Most of the year you cannot change your Medicare arrangements. Then something happens in your life, and for a short stretch you can.
These are called special enrolment periods. They exist because it would be unreasonable to move house in April and be told to live with a plan whose doctors are four hundred miles away until January. They are short, they are not advertised, and they usually arrive while you are busy with the thing that triggered them.
The events that open a window
You moved. If your new address is outside your plan’s service area, you get a window. You also get one if you moved within the service area but new plan options are now available to you. Moving from Ohio to Kentucky counts. Moving from one county to the next may also count, because Medicare Advantage and Part D plans are approved county by county.
You left a job, or lost employer coverage. Retiring, being laid off, or the employer dropping the plan all open a window. So does a spouse’s employer coverage ending, if you were covered by it.
Your COBRA ended. The end of COBRA opens a window for Part D and Advantage plans.
A spouse died and their coverage ended with them. One of the cruellest administrative facts of Medicare is that this is a paperwork deadline as well as a bereavement. Ask someone to help you with it.
You moved into, live in, or moved out of a nursing home or long-term care facility. People in institutional care actually get a continuous right to change plans, monthly, for as long as they are there.
Your plan left, or changed. If a plan stops serving your county, or terminates its contract, or loses its star rating in certain ways, everyone affected gets a window.
You became eligible for help paying. Qualifying for Medicaid, for a Medicare Savings Program, or for Extra Help with drug costs opens a window, and losing that eligibility opens one too.
You gained or lost creditable drug coverage through no fault of your own.
You enrolled in the wrong thing because somebody misled you. If a plan or an agent gave you materially misleading information, Medicare can grant an exceptional-circumstances window. It is not automatic and you have to ask, but it exists, and it is worth knowing about if you are reading this because something feels wrong about how you were sold a plan.
How long you get
Most of these windows are two months long, counted from either the event or the month you were notified of it, whichever is later. Some are longer. The loss-of-employer-coverage window for Part B runs eight months, while the drug and Advantage window from the same event runs two.
Because the lengths differ, the practical advice is the same for all of them: act in the first fortnight, not the last.
What a window actually lets you do
It depends on which one. Broadly, a special enrolment period lets you join, switch or drop an Advantage plan or a Part D plan.
What it usually does not do is guarantee you a Medicare Supplement. Medigap has its own guaranteed-issue rules, which are related but separate, and narrower. Some of these events — losing employer coverage, a plan leaving your area — do carry a guaranteed-issue right to certain supplement plans, for a limited period, with the burden on you to apply in time.
That distinction is where people get hurt. “I have a special enrolment period” is not the same sentence as “a supplement has to accept me.” Ask specifically about the second one.
What to do in the first fortnight
Write down the date the event happened. Not the month — the date. Everything is counted from it, and you will be asked.
Keep the letter. The termination notice from the employer, the plan’s notice that it is leaving the county, the confirmation of your new address. These are the evidence that the window is yours.
Then telephone someone. Your State Health Insurance Assistance Program will help you free of charge and has nothing to sell. 1-800-MEDICARE is answered around the clock. We are here as well, and we would rather you called us in week one with an unformed question than in week nine with a decision to unwind.
If you are helping a parent
Two of these events — a move into care, and a spouse dying — usually happen when the person concerned has the least capacity to handle a deadline.
If you are the one helping, you will need authorisation to speak to Medicare and to plans on their behalf. Medicare has an authorisation form for this. Filling it in before you need it takes twenty minutes. Trying to arrange it during a crisis takes considerably longer.
Nothing on this page should be settled the same week as a funeral. But the calendar does not know that, so if you can, ask somebody to keep an eye on the dates while you deal with everything else.
General information, not advice
This guide describes how Medicare generally works. It is not advice about your situation, and rules, dates and figures change — verify anything that matters to a decision against Medicare.gov,1-800-MEDICARE, or your State Health Insurance Assistance Program, all of which are free.
Rights and rules vary by state; this describes Ohio, Kentucky and Indiana. Clearview Medicare Advisers LLC is not connected with or endorsed by the United States government or the federal Medicare program.
Not sure how this applies to you?
Tell us your birthday and whether you are still working. That is usually enough for us to say which periods apply to you and by when. No charge and no obligation.
