Election Period Hierarchy
When more than one election period applies, select the highest-priority election period below to help ensure the enrollment processes smoothly.
Priority | Election Period | When it Typically Applies |
1 | AEP | Annual Election Period (Oct 15 – Dec 7) |
2 | IEP / ICEP / MRD | New to Medicare due to age or disability |
3 | OEP | Medicare Advantage Open Enrollment (Jan 1 – Mar 31) |
4 | SEP | Special qualifying life events |
Annual Enrollment Period (AEP)
Dates
October 15 – December 7
Who can use AEP
All Medicare beneficiaries
What beneficiaries can do
Enroll in a Medicare Advantage (MA / MAPD) or PDP plan
Switch between MA, MAPD, or PDP plans
Dis-enroll from MA and return to Original Medicare
Add, drop, or change Part D coverage
Coverage effective date
January 1 of the following year
AEP is a great option when no higher-priority election period applies.
Initial election periods
Initial Enrollment Period (IEP)
Who qualifies
Beneficiaries who are new to Medicare—either turning 65 or newly eligible.
Timing
A 7-month window:
3 months before → month of → 3 months after Medicare eligibility
Plans allowed
Medicare Advantage (MA / MAPD)
Prescription Drug Plan (PDP)
Med Supp
What this may look like in the application
What this may look like in the application
I am new to Medicare
Initial Coverage Election Period (ICEP)
Who qualifies
Beneficiaries who already have Part A and are newly enrolling in Part B.
Timing
3 months before the Part B effective date through the Part B effective month
Plans allowed
Medicare Advantage (MA / MAPD)
Prescription Drug Plan (PDP)
Med Supp
What this may look like in the application
What this may look like in the application
I already have Hospital (Part A) and recently signed up for Medical (Part B). I want to join a Medicare Advantage Plan.
Medicare Replacement Drug (MRD) / IEP 2
Who qualifies
Beneficiaries who already have Medicare and are now turning 65
Timing
A 7-month window:
3 months before → the month of → 3 months after their 65th birthday.
Plans allowed
Medicare Advantage (MA / MAPD)
Prescription Drug Plan (PDP)
Med Supp
What this may look like in the application
What this may look like in the application
I have had Medicare prior to now, but I am now turning 65.
Open enrollment periods (MA OEP)
Dates
January 1 – March 31
Who qualifies
Beneficiaries currently enrolled in a Medicare Advantage (MA or MAPD) plan.
What beneficiaries can do
Switch from one Medicare Advantage plan to another
Dis-enroll from Medicare Advantage and return to Original Medicare, with the option to add a Prescription Drug Plan (PDP)
What’s not available during OEP
Enrolling in Medicare Advantage if currently on Original Medicare only
Using OEP more than once per plan year
What this may look like in the application
What this may look like in the application
I am in a Medicare Advantage Plan and have had Medicare for less than 3 months. I want to make a change.
I am enrolled in a Medicare Advantage plan and want to make a change during the Medicare Advantage Open Enrollment Period (MA OEP).
Special Enrollment Periods (SEPs)
1. Loss of employer or creditable coverage
SEP code: SEP-LEC
Examples
Retirement (Loss of active employer coverage)
Employer coverage ends
COBRA ends
Union coverage ends
Timing
Up to 2 months after coverage ends
Plans allowed
MA, MAPD, PDP
Med Supp - See GI section below, GI rules may apply
What this may look like in the application
What this may look like in the application
I left coverage from my employer or union (including COBRA coverage).
I am new to Medicare, and I was notified about getting Medicare after my Part A and/or Part B coverage started.
2. Change of residence (permanent move)
SEP code: SEP-MOVE
Examples
Moving to a new county or state
Moving outside of a plan’s service area
Moving from another country to the United States
Release from incarceration
Timing
1 month before the move through 2 months after the move
Plans allowed
MA, MAPD, PDP
What this may look like in the application
What this may look like in the application
I recently moved outside of the service area for my current plan or I recently moved and this plan is a new option for me.
I recently was released from incarceration.
I recently returned to the United States after living permanently outside of the U.S.
I recently obtained lawful presence status in the United States.
