Do I Qualify for Medicare Special Enrollment?

Qualifying for Medicare coverage outside the traditional Open Enrollment Period involves using a Special Enrollment Period. Certain life events, such as moving, losing your plan etc. may allow you to join, switch or drop a Medicare plan. If you’d like to learn more about whether or not you qualify for Medicare Special Enrollment here’s some information that can help. 

Special Enrollment Periods – Qualifying Events

Under certain “special” conditions, you may be able to sign up for Medicare coverage outside of regular enrollment periods. Special qualifying events allow people to enroll in coverage even after traditional Open Enrollment Period has ended. The following life events may qualify you for Special Enrollment Periods:

  • Loss of health care coverage
  • Changes in household size
  • Changes in residence
  • Becoming a U.S. citizen
  • Getting out of jail

Loss of health care coverage If you lose your health care coverage, either voluntarily or involuntarily, you may qualify for a Special Enrollment period. If you lose coverage provided through work or a family member, expect to in the next 60 days or have the opportunity to enroll in private coverage offered through an employer, you may qualify. Additionally, if you are no longer eligible for Medicaid, you may qualify for a Special Enrollment Period.

Changes in household size Certain events like marriage, having a baby, going through a divorce or death change household size, which may qualify you for Special Enrollment periods.

Changes in residence If you move to a new address that isn’t in your current plan’s service area or you have new options available to you in a new area, you may qualify for a Special Enrollment Period. In addition, if you are moving in or out of a skilled nursing facility or long-term care facility, you may qualify. 

In addition to the above, becoming a U.S. citizen or getting out of jail may serve as a qualifying event for special enrollment. Of course, if Medicare terminates your plan’s contract or your contract isn’t renewed, you may qualify for a Special Enrollment Period. 

5 Star Special Enrollment Period

Medicare rates individual plans for quality and performance using a star system from 1 to 5, with 5 considered “excellent”. Using customer satisfaction surveys and information from health care providers, updates are made annually giving customers reliable information about any plans they are considering.

You may switch to a 5-star Medicare Advantage plan, Medicare Cost plan or Medicare Prescription Drug plan during the 5-Star Special Enrollment Period if a 5-star plan is available in your area. However, you may only use this Special Enrollment Period once from December 8 – November 30.