Medicare — Glossary

What is SEP (Special Enrollment Period)?

Special Enrollment Period

Definition

A Special Enrollment Period (SEP) is a time outside the standard enrollment windows when a Medicare beneficiary can make changes to their coverage due to qualifying life events. These events include moving to a new area, losing employer coverage, qualifying for Medicaid, or experiencing other specific circumstances defined by CMS.

Why SEP (Special Enrollment Period) Matters for Insurance

SEPs create year-round sales opportunities beyond AEP and OEP. Insurance agents who understand SEP qualifying events can help prospects enroll at any time during the year. This creates a steady pipeline of leads rather than seasonal feast-and-famine cycles. Tracking and documenting SEP eligibility is critical for compliance.

Key Points

  • Triggered by qualifying life events (move, loss of coverage, Medicaid eligibility, etc.)
  • Different events have different SEP durations (typically 60 days)
  • Must document the qualifying event for CMS compliance
  • Available year-round when qualifying events occur
  • Some SEPs allow immediate plan changes; others have specific effective dates

How AgentTech Handles SEP (Special Enrollment Period)

AgentTech helps agents identify and document SEP eligibility during calls. AI compliance monitoring flags when agents discuss SEP enrollment to ensure proper documentation of qualifying events. The built-in CRM tracks SEP dates and follow-up schedules.

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Frequently Asked Questions

Common qualifying events include moving to a new service area, losing employer health coverage, qualifying for Medicaid, being released from incarceration, or having a plan leave your area. Each event triggers a specific enrollment window.

Most SEPs last 60 days from the qualifying event, though some are shorter or longer. The Five-Star SEP allows switching to a five-star rated plan at any time from December 8 - November 30.

See SEP (Special Enrollment Period) in Action

AgentTech Dialer puts these concepts to work. Try AgentTech Dialer today.

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