I recently moved out of a long-term facility (for example, a nursing home or rehabilitation hospital)
3a. Medicaid / LIS (Extra Help)
SEP code: SEP-LIS
Who qualifies
Beneficiaries who gain, lose, or experience a change in Medicaid or LIS status
Timing
One election per status change, starts the month of the change plus 2 additional months.
Plans allowed
MAPD, PDP
Note
Beginning January 1, 2025, Centers for Medicare & Medicaid Services (CMS) split the Dual/LIS SEP into two separate SEPs
What this may look like in the application
What this may look like in the application
I recently had a change in my Medicaid (newly got Medicaid, had a change in level of Medicaid assistance, or lost Medicaid).
I have both Medicare and Medicaid (or my state helps pay for my Medicare premiums) or I get Extra Help paying for my Medicare prescription drug coverage, but I haven't had a change.
I lost my Special Needs Plan because I no longer have a condition required for that plan
3b. Monthly Dual / LIS SEP (Part D SEP)
SEP Code: SEP-LIS
Who Qualifies
Beneficiaries who currently have Full Medicaid, Partial Medicaid, Extra Help (LIS) only.
Timing
Once per month, available year-round.
Changes allowed
PDP → PDP
MAPD → Original Medicare + PDP
What this may look like in the application
What this may look like in the application
I recently had a change in my Extra Help paying for Medicare prescription drug coverage (newly got Extra Help, had a change in the level of Extra Help, or lost Extra Help).
3c. Integrated Care SEP (for MA/MAPD changes)
This SEP is designed to help dual eligible beneficiaries move into integrated plans.
SEP Code: SEP-INT
Who qualifies
Full Medicaid + Medicare, (QMB+, SLMB+, FBDE)
Timing
Once per month, available year-round.
Changes allowed
MAPD → MAPD
MAPD → Original Medicare + PDP
Enroll into a Dual Eligible Special Needs Plan (D-SNP)
Additional Notes
Additional Notes
An integrated plan means the member’s Medicare and Medicaid are working together under the same carrier — which is why eligibility and MCO alignment matter before enrolling
Types of integrated plans
FIDE SNP (Fully Integrated Dual Eligible SNP)
Medicare + Medicaid are fully aligned
MCO must match (No Exception)
HIDE SNP (Highly Integrated Dual Eligible SNP)
Partially integrated (some Medicaid benefits included)
MCO usually needs to match (verify by state)
AIP (Aligned/Applicable Integrated Plans)
Varies by carrier/state
Often requires alignment, but always confirm
MCO (Managed Care Organization) = the company managing the member’s Medicaid benefits.
👉 For many integrated plans, this must match the Medicare carrier.
Enrollment guidance
Check Medicaid eligibility in the carrier portal before enrolling - regardless of election period, carriers will still verify Medicaid / DSNP eligibility and MCO alignment
Integrated D-SNP (FIDE/HIDE/AIP) → use SEP-INT
Non-integrated D-SNP → requires a valid SEP (Medicaid/LIS, Move, etc.
What this may look like in the application
What this may look like in the application
I have Medicare and get full Medicaid benefits. I want to join or switch to a plan that coordinates coverage between my Medicare and Medicaid managed care plans (called an integrated Dual Eligible Special Needs Plan (D-SNP)).
4. Institutionalized (facility) SEP
SEP code: SEP-INST
Who qualifies
Beneficiaries who move into, reside in, or move out of:
Skilled nursing facilities
Long-term care facilities
Psychiatric hospitals
Timing
Continuous while institutionalized and up to 2 months after discharge
Plans allowed
MA, MAPD, PDP
What this may look like in the application
What this may look like in the application
I live in a long term care facility (for example, a nursing home or rehabilitation hospital).
5. Plan termination or contract violation
SEP code: SEP-CTEP
Examples
Carrier exits the market / stops offering a specific plan
CMS terminates a plan’s contract
Timing
A CMS-defined enrollment window, which may vary depending on the situation.
Plans allowed
MA, MAPD, PDP
Note: May also have a Med Supp option through Guaranteed Issue.
