Medicare 2026

Medicare Special Enrollment Periods: When You Can Change Plans Outside Open Enrollment

Most people think of fall as the only time to make Medicare decisions. Annual Enrollment runs October 15 through December 7, 2026, with changes taking effect January 1, 2027. But life rarely lines up with a calendar. You might move. An employer plan might end. A loved one might enter a nursing home. Medicare builds in Special Enrollment Periods (SEPs) for moments like these — windows outside the annual window when you can join, switch, or leave a Medicare Advantage or Part D plan.

Here is a plain-English tour of the most common SEPs, who they help, and where to go for the specifics.

Why SEPs exist

Annual Enrollment is the yearly reset. SEPs exist because people don't always get to choose when their circumstances change. The rule of thumb: the window and the choices available depend on the triggering event. There is no single "SEP" — there are many, each with its own clock.

Moving out of your plan's service area

If you move somewhere your current Medicare Advantage or Part D plan isn't offered, you qualify for an SEP. The window can start the month before the move if you tell your plan in advance, and it runs for two full months after the month you move. That gives you time to compare what's available at your new address and pick a plan — or drop a plan entirely and return to Original Medicare.

Even if your old plan is offered in the new area, moving can still open an SEP because the plan options differ by location. Letting your plan know ahead of time preserves the earliest possible start date.

Losing employer or union coverage

Many people delay Part D or Medicare Advantage because they have creditable drug coverage through a job or a spouse's job. When that coverage ends, you have two full months after the month it ends to join a Medicare Advantage plan or a Part D plan without a late-enrollment penalty for that period.

This SEP also applies to COBRA ending or retiree coverage changing in certain ways. The key is timing: don't let the two-month window close while you shop.

Moving into, living in, or leaving a nursing home or institution

If you move into, live in, or move out of a skilled nursing facility, long-term care hospital, or similar institution, you can change your Medicare Advantage or Part D plan. This SEP recognizes that drug needs, provider networks, and plan logistics all shift when someone's living situation changes.

People with Medicaid or Extra Help

Since 2025, people enrolled in Medicaid or the Extra Help program for Part D have a monthly SEP to move to Original Medicare paired with a stand-alone Part D plan, or to switch from one stand-alone Part D plan to another. Full-benefit dual-eligible individuals — those with both Medicare and full Medicaid — can also join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month.

The practical effect: if your prescription costs change, your pharmacy drops a plan, or your needs shift, you don't have to wait until fall.

The five-star SEP

Medicare rates plans each year on a one-to-five-star scale. If a five-star Medicare Advantage or Part D plan is offered where you live, you can use a one-time SEP between December 8 and November 30 to switch into it. Five-star plans aren't offered everywhere, and this SEP can only be used once in that window.

Other triggers worth knowing

There are additional SEPs — for example, when a plan's contract with Medicare ends, when you qualify for or lose a Special Needs Plan's eligibility category, or when CMS determines a plan materially misled you. Because the rules and windows for each are specific, confirm the details for your situation on Medicare.gov before acting.

Thinking about the choice itself

When an SEP opens the door, you'll generally be weighing two paths: Medicare Advantage, which bundles hospital, medical, and usually drug coverage through a private plan with a network and set rules; or Original Medicare, often paired with a stand-alone Part D plan and sometimes a Medigap policy to help with cost-sharing. Each path has trade-offs around provider choice, out-of-pocket exposure, extra benefits, and administrative simplicity. Neither is universally better — the right fit depends on your doctors, your medications, your budget, and your preferences.

A few program-level facts can help frame the drug side of the decision. In 2027, the Part D out-of-pocket cap is $2,400 (it is $2,100 in 2026). The most any Part D plan may charge as a deductible in 2027 is $700. The Part D base beneficiary premium for 2027 is $41.33 — a national figure used in calculating the late-enrollment penalty; actual plan premiums are set plan by plan. Social Security announced a 3.6 percent cost-of-living adjustment for benefits payable beginning January 2027.

Figures for the 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets, have not yet been announced. CMS typically releases them in the fall, usually November. Check Medicare.gov for those updates when they post.

How to act when an SEP applies

Mark the date your event occurred — the move, the coverage end, the admission — because the clock almost always runs from that date. Gather any letters from your plan or employer confirming the change. Then compare your options using the Plan Finder on Medicare.gov, or call 1-800-MEDICARE to talk through what's available and how enrollment works.

Medicare is complicated, but SEPs are designed to make sure life events don't trap you in the wrong coverage. Knowing they exist — and acting within the window — is most of the battle.