Special Enrollment Period

More often than not, circumstances change or certain events occur that can alter plans. Medicare Advantage and Medicare Prescription Drug Coverage are subject to change due to the course of certain events like relocating from one state to another or if you lose coverage. However, these events can open up what is known as a Special Enrollment Period (SEP), which allows you to make any necessary changes to your coverage or enroll in a new plan without facing penalties.
There are several ways in which you can qualify for a Special Enrollment Period, which includes:


You can qualify for a Special Enrollment Period if:
  • You just moved into, currently live in, or just moved out of an institution (like a skilled nursing facility). If this is the case for you, your SEP will last for as long as you live in the institution, including two months after you leave the institution.
  • You moved to a new address that isn’t in your plan’s service area. If you’re in a Medicare Advantage Plan and you move outside your plan’s service area, you can also choose to return to Original Medicare. With efficient planning, the chance to switch Medicare Advantage or Part D plans starts a month before you actually move and will continue for 2 full months after.
  • You moved back to the U.S after living abroad, and your SEP will last for a total of two months, starting after the month you move back into the U.S.
  • You moved to a new address that’s still in your plan’s service area, but you have new plan options to choose from.

Loss of Current Coverage

Losing your current coverage isn’t always ideal, but you can qualify for a Special Enrollment Period if this happens to you:
  • You had drug coverage through a Medicare Cost Plan and you left the plan.
  • You left coverage from your employer or union. This includes COBRA coverage.
  • You’re no longer eligible for Medicaid.
    You dropped your coverage in a Program of All-inclusive Care for the Elderly plan, also known as PACE.

Chances at Other Coverage Plans

You can also qualify for an SEP if:
  • You have or are enrolling in other drug coverage as good as Medicare prescription drug coverage, such as VA coverage or TRICARE.
  • You enrolled in a PACE plan.
  • You have a chance to enroll in other coverage offered by your employer or union.

Coverage Plans Altering Their Contract with Medicare

  • In the case of Medicare taking an official action (called a “sanction”) because of a problem with the plan that affects you, the next step is to switch from your Medicare Advantage Plan to another plan. The chance to switch is determined by Medicare on a case by case basis.
  • Medicare terminates your plan’s contract.
  • Your plan’s contract with Medicare isn’t renewed.
To find out more about Special Enrollment Periods, call us at 808-735-0106. We are here to help all of Hawaii find the coverage they not only need, but deserve!