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  • Writer's pictureTom Cianflone

All About Special Enrollment Periods

medicare special enrollment periods sep

The period from April 1st to December 31st is known to Medicare insiders as the "lock-in period" for Medicare Advantage (MA, aka Part C) plans. That is because, in general, there are no open election/enrollment periods for MA plan members to change plans. For most, the plan they are in on April 1st is the plan they will remain in until December 31st. However, there are special enrollment periods (SEPs) that may be available to MA plan members. If an MA plan member is in need of a plan change, it's always best to speak with me directly about what may be available or possible.

Here are a few of the SEPs that may be available to you during the so-called lock-in period:

  • Moved out of service area. If you have changed your residential address to another county you can make pretty much any plan change you want. In fact, for Medicare Advantage plans and standalone Part D (drug) plans, you must change to a plan that is available in your new county of residence. This SEP also gives you the opportunity to switch from Medicare Advantage to Original Medicare and enroll in a Medicare Supplement (MediGap) policy with NO underwriting questions to pass (guaranteed issue).

  • FEMA Declared Disaster SEP. This is a very common SEP in Florida due to the tropical storm activity we see every year. An MA plan member can make any change that was available to them during the annual/open enrollment periods if there is a current FEMA declared disaster SEP and it is being honored by the plan carrier they want to switch to.

  • 5 star SEP. Star ratings is how CMS (Centers for Medicare and Medicaid Services) rates MA plans available in each county, with 5 stars being the highest plan rating. An MA plan member can switch to any plan that is rated 5 stars once during a calendar year. For an in-depth look at the 5 star SEP, see my blog post The Value of the 5 Star SEP.

If you or someone you know is contemplating a plan change, contact me for additional information to see whether an SEP might be available to you.


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