Medicare has only a few clearly defined periods where people can enroll into, switch or disenroll from Medicare Advantage and/or Medicare Part D prescription drug plans. Yet, just as in life, there are also many exceptions. These exceptions are called Special Election Periods (SEPs). On our website we have a section that reviews many of the most commonly used SEPs. Recently, however, we received a question about another little used Part D SEP, which is introduced below.
The question received was:
“Does someone who moved from Idaho to California, who didn’t have a Part D drug plan in Idaho, have a Special Election Period to enroll into a Part D plan in California?”
Answer:
Yes, if a beneficiary moves to another state and did not previously have Part D coverage, they have an SEP when they relocate.
Below are excerpts from the Medicare Prescription Drug Benefit Manual (§30.3.1, Chapter 3). The 4th scenario applies in the case in question above. And in Example 2 below, the beneficiary was not enrolled in a prescription drug plan (PDP) before the relocation.
Excerpts from §30.3.1:
An SEP for changes in residence exists for these scenarios:
- Individuals who are no longer eligible to be enrolled in a PDP due to a change in permanent residence outside of the PDP’s service area.
- Individuals who were not eligible for Part D because they have been out of the U.S. and have now moved back to the U.S.
- Individuals who were not eligible for Part D because they were incarcerated and have now been released.
- Individuals who will have new Medicare health or Part D plans available to them as result of a permanent move.
Example 2:
A beneficiary resides in Florida and is currently in Original Medicare and not enrolled in a PDP. The individual intends to move to Maryland on August 3. An SEP exists for this beneficiary from July 1 through October 31.
At the time the individual enrolls in a PDP, the individual must provide the specific address where s/he will permanently reside upon moving into the service area, so that the PDP sponsor can determine that the individual meets the residency requirements for enrollment in the plan.
For more information on Part D SEPs, see our website.
