The Medicare Agent Blog

Medicare Special Enrollment Periods (SEPs) Explained

Life doesn’t always follow a predictable schedule, so major life events may not always align with Medicare’s enrollment periods.

Luckily, Medicare offers Special Enrollment Periods (SEPs) for situations like these.

While Medicare’s standard enrollment periods are the Open Enrollment Period (January 1-March 31) and the Annual Enrollment Period (October 15-December 7), SEPs allow your clients to make changes to their Medicare coverage outside of these times. Read on to learn more about how you can get prepared to assist enrollees with plan choices!

Qualifying for a Special Enrollment Period

There are 3 main reasons your client may qualify for a SEP.

  1. Qualifying Life Events (QLEs): Clients experiencing a QLE, such as moving to a new area, losing health coverage, or other life-changing events, may be eligible for a SEP.
  2. 5-Star Special Enrollment Period: Inform your clients that if a 5-star plan becomes available in their area, they can switch to it during a SEP.
  3. Working Past Age 65: Advise clients who delayed enrolling in Medicare due to employer-based coverage about the 8-month SEP available once that coverage ends.

Enrollment in Medicaid or Extra Help

Inform your clients know that if they have Medicaid or Extra Help, they might be able to change their coverage once in each of these timeframes: January – March, April – June, and July – September. If they lose benefits from Medicaid or Extra Help, they get a one-time chance to adjust their Medicare Advantage enrollment.

Disenrollment and Re-enrollment

Clients who initially enrolled in a Medicare Advantage plan upon becoming eligible for Medicare have a 12-month window to disenroll from the plan and return to Original Medicare. Similarly, if clients previously dropped a Medicare Supplement Insurance plan to join a Medicare Advantage plan but now want to switch back, they also have a 12-month period to do so, as long as this was their first enrollment in a Medicare Advantage plan.

Changes in your clients’ addresses can impact their Medicare Advantage (MA) or Medicare Part D plans, as they are often tied to their location.

If your clients move to an area not covered by their current MA or Part D plan, they can switch to a different plan during a Special Enrollment Period (SEP). Similarly, even if their new address is within their plan’s service area, they still qualify for a SEP, giving them the option to enroll in a new plan that wasn’t available at their previous address.

Most SEPs related to moving last for two full months after the month your client moves or the month that they inform their plan administrator of their move.


Did you know that experiencing a FEMA emergency could qualify your clients for a Medicare Special Enrollment Period? This qualification typically depends on the state or county where they reside, among other factors. FEMA stands for the U.S. Federal Emergency Management Agency, which declares emergencies in response to events like severe storms, wildfires, pandemics, and other disasters.

Your clients may qualify for a Medicare Special Enrollment Period (SEP) due to a FEMA emergency if all of the following conditions are true:

  • They live in a specific county and state where FEMA has declared an emergency, or they lived in that specific county and state at the start of the FEMA emergency declaration.
  • An election (enrollment) period was in effect during the FEMA emergency.
  • They weren’t able to enroll in a Medicare plan, or switch Medicare plans, during an election period that was going on during the incident period.

Please note:

  • The client does not qualify for this Medicare SEP if they already used a Medicare open enrollment period to make a coverage change during the FEMA incident period.
  • This SEP only applies to Medicare Advantage plans (and other Medicare health plans), and Medicare prescription drug plans.

For more information on FEMA SEPs, please refer to the document attached.

Understanding Medicare Special Enrollment Periods (SEPs) is crucial for your clients to make informed decisions about their healthcare coverage. Whether they’re experiencing a qualifying life event, have access to a 5-star plan, or are affected by a FEMA emergency, knowing their options and timing is key to maximizing their Medicare benefits.

For more information on the Medicare SEP, please contact our Broker support services at or (844) 998-7878.

Key Takeaways

  • A Special Enrollment Period  (SEP) gives your clients the ability to make changes to their Medicare coverage outside of regular enrollment periods.
  • One of the most important SEPs is the one granted to a beneficiary after they leave employer-sponsored health insurance and want to enroll in Medicare.
  • Other events that trigger SEPs include a change of address and documented issues with their current Medicare.

Trusted American Insurance Agency is a National Marketing Organization (NMO) headquartered in Roseville, CA. Trusted American provides a full range of insurance and financial services products across all 50 states for all major and niche carriers, with a specialty in the Senior Marketplace.

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