Medicare Special Enrollment Periods Granted Due to Coronavirus (COVID-19) Outbreak

checkmark Fact checked Reviewed by: Leron Moore - Published: March 10, 2021

 

In response to the coronavirus outbreak, the Centers for Medicare & Medicaid Services (CMS) announced it would provide a COVID-19 Special Enrollment Period (SEP) for individuals who were unable to make changes to their Medicare Advantage or Part D prescription drug plans during the open enrollment period from January 1 to March 31, 2020. This COVID-19 SEP was an extension of the existing SEP granted for natural disasters.[1] Although the COVID-19 SEP has passed, you may still have options for enrollment.

What you should know:

  • 1 The COVID-19 Special Enrollment Period for Medicare expired on June 30, 2020.
  • 2 The Medicare annual open enrollment period, when you can join, switch or drop a Medicare Advantage Plan or Medicare drug plan, is from October 15 to December 7.
  • 3 If you missed the special or annual enrollment period due to an exceptional circumstance, you can contact Medicare.gov to discuss other enrollment options.
  • 4 Special Enrollment Periods are granted on a case-by-case basis.

In addition to the Medicare SEP for COVID-19, the CMS granted “special equitable relief” to individuals who were unable to enroll in Medicare Part A or Part B during an Initial Enrollment Period (IEP), General Enrollment Period (GEP) or SEP on or after March 17, 2020. Both the special equitable relief and COVID-19 SEP expired in 2020: The Medicare COVID-19 SEP expired on June 30, 2020 and the special equitable relief option expired on June 17, 2020.

“Program beneficiaries were encouraged to explore their Medicare coverage options and make a selection during the annual election period,” says a spokesperson for the CMS. “However, if a beneficiary missed the election period and believes an exceptional circumstance — for example, a serious medical emergency during the entire election period — kept them from making an election during the AEP, they may call 1-800-MEDICARE and explain their situation.”

“Advocates are pushing for the Biden administration to resurrect that policy, so we may see that option soon,” says Joe Boden, CFP, senior wealth advisor and partner at EP Wealth Advisors

When are the Medicare special enrollment periods for COVID-19?

Medicare special enrollment periods for COVID-19 were granted through June 30, 2020.

On May 5, 2020, the CMS announced a Special Enrollment Period for COVID-19 that allowed individuals to make changes to their Medicare Advantage or Part D plans outside of the open enrollment period that ended on March 31, 2020. This COVID-19 SEP ended on June 31, 2020.

Equitable relief was made retroactively available effective March 17, 2020. This allowed individuals who couldn’t enroll in Medicare on time due to the pandemic’s impact on SSA’s processing to enroll late without penalty. Special equitable relief was available until June 17, 2020.

You can otherwise enroll in Medicare Advantage Plans or Part D during open enrollment from October 15 through Dec 7 of each year. Individuals already enrolled in a Medicare Advantage plan can also make changes to their plan elections during the Medicare Advantage Annual Election Period (AEP) from January 1 through March 31 of each year. If you miss this period due to extenuating circumstances, such as a medical emergency, you can contact Medicare.gov to discuss a SEP.

Who is eligible during the Medicare special enrollment periods?

Anyone over the age of 65 who meets certain criteria may be eligible for a Medicare SEP.

Certain life events can trigger a SEP, such as if you move or lose insurance coverage. Anyone over the age of 65 who meets the criteria is eligible for a Medicare SEP, although these are generally granted on a case-by-case basis, Boden says.

Circumstances that may warrant an SEP include:

  • Moving to a new address outside your current plan’s coverage or where you have new plan options.
  • Leaving your employer’s health insurance plan, including COBRA.
  • Losing Medicaid eligibility or becoming eligible for both Medicaid and Medicare.
  • Feeling you made the wrong plan choice due to misinformation.
  • Medicare taking an official action because of a problem affecting you.

If you believe you qualify for a SEP, contact Mediare.gov by calling 1-800-MEDICARE.

What is allowed during the special enrollment periods?

The changes you can make and duration of a SEP will depend on your circumstances. 

For instance, moving may allow you to switch plans while losing or becoming eligible for Medicaid coverage would enable you to join, switch or drop a Medicare Advantage or prescription drug plan. You generally won’t be able to enroll in Medicare Part A or Part B during an SEP, although you may be able to drop a Medicare Advantage Plan and return to Original Medicare. 

The exception to this is individuals who decline Part B coverage during their initial enrollment because they are covered by their own or a spouse’s employer group health plan or would like to continue making contributions to a Health Savings Account but would incur a tax penalty for doing so while enrolled in Medicare, Social Security or Railroad Retirement Benefits (RRB). Under these circumstances, a SEP may be granted to allow you to enroll in Medicare outside of the general enrollment period without penalty so you won’t have a gap in medical coverage.

You also generally can’t make Medigap changes unless you dropped a Medigap policy the first time you join a Medicare Advantage Plan. In this case, you’ll be granted special rights to buy a Medigap policy.

Beneficiaries who qualify for Extra Help paying for Medicare drug coverage can make changes to their drug coverage during three annual periods: between January and March, April and June, and July and September.

Medicare also provides 5-star special enrollment periods to all Medicare beneficiaries. Medicare plans are rated on a scale of 1 to 5 stars. If a 5-star Medicare Advantage Plan, Medicare drug plan or Medicare Cost Plan becomes available in your area, a 5-star SEP will allow you to switch to that plan between December 8 and November 30.

How can you take advantage of the special enrollment periods?

Contact Medicare.gov to discuss your special enrollment period options.

Since SEPs are granted on a case-by-case basis, you should contact Medicare.gov to learn how you best can take advantage of your SEP. They will also be able to tell you what steps to take to complete the process.

“There are specific forms you must complete based on the reason you qualify for an SEP,” Boden says. For instance, if you become eligible for Part B during a SEP, you may need to provide a Request for Employment Information (form CMS-L564). You’ll also need to send proof of employment, Group Health Plan (GHP) or large Group Health Plan (LGHP) coverage.

No-contact enrollment options are available. You can enroll over the phone with an agent or online.

“During COVID, you can now do this online for the first time ever,” Boden says. In non-COVID times, you must fax, mail or hand deliver your forms to the Social Security office.

This expert was consulted for insight into Medicare SEP.

Joe Boden, CFP®, senior wealth advisor and partner at EP Wealth Advisors

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Reviewed by:

Leron Moore, Medicare Consultant

With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.