Special Election Period
By Kendra Knouff
eMedicareSupplements Senior Writer
A Special Election Period, or SEP, occurs when one has the ability to enroll in a Medicare Advantage Plan even after the Initial Enrollment Period (IEP) and/or Annual Enrollment Period (AEP) have passed. A beneficiary becomes eligible for a Special Election Period when he or she meets specific requirements set forth by the U.S. government.
These specific requirements include one of the multiple situations listed below:
- The beneficiary has been displaced due to a hurricane or other natural disaster and resides in a particular zip code as identified by the FEMA at the time of the disaster.
- The beneficiary permanently moves from the area where his or her previous service plan was available.
- The beneficiary lives in, is moving into, or is moving out of a skilled nursing/swing bed facility, intermediate care facility for the mentally handicapped, psychiatric hospital or unit, therapy hospital or unit, or a long-term care hospital.
- The beneficiary has enrolled in a prescription drug plan or a Medicare Advantage Plan whose contract has since been terminated.
- The beneficiary has lost previous creditable coverage through no action of his or her own.
- One’s enrollment or non-enrollment is caused by a mistake made by a federal employee or contractor hired by the federal government.
- The beneficiary was dually eligible for both Medicare and Medicaid but lost his or her status as dually eligible.
- The beneficiary is ineligible for premium-free Part A and thus chooses to enroll in Medicare Part B during the General Enrollment Period.
- The beneficiary would like to leave his or her current Medicare Prescription Drug Plan because the federal government has either reprimanded it or has determined that the plan violated a material provision of its Medicare contract in relation to services provided.
- The beneficiary chooses to switch from using an employer-provided prescription drug plan to a Medicare Prescription Drug Plan.
- One is enrolled in a Cost Plan that is not renewing its contract with Medicare.
- The beneficiary chooses to move from a Program of All-Inclusive Care for the Elderly (PACE) to an MA-PD.
- The judgment of one’s Medicare entitlement is made retroactively.
- The beneficiary receives low-income assistance.
The federal government may authorize other special election periods as it sees appropriate.
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