Who can qualify for a Special Election Period (SEP)?

For a variety of reasons, you may be able to sign up for or change Medicare coverage at any time of the year. This is known as a Special Election Period (SEP). Below are situations that might qualify you for an SEP:

  • You move permanently outside your plan’s service area.
  • You’re enrolled in another prescription drug plan or a Medicare Advantage Plan whose contract is ended.
  • You are eligible for both Medicare and Medicaid (you are "dual eligible").
  • You either recently qualified or no longer qualify for extra help paying for prescription drugs.
  • You belong to a pharmacy assistance program provided by the state.
  • You want to move from an employer-sponsored Prescription Drug Plan to a Medicare Prescription Drug Plan.
  • Your enrollment or disenrollment is caused by an error by a federal employee or contractor hired by the federal government.
  • You lose your previous coverage through no action of your own.
  • You are approved for Medicare on a date after your Initial Election Coverage Period (ICEP).
  • You want to leave your current Medicare Prescription Drug Plan because it was:
  • Warned by the federal government; or
  • The federal government has determined the plan broke its Medicare contract in relation to services provided to you.
  • You’re enrolled in a plan that isn’t renewing its contract with Medicare. This SEP will last from October 1-December 31 of that year.
  • You want to move from a Program of All-Inclusive Care for the Elderly (PACE) to an MA-PD.
  • You live in — or are moving in or out of — one of the following:
  • Skilled nursing facility
  • Nursing facility
  • Intermediate care facility for the mentally retarded
  • Psychiatric hospital or unit
  • Rehabilitation hospital or unit
  • Long-term care hospital
  • Swing-bed hospital
  • You are not eligible for premium-free Part A and enroll in Medicare Part B during the Part B General Enrollment Period.

Click here to learn more about how you might qualify for an SEP.