medicare advantage special needs plan You can enroll in a Special Needs Plan once you’re first eligible for Medicare if there is a Special Needs Plan in your service area for your target group and you meet the eligibility requirements of that plan.
Most people are first eligible for Medicare during their Initial Enrollment Period, the seven-month period that starts three months before your 65th birthday, includes your birthday month, and ends three months later. If you qualify for Medicare because of disability, your Initial Enrollment Period starts three months before the 25th month that you are receiving Social Security or Railroad Retirement Board disability benefits and lasts seven months.
You can also enroll in a Special Needs Plan during the Annual Election Period from October 15 to December 7 of every year. During this period, you can enroll in a Special Needs Plan for the first time, switch plans, or disenroll from your plan.
Outside of these periods, you may be able to join a Special Needs Plan with a Special Election Period in certain situations. Some situations that may qualify you for a Special Election Period to enroll in a Special Needs Plan or make coverage changes include:
• You are diagnosed with a severe or disabling condition: You can enroll in a Chronic-Condition Special Needs Plan for beneficiaries with your illness at any time, and your Special Election Period ends once you enroll in the plan.
• You move into, currently live in, or leave a nursing home: You can enroll in a Special Needs Plan or switch plans at any time.
• You qualify for Medicaid: If you have Medicaid or are newly eligible for Medicaid, you can enroll in a Medicare Special Needs Plan at any time.
• You move outside of your Special Needs Plan’s service area: You can use a Special Election Period to switch to a new plan, or you’ll be automatically returned to Original Medicare.
• Your Special Needs Plan leaves the Medicare program: You can use a Special Election Period to switch to a different Special Needs Plan.
Keep in mind that you can only remain enrolled in a Special Needs Plan for as long as you meet the eligibility criteria of that plan. If your situation changes and you no longer meet the enrollment requirements for the Special Needs Plan, you’ll get a Special Election Period to switch to a different Medicare Advantage plan or return to Original Medicare.