Examples:
MAPD > MAPD, PDP
MA > MA, MAPD, Original Medicare / PDP
PDP > PDP, MAPD
Med Supp > Med Supp (GI applies), MAPD, MA
What this may look like in the application
What this may look like in the application
I am in a plan that was recently taken over by the state because of financial issues. I want to switch to another plan.
I lost my coverage because my plan no longer covers the area that I live or it ended its contract with Medicare.
I lost my coverage because Medicare ended its contract with my plan. I received a letter from Medicare saying I can join another plan.
6. CMS disaster or emergency SEP
SEP code: SEP-DST
Who qualifies
Beneficiaries affected by a FEMA-declared disaster or emergency who missed an enrollment opportunity
Timing
CMS-specified timeframe
Plans allowed
MA, MAPD, PDP
What this may look like in the application
What this may look like in the application
I was affected by an emergency or a major disaster (as declared by the Federal Emergency Management Agency, or by Federal, my state, or my local government). One of the other statements on this page applied to me, but I was unable to make my request because of the disaster.
7. Five-Star SEP
SEP code: SEP-5STAR
Who qualifies
Beneficiaries enrolling into a CMS 5-Star rated plan
Timing
December 8 – October 31st (once per year)
Plans allowed
MA, MAPD, PDP
What this may look like in the application
What this may look like in the application
I am enrolling in a 5-star Medicare plan.
8. Trial Right SEP - Example 1
SEP code: SEP-TRIAL
Examples
A beneficiary joins a Medicare Advantage plan for the first time after previously having Medicare Supplement (Med Supp) with Original Medicare
The beneficiary leaves the MA plan within the first 12 months
Timing
Available during the first 12 months after enrolling in the Medicare Advantage plan. The Trial SEP is a one-time election period, meaning once it has been used, it cannot be used again in the future.
Plans allowed
Return to Original Medicare
Enroll in a Prescription Drug Plan (PDP)
Note
Beneficiaries may also have a guaranteed issue right to return to their previous Medicare Supplement plan (or purchase certain Med Supp plans).
What this may look like in the application
What this may look like in the application
I dropped a Medicare Supplement Insurance (Medigap) policy when I first joined a Medicare Advantage Plan. It's been less than 12 months since I left my Medigap policy. I want to switch to Original Medicare so I can go back to my Medigap policy, and I'm joining a Drug Plan (Part D).
9. Trial Right SEP - Example 2
SEP code: SEP-TRIAL
Example
A beneficiary started Medicare with a Medicare Advantage plan
They switch to Original Medicare and purchase a Medicare Supplement plan
They later decide to return to Medicare Advantage
Timing
Available within 12 months of first enrolling in the Medicare Advantage plan. The Trial SEP is a one-time election period, meaning once it has been used, it cannot be used again in the future.
Plans allowed
MA, MAPD
10. SPAP - SEP
SEP code: SEP-SPAP
Who qualifies
Beneficiaries enrolled in a State Pharmaceutical Assistance Program (SPAP), typically individuals who also qualify for LIS (Extra Help) or Medicaid-related assistance.
Qualifications can vary depending on the member's income eligibility and the type of SPAP they are enrolled with.
Timing
Can be used once per calendar year.
Plans allowed
MAPD, PDP
What this may look like in the application
What this may look like in the application
I'm in a State Pharmaceutical Assistance Program, or I'm losing help from a State Pharmaceutical Assistance Program.
11a. Chronic Condition (C-SNP) - SEP
SEP code: SEP-CSNP
Who qualifies
Beneficiaries diagnosed with a qualifying chronic condition(i.e. Diabetes, Chronic Heart Failure, ESRD, Lung conditions) that is served by a Chronic Condition Special Needs Plan (C-SNP).
What beneficiaries can do
Enroll in a Chronic Condition Special Needs Plan (C-SNP) designed for their condition.
Timing
Beneficiaries can join at any time if eligible. Once enrolled, the opportunity to use this SEP ends for that specific condition.
Plans allowed
MAPD
Note
Carriers may verify chronic conditions directly with the member’s provider.
What this may look like in the application
What this may look like in the application
I want to join a Special Needs Plan that tailors its benefits to my chronic condition.
