Beyond Open Enrollment
Grow your business year-round with Special Enrollment Periods
Medicare Enrollment Periods
Newly eligible individuals
Both the ICEP and IEP are for people who are just becoming eligible for Medicare. They need to enroll in both Medicare Part A and Part B to use these eligibility timeframes. They can do this at a Social Security office.
If an individual chooses to delay enrollment in Part B (usually because they have health coverage through an employer or a spouse’s employer) their ICEP will also be delayed.
Enroll in a Medicare Advantage plan or Medicare Part D plan
Enroll the month before their employer coverage ends or up to two months after coverage ends
Effective date will be the first of the following month.
Retroactive Medicare Part D entitlement provides a four-month enrollment period. This period begins the month the individual is notified of their Medicare entitlement. Their coverage effective date is generally the first day of the month after the health plan receives the enrollment request.
Annual opportunities to change enrollment
Each year, Medicare-eligible individuals may enroll in a Medicare plan during October 15 through December 7.
Enroll in a Medicare Advantage plan from Original Medicare only
Switch enrollment between Medicare Advantage plans
Enroll in a Medicare plan for the first time
Annually during January 1 through March 31, Medicare Advantage beneficiaries may make an enrollment change. Does not apply to those with Medicare Savings Accounts or other Medicare plan types (such as Cost, PACE, or Original Medicare only)
Individuals enrolled in a Medicare Advantage – Prescription Drug (MA-PD) plan or a medical only Medicare Advantage (MA-only) plan may:
- Switch between or enroll in a MA-PD plan
- Switch to an MA-only plan
- Drop MA to go to Original Medicare only (with or without a Part D standalone plan)
Nursing home residents
This continuous enrollment period allows an individual who moves into, resides in, or moves out of an institution (as defined in § 10) to change their Medicare enrollment. The OEPI ends two months after the month the individual moves out of the institution. The individual can make an unlimited number of Medicare Advantage (MA) enrollment requests during the OEPI.
Medicare Special Enrollment Periods (SEPs)
SEPs allow individuals to take one of three actions:
- Disenroll from a Medicare Advantage plan and enroll only in Original Medicare
- Enroll in a Medicare Advantage plan
Switch from one Medicare Advantage plan to another Medicare Advantage plan
There are several types of SEPs:
- Change in residence
- Leaving/Losing Employer or Union Group Health Plan
- 5-Star Medicare Plans
- Disenroll from Part D to enroll in Creditable Coverage
- Retroactive notice of Medicare entitlement
- Change in Dual/LIS status
Typically, the SEP ends when an individual elects a new Medicare Advantage plan or when the SEP timeframe ends, whichever occurs first.
- Individual moves permanently outside of their current MA plan service area
- Individual is now eligible for an MA plan because they have been recently released from incarceration
- Individual has moved permanently, and is now eligible for the MA plans in their new geographical area
The SEP lasts for three months. If the plan is notified in advance, the SEP begins on the first day of the month of permanent move. If the individual notifies the plan after the move, the SEP begins the month of the notification. The individual can choose an effective date up to three months after the month they send the enrollment request, but it may not begin prior to their move date.
An individual is a member of an MA plan in Minnesota and intends to move to Arizona on June 7. They have an SEP from May 1 through August 31.
|When notify plan/enroll||SEP begins||SEP ends||Effective date options|
The month before the move or earlier (May or before)
The month before the move (May)
Two months after the move (August)
July, August or September
The month of the move (June)
The month of the move (June)
Two months after the move (August)
July, August or September
After the move (July)
The month of the enrollment request (July)
Two months after the SEP begins (September)
August, September or October
When CMS does not renew a Cost or Medicare Advantage plan contract, the plan’s enrollees may select a Medicare Advantage plan in their area. They must meet MA eligibility requirements.
The SEP is available December 8 through the last day of February.
