Prescription Drug Plan Special Enrollment Periods

Information Provided by a Senior Prescription Drug Program Representative

You can make changes to your Medicare prescription drug plan when certain events happen in your life. Specifically, certain instances of moving from one location to another or certain circumstances leading to loss of prescription drug coverage can qualify you for a special enrollment period (SEP).

Below are rules and conditions relating to special enrollment periods:

Concerning Moving-Related SEPs

If you move to a new address outside your plan’s service area, you can switch to a new Medicare prescription drug plan. You can also switch plans if your new location is within your plan’s service area but new plan options are available at this location. If you inform your plan provider before you move of your intent to move and change plans, your SEP extends from the month before the month you move until two full months after you move. If you inform your plan provider after you move, your SEP begins the month you give notice to your plan provider and continues for two more months.

If you return to the United States after living outside the country, you can join a Medicare prescription drug plan. Your special enrollment period lasts for two full months after the month you return to the US.

If you currently live in, or have just left, an institution such as a skilled nursing facility or long-term care hospital, you can do one of the following:

    • Join a Medicare prescription drug plan.
    • Switch from  your current plan to another Medicare prescription drug plan.
    • Drop your Medicare prescription drug plan

Your chance to join, switch, or drop coverage lasts as long as you live in the institution and continues for two full months after the month you move out of the institution.

If you’re released from jail you can join a Medicare prescription drug plan. In this instance your SEP lasts for two full months after the month of your release.

Concerning SEPs Resulting from Loss of Drug Coverage

If you’re no longer on Medicaid, you can:

  • Join a Medicare prescription drug plan.
  • Switch from your current plan to another Medicare prescription drug plan.
  • Drop your Medicare prescription drug plan.

Your special enrollment period lasts for two full months after the month you learn you’re no longer eligible for Medicaid.

“What if I have COBRA?”

If you leave coverage from your employer or union (including COBRA coverage), you can join a Medicare prescription drug plan provided you do so within two full months after the month your coverage ends.

If you involuntarily lose other drug coverage equal in quality to Medicare drug coverage (Creditable Coverage), or your other coverage changes and is no longer creditable, you will be permitted to join a Medicare prescription drug plan provided you do so within two full months after the month you lose your creditable coverage or are notified of the loss of creditable coverage, whichever is later.

If you have drug coverage through a Medicare Cost Plan and leave the plan, you can join a Medicare prescription drug plan provided you do so within two full months after the month you drop your Medicare Cost Plan.

If you drop your coverage in a Program of All-Inclusive Care for the Elderly (PACE) plan, you can join a Medicare prescription drug plan provided you do so within two full months after the month you drop your PACE plan.

Whether you’re new to Medicare or a Medicare veteran, that’s a lot to digest. But rest easy, because MedicareMall stands ready to lead you through every step of the Medicare maze. Contact us now and we’ll be glad to answer any questions about Medicare supplement insurance, prescription drug plan enrollment, and more.

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