Medicare qualifying life events: What are they?

If there’s anything we’re certain of in life, it’s to expect the unexpected. You never know what life may throw your way — even in the days of retirement. (When you might have thought those days were behind you.)

Luckily, if your situation changes, your Medicare can change along with it. That’s right — if you thought you could only change your Medicare during the Annual Election Period, think again. (Well, only if you’re experiencing a qualifying life event.) Keep reading to find out more about this not-so-secret loophole for changing your Medicare below.

What is a Medicare qualifying life event?

A qualifying life event (or QLE) is a change in your situation (like moving or losing health coverage) that can make you eligible for a 60-day Special Enrollment Period outside Medicare’s Annual Election Period.

What are examples of Medicare qualifying life events?

Change of address

Many people might not know that moving is a qualifying life event — it could be that you relocate to an area where your current coverage isn’t available or with new health plans to consider. Here are some specific situations:

Moving to a new address that isn’t in your plan’s service area.
Moving to a new address that’s still in your plan’s service area, but you have new plan options in your new location.
Moving back to the U.S. after living outside the country.
Moving into or moving out of an institution (like a skilled nursing facility or long-term care hospital).

Loss of current coverage

You can qualify for a Special Enrollment Period if you experience any of these events:

You’re no longer eligible for Medicaid.
Your plan closes, stops serving in the area you live in, significantly reduces its provider network, or consistently receives low Medicare star ratings.
You left coverage from your employer or union (including COBRA coverage).
You involuntarily lose other drug coverage that’s as good as Medicare drug coverage, or your other coverage changes and is no longer credible.
You had drug coverage through a Medicare Cost Plan and left the plan.

Your plan provider changes its contract with Medicare

Sometimes, these things happen through no fault of your own, which will make you eligible for a Special Enrollment Period:

Medicare takes an official action because of the problem with the plan that affects you.
Medicare ends your plan’s contract.
Your Medicare plan’s contact with Medicare isn’t renewed. (Applicable for a Medicare Advantage, Medicare Part D, or Medicare Cost Plan.)

Opportunities to get other coverage

If you have a chance to enroll in other coverage (offered by your employer or union), you can qualify for a Special Enrollment Period. The same goes for prescription drug coverage, or if you enrolled in a Program of All-inclusive Care for the Elderly (PACE) plan. With a PACE plan, you have a team of healthcare professionals working with you and your family to make sure you get the care you need, and it covers all Medicare- and Medicaid-covered care and services.

Other Medicare qualifying life events

You’re eligible for both Medicare and Medicaid.
You qualify for Extra Help (benefits from the government) for Medicare prescription drug coverage.
You enroll in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility.
An insurance representative did not properly tell you that your other private drug coverage wasn’t as good as Medicare drug coverage (creditable coverage), or that you were losing private drug coverage that was as good as Medicare drug coverage (creditable coverage).

How long do you have to select a new Medicare plan or switch Medicare plans if you experience a qualifying life event?

If you experience a qualifying life event, you typically have 60 days to choose a new plan or switch to a different plan — but this can vary. This Special Enrollment Period is an exception to help you make the necessary changes to your Medicare coverage. Without Special Enrollment Periods, you would usually have to wait until the next Annual Election Period to enroll in coverage.

What to do when you experience a Medicare qualifying life event

If you know that a qualifying life event is in your future, be sure to give the number on your Medicare member ID card a call. They’ll be able to help you determine what your options are — and how long you have until you need to make a decision.

And here’s a quick tip: while you’re on the phone discussing your options, make sure to confirm if your insurance will need to see any official documentation or paperwork. (Like a mortgage, for example.) Knowing what you need to switch ahead of time will make the transition that much easier.

Working past age 65: Your 8-month Special Enrollment Period

If you decide to work past age 65, you can qualify to delay enrolling in Medicare, since you still have access to your employer’s group plan. For those that choose to do this, there is an 8-month Special Enrollment Period that allows you to enroll in Part A (if you haven’t yet), Part B, Part C, and Part D without late penalties. Your Special Enrollment Period will begin eight months after your employer coverage ends or you leave your job (whichever happens first).

Keep in mind, though: while you can wait the entire eight months to get Parts A and B, you must enroll in Part C or D in the first two months of your Special Enrollment Period, or you will be subject to late enrollment penalties.

It’s important that your Medicare plan continues to meet your needs as life unfolds — it could save you money and give you access to the best caregivers in your new area. So the next time you experience a qualifying life event, make sure to give your Medicare provider a call to know what your options are. But don’t wait: once a qualifying life event happens, your 60-day countdown starts immediately!