- Enrollments received in December will be effective January 1
- Enrollments received in January will be effective February 1
- Enrollments received in February will be effective March 1
When an individual has an opportunity to:
- Enroll in an employer-sponsored Medicare Advantage plan (Medicare Group plan)
- Disenroll from a Medicare Advantage plan to enroll in employer sponsored coverage of any kind
- Disenroll from employer sponsored coverage or COBRA to enroll in an MA plan
Effective date can be:
- Up to three months after the month when they submitted an enrollment or disenrollment request
- Must begin after the first day of entitlement to both Medicare Part A and Part B
- For example, if the submission was sent in March, the effective date could be April 1, May 1 or June 1
Each year, CMS rates Medicare Advantage, Cost and standalone Part D prescription drug plans on performance and quality categories based on member surveys and other information. Ratings are between 1 and 5 stars, with 5 stars indicating excellence. These ratings can change each year.
The 5-star SEP is available for a one-time switch to a Medicare Advantage, Cost or standalone Part D prescription drug plan with a 5-star rating. The SEP is open December 8 through November 30.
Please note that if a beneficiary moves from a Medicare Advantage plan to a standalone Part D plan, they will be disenrolled from their Medicare Advantage medical coverage and returned Original Medicare for their medical coverage.
Individuals may disenroll from a Part D plan (PDP or MA-PD) to enroll in or maintain other creditable coverage such as TriCare or VA coverage. Their disenrollment effective date is the first day of the month after the month the plan receives the disenrollment request. Individuals who are enrolled in an MA-PD plan may also use this SEP to disenroll in the MA-PD plan and select an MA-only plan.
When an individual is given a retroactive Medicare entitlement determination from CMS, they are also given a three month SEP. The SEP begins the month they receive notice of their Medicare entitlement from CMS and continues for an additional two months.
Individuals who no longer qualify for a Special Needs Plan (SNP) will have to disenroll and select new coverage. This SEP begins when the period of deemed continued eligibility starts (as defined in § 50.2.5) and ends when the individual makes an enrollment request, or three months after the deemed continued eligibility period expires. CMS will send a letter printed on grey paper called a “Loss of Deemed Status notice” to tell the individual if they no longer qualify for a SNP.
An individual who receives “Extra Help” may make one enrollment change, or notify such a change is coming, within three months of any of the following situations.
- Becomes eligible for any type of assistance from Title XIX program (includes those who receive cost-sharing assistance from Medicaid, i.e., “partial duals”) and individuals who qualify for LIS but do not receive Medicaid benefits
- Loses eligibility for any type of assistance
- Has a change in the level of assistance they receive (such as Medicaid benefits end but still qualify for LIS, or those who have a change in their cost-sharing level.)
Non-U.S. citizens who become lawfully present in the United States may apply for an MA plan. The plan’s regular eligibility requirements apply. This SEP begins the month the lawful presence begins, and ends either:
- Two full calendar months later or
- When the individual makes an enrollment request
Individual and Family Plan (IFP) Enrollment Periods
Most IFP SEPs allow 60 days to enroll after a Eligible life event. The SEP typically begins on the day of the eligible event. The MNsure website lists what documentation is required to prove eligibility.
- Dependent is turning age 26 and will lose coverage through parent’s plan
- Losing employer-sponsored coverage (includes COBRA and retiree coverage)
- Employer ends coverage
- Lose or leave a job, thus ending employer-sponsored coverage
- No longer qualify for Medical Assistance or MinnesotaCare
- Lose other government-sponsored coverage such as TRICARE
Non-U.S. citizens who become lawfully present in the United States may apply for an MA plan for which they are eligible. The SEP lasts for 60 days.
Individual moves permanently to a new zip code or county and now has access to different qualified health plan options. The SEP lasts for 60 days and begins the day of your move.
Gained or lost dependent
- Through birth, adoption, foster care or child support order
Death, divorce, or legal separation
- Lost coverage on another MNsure plan
- Household size changed due to marriage
The SEP begins the day of the event (birth, death, court order, marriage) and lasts for 60 days.
- If an error, action or inaction by MNsure, navigator or broker prevented enrollment, the individual may qualify for a SEP. The individual has 60 days to report the error to MNsure. If a SEP is granted, the individual has 30 days from the approval date to enroll.
Violation of qualified health plan terms and conditions
- If the enrollee can demonstrate that their qualified health plan terms and conditions were violated, the enrollee may qualify for this SEP
The SEP is 60 days and begins on a date set by MNsure.
American Indian or Alaska Natives
Enrolled members of a federally recognized tribe are eligible to enroll in a qualified health plan or change their plan enrollment once a month year-round.
SEP begins on the first of the month and ends on the last day of the month.