For individual health insurance, a Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child. If you qualify for an SEP, you usually have up to 60 days following the event to enroll in a plan. If you miss that window, you have to wait until the next Open Enrollment Period to apply. You can enroll in Medicaid and the Children’s Health Insurance Plan (CHIP) any time of year, whether you qualify for a Special Enrollment Period or not. Job-based plans must provide a special enrollment period of at least 30 days.
For Medicare, a Special Enrollment Period is a set time when you can sign up for Medicare Part B if you didn’t take Medicare Part B during the Initial Coverage Election Period, because you or your spouse were working and had group health plan coverage through an employer or union. You can sign up at any time while you are covered under the group plan, based on current employment status. The last 8 months of the Special Enrollment Period starts the month after the employment ends or the group health coverage ends, whichever comes first.
A Medicare Special Election Period—which is different from a Medicare Special Enrollment Period—allows you to enroll in Medicare or change your Medicare coverage outside of your Initial Coverage Election Period. During the Medicare Special Election Period, you can change Medicare+Choice plans or to return to Original Medicare in certain situations, which include: You make a permanent move outside the service area, the Medicare+Choice organization breaks its contract with you or does not renew its contract with Centers for Medicare & Medicaid Services (CMS); or other exceptional conditions determined by CMS.