Exceptions to Missing the Enrollment Period for Part D

Under certain circumstances, Medicare allows people to enroll in the Part D drug program outside the normal enrollment period. The recipient must qualify under one of the special situations listed in Medicare's guidelines, may have to pay a penalty for enrolling late and may have a limited number of days to complete the enrollment process.

Loss of Drug Coverage

• If you lose drug coverage because of circumstances beyond your control, you may enroll in Medicare's Part D drug plan provided you qualify. Drug coverage loss due to non-payment of premiums does not meet the criteria for a special enrollment period.

Change of Union or Employer Drug Coverage

• An employer or union may change or drop drug coverage at times that do not coordinate with the Medicare Part D enrollment period. If this situation occurs, you may enroll in Medicare's drug coverage when the employer's drug coverage changes take place.

Institutionalization

• Moving in or out of a qualifying institution allows you to enroll in Part D outside of the normal enrollment dates. Skilled nursing facilities, psychiatric hospitals and rehabilitation units are a few of the qualified institutions.

Gain or Loss of a State Pharmaceutical Assistance Program (SPAP)

• Some state pharmaceutical assistance programs work with Medicare Part D to provide drug coverage. In this situation, you will choose the drug plan when accepted into the SPAP program. If you lose your SPAP eligibility, you may enroll in Medicare's stand-alone drug program during the same month that the SPAP ended.

You Require Extra Help

• Medicare's Extra Help programs include Medicaid, Supplemental Security Income and the Medicare Savings Program. Seniors eligible for these programs may enroll in Medicare's drug plan during the same month they become eligible for one of these services.

Replacing PACE With Medicare Part D

• Senior citizens who have enrolled in the Program of All-inclusive Care for the Elderly may drop their PACE coverage and enroll in Medicare Part D outside of the normal enrollment dates.

Relocation

• A special enrollment period is provided for people who move outside of their current Part D plan service areas.

Medicare Eligibility Delays

• People who are out of the country or in prison during the initial drug coverage enrollment period may sign up for Part D at a later date.

Medicare Special Needs Plan

• Becoming eligible or losing eligibility in a Medicare special needs plan allows you to enroll in the Part D drug coverage outside the annual enrollment period. The special needs plans provide Medicare drug coverage, but a change in eligibility may require you to re-enroll in Part D under a stand-alone plan.

Marketing and Enrollment Issues

• Any Medicare Part D eligible person may enroll outside the normal dates if there were enrollment errors during the normal enrollment time frame. Proof of misleading marketing tactics used by Medicare Private-Fee-For-Service (PFFS) plans may also allow the participant to drop paid coverage and enroll in Medicare Part D.