also include dental, vision, hearing, in-home care visits, mail-order pharmacy services, and more.

Call us at 1-888-778-1478 (TTY 711) 8 am to 8 pm local time, 7 days a week* to find out more about the Special Enrollment Period and how our plans can help you.


Published on 1/4/21