What Are Special Enrollment Periods for Part D?

Can I change my coverage outside the Open Enrollment Period? Yes, you can, in certain cases.


You might be allowed to join, switch or drop a Medicare drug plan outside the
Open Enrollment Period

The usual case is that you must sign-up for a Medicare Drug plan during the Open Enrollment Period of October 15 through December 7. And then you must stay enrolled for a calendar year, which is Jan. 1 to Dec 31. In some situations, you can change your coverage at other times. These are called Special Enrollment Periods.

Some examples are:

  1. You move out of your current plan's service area
  2. Lose other prescription coverage that you had outside of Medicare
  3. Are enrolled in Medicaid
  4. Live in an institution (i.e., a nursing home)
  5. Qualify for Medicare's Extra Help program

Switching to a 5-star plan

If you want to switch to a plan that's rated 5-stars in its overall performance, there is a much longer period open to make the switch. In 2015 it was from Dec 8, 2014 through Nov 30, 2015.

There are some restrictions. You can only use this Special Enrollment once in period. You can't switch to a 5-star plan unless one is available in your geographical area

When You First Sign-Up for Medicare

In addition, when you first sign-up for Medicare there is a special Enrollment Period. It begins 3 months before the month you turn 65; and end 3 months after the month you turn 65.

If you qualify for Medicare because you are disabled, there is special enrollment process you may be able to use.

The rules for joining Medicare Advantage Plans (Part C Medicare) are a little different from this Part D discussion.

Web pages and sites to provide more information:
  • Special circumstances (Special Enrollment Periods)

    languages: English
    A very complete presentation of over two dozen situations that qualify as special circumstances.
DibbernsWhy this website?

We are a family of senior adults, with all the health issues of the average older American. Medicare has been a factor in our lives, as it is for millions of people like us. This website exists to offer plain talk, simple introductions to the maze of details that make up the Medicare program.

We aren't experts- we'll leave that to the real experts-- for the more complicated rules and issues of Medicare. What you'll find here is a beginning point. A start in your Medicare journey.

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Medicare & You Where is this topic in 'Medicare & You 2015'?

Part D Plans: pages 98 and 99

Medicare Advantage Plans: page 86

You should have received a copy of 'Medicare & You 2015' in the mail. If you don't have your copy, call 800-803-7174. Download a pdf version.