In a previous article, we talked about Special Enrollment Periods for Medicare members. These are opportunities to make changes to your current Medicare Advantage Plan outside of the Open Enrollment period.

In the previous article, we focused on different moving scenarios that make Medicare members eligible for a Special Enrollment Period. A move is perhaps the most common reason why Medicare members become eligible for a Special Enrollment Period, but there are also other common events that can open a Special Enrollment Period. In this article, we’ll talk a bit about some of those other events.

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Losing Employer or Union Group Coverage

You qualify for a Special Enrollment Period if you lose group coverage through your employer or union. Your Special Enrollment Period begins when your employer or union coverage ends, and that Special Enrollment Period ends two months after the employer/union coverage ends.

You also qualify if you leave your Medicare Advantage plan and enroll in coverage through an employer or union.

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If you lose current creditable health coverage due to retiring from your job, you could qualify for a Medicare Special Enrollment Period.

Here are some examples of how this Special Enrollment Period might work:

  • John is receiving employer coverage through work, and leaves his company in April. His Special Enrollment Period will begin in April and end June 30.

Special Enrollment Period April May June

  • Ellen is currently enrolled in a Medicare Advantage plan. She decides to go back to work and plans to enroll in the employer plan in April. After she gets coverage through her employer, she can end coverage through her Medicare Advantage plan.

Changes in Your Medicare Advantage Plan’s Provider Network

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If you find out that your current health plan’s contract with Medicare has ended or been changed, you are eligible for a Medicare Special Enrollment Period.

If your Medicare Advantage plan makes significant changes to its provider network, and the Centers for Medicare and Medicaid Services (CMS) determines these changes are valid and substantial, you qualify for a Special Enrollment Period. Your plan will mail you a letter to notify you of the change.

In this case, the Special Enrollment Period begins the month you are notified of the network change and ends two months after that.

Here is an example of how this Special Enrollment Period might work:

  • In May, Jim’s plan sends him a letter stating that a large number of providers are no longer participating in his current plan. If Jim decides to switch plans, he can qualify for a Special Enrollment Period from May until July 31.

Special Enrollment Period May June July

Becoming a Legal U.S. Citizen

If you become a legal U.S. citizen, you qualify for a Special Enrollment Period that starts the month you become a legal citizen, and ends when you enroll in a plan or two months after receiving legal citizenship, whichever occurs first.

This also applies to people who are born U.S. citizens, but have been living outside the country for a long time and are coming back. Their Special Enrollment Period will begin once they gain residency in a particular state.

Here is an example of how this Special Enrollment Period might work:

  • Maria, who’s 67 years old, just became a legal U.S. citizen on April 10. She qualifies for Medicare, she is paying Parts A & B, and she is looking into purchasing a Medicare Advantage Plan. Maria’s Special Enrollment Period starts the moment she acquired citizenship (on April 10) and ends on June 30, unless she enrolls in a plan before the end date.

Special Enrollment Period April May June

Learn More About Other Qualifying Events

There are other qualifying events that could make you eligible for a Special Enrollment Period. You can find a full list of events that open a Special Enrollment Period on Medicare.gov.

Highmark Is Here to Help

If you have other questions about Medicare coverage — Highmark is here to help. Check out these online resources to help you understand your Medicare plan options.

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