11b. Chronic Condition (C-SNP) - Loss of SNP eligibility SEP
SEP code: SEP-SNP
Who qualifies
After enrollment into a C-SNP, an individual who is determined to not have the qualifying condition necessary to be eligible for the C-SNP.
What beneficiaries can do
Enroll in another MA-PD or MA-only plan
Timing
Month of notification + 2 additional months
Plans allowed
MAPD, MA
12. Veterans with other creditable drug coverage
SEP code: OCC
Who qualifies
Veterans who have other creditable prescription drug coverage through VA, TRICARE, or CHAMPVA and are currently enrolled in a Medicare Advantage Prescription Drug (MAPD) plan or a Medicare Part D plan (PDP).
Examples
A veteran enrolled in an MAPD plan who receives prescription drug coverage through the VA
A beneficiary with TRICARE or CHAMPVA drug coverage who does not want Medicare Part D coverage
Timing
This Special Election Period (SEP) is available when a beneficiary is enrolling in or maintaining other creditable prescription drug coverage.
What beneficiaries can do
Switch MAPD → MA-only plan (no Part D)
Dis-enroll from Part D
Return to Original Medicare
Maintain prescription coverage through VA / TRICARE / CHAMPVA
Note
We recommend confirming the type of Veterans coverage the beneficiary has - VA benefits can vary. VA drug coverage is generally considered creditable, but it may only cover medications related to certain conditions, some veterans choose Medicare Part D (PDP) for broader prescription coverage.
What this may look like in the application
What this may look like in the application
I am leaving a Medicare MAPD or PDP plan and enrolling in a standalone Medicare Advantage plan without drug coverage (MA) because I have other creditable drug coverage.
13. Loss of Creditable Prescription Drug Coverage - SEP
SEP CODE: LCD / LCC
What qualifies
Loss of creditable prescription drug coverage, OR
Notification that existing coverage is no longer creditable
Timing
Begins when:
Coverage ends, OR
Beneficiary is notified (whichever is later)
Lasts: Month of loss/notice + 2 additional full months
Plans allowed
MAPD, PDP
What this may look like in the application
What this may look like in the application
I lost other, non-Medicare prescription drug coverage that's as good as Medicare prescription drug coverage (creditable coverage), or my other, non-Medicare prescription drug coverage changed and is no longer considered creditable.
Medicare Supplement (Med Supp) notes
Guaranteed Issue (GI)
Common triggers
Med Supp plan termination
Trial Right SEP
Loss of employer or union coverage
Note: If the beneficiary already has Medicare Part B and simply loses employer coverage, this does not always create a Guaranteed Issue (GI) right for Medicare Supplement.
Loss of Medicaid eligibility
Note: CMS gives the beneficiary a Guaranteed Issue window of 63 days after Medicaid coverage ends
Helpful reminders
GI rules vary by carrier and state
When GI applies, beneficiaries can usually return to the same carrier and letter plan (Plan G, F) they previously had (if it is still offered)
GI windows are time-limited, so enrollment must be completed within the allowed period
Some carriers may require documentation stating the Medicaid or other credible coverage ended
Additional GI situations to be aware of
Some states have Birthday Rules, which allow beneficiaries to change Med Supp plans each year (rules vary by state)
Note
Because GI rules, timing, and eligible plans vary by state and carrier, it’s always best to confirm details with the carrier or review the state’s Med Supp guidelines.
Key reminders for agents
Election period eligibility is attested by the agent, and carriers may request documentation to verify eligibility.
Selecting an election period that aligns with the client’s qualifying event helps prevent delays and supports smoother carrier processing.
Carriers control how the election period section is configured within the application.
Although the section may be labeled as a Special Enrollment Period, it includes options for other election types such as IEP, ICEP, and MA OEP.
We recommend using this as a guide and working with your client, along with CMS and carrier guidelines, to confirm eligibility for the appropriate election period.
TroubleShooting
If you’re not seeing a specific Election Period available in the application, please don’t hesitate to reach out to our Medicare Support Team—we’re happy to help take a closer look. If you’re able to include the carrier, plan, and ZIP code, we’d be happy to review this more closely and check if anything may be missing.
You can contact our Medicare Support Team at (855) 521-4984 or medicare-agents@healthsherpa.com.