April 1st through September 30th is sometimes referred to as the “Lock-in Period” on the Medicare enrollment calendar. To understand the reference, we need to start with the Annual Enrollment Period (“AEP”).
AEP is the same time every year — October 15th through December 7th — and it is the time period during which every Medicare beneficiary may change their Medicare elections for the upcoming plan year. If a beneficiary enrolls in a Medicare Advantage Plan (“MA Plan”) during AEP, that coverage becomes effective on January 1st of the upcoming year.
Nevertheless, that beneficiary will then have a 1-time opportunity from January 1st to March 30th (called the “Open Enrollment Period”) to either change to another MA Plan, or to return to Original Medicare. As a general rule, once the Open Enrollment Period ends, as of April 1st, each beneficiary is “locked into” their current coverage until the start of AEP. Thus, April 1st to September 30th is referred to as the “Lock-in” Enrollment Period.*
An exception to this general rule arises if a beneficiary qualifies for a “Special Election.” If so, the beneficiary will have a “Special Election Period” or “SEP,” during which they may change their Medicare coverage, regardless of the time of year. To qualify for an SEP, a beneficiary must demonstrate one of the following “qualifying events”:**
- they lost their current health care coverage (e.g., a loss of employer coverage);
- they moved outside of their current health plan’s coverage area;
- they want to enroll in a Five Star healthcare plan; and/or
- their eligibility for Medicaid or a Low Income Subsidy has changed.
To confirm whether you qualify for an SEP, we recommend that you contact one of our licensed agents at 1-877-766-4448. If you do qualify, in most cases, you have three (3) months from the date of a qualifying event in which to enroll in a new MA Plan or MAPD Plan, or switch back to Original Medicare.
* Technically, the Lock-in Period extends until AEP officially starts on October 15th. However, between October 1st and October 14th, beneficiaries are permitted to speak with agents and begin evaluating their Medicare options for the upcoming plan year. Even if a beneficiary determines on October 1st that they want to switch their coverage, they still must wait to do so until October 15th — the official start of AEP.
**The qualifying events listed above are for those beneficiaries already enrolled in Medicare. If you are new to Medicare, you will have a 7-month Initial Enrollment Period that is unique to you, that is not dependent on the factors identified above. For more information on your 7-month Initial Enrollment Period, please review “When can I enroll in Medicare?”