Special Enrollment Periods

 

Understanding the nuances of Medicare enrollment can be overwhelming, especially when dealing with unique circumstances. Special Enrollment Periods (SEPs) offer a lifeline to those who need to enroll in Medicare outside the standard periods due to specific situations.

This guide will walk you through the essentials of SEPs, who qualifies, and how to navigate the enrollment process. Stay informed and empowered with our comprehensive insights, ensuring you make the best choices for your healthcare needs, no matter your circumstances.

 
 

Special Enrollment Period for Medicare

What is a Special Enrollment Period (SEP)? A Special Enrollment Period is an opportunity for individuals with unique circumstances to enroll in Medicare outside of the standard annual enrollment periods, such as the Open Enrollment Period. This guide will help you understand how to sign up for Medicare during an SEP.

 

Who Qualifies for a Special Enrollment Period

SEPs are available for Original Medicare (Parts A and B), Medicare Advantage (Part C), and prescription drug plans (Part D) for those who couldn't enroll during the regular enrollment periods due to specific reasons.

Learn More About Medicare

Stay informed by joining our email series to receive a free Medicare guide and the latest updates on Medicare and Medicare Advantage.

Special Enrollment Periods for Original Medicare (Parts A & B)

  1. Employer Coverage

    If you were covered by your employer’s health insurance when you turned 65 and did not enroll in Medicare, you could get an SEP to enroll after your employer coverage ends. This SEP lasts for eight months starting from the month after your employment or coverage ends. Note: COBRA and retiree health plans do not count as active employer coverage.

  2. Foreign Volunteer Work

    If you were volunteering outside the U.S. for at least 12 months in a tax-exempt program and had health insurance during your service, you may qualify for an SEP when you return.

  3. Disabled TRICARE Beneficiaries

    TRICARE beneficiaries under 65 who qualify for Medicare due to a disability, ALS, or ESRD and did not sign up for Medicare Part B when first eligible can use an SEP to enroll.

How to Enroll in Medicare

You can sign up for Original Medicare (Parts A & B) in several ways:

  • Apply online via the Social Security website.

  • Visit your local Social Security office.

  • Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778).

  • If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.

Changing Medicare Advantage or Part D Plans Outside Open Enrollment

Medicare beneficiaries can often switch plans during the fall Open Enrollment Period. However, certain situations allow changes outside this period through an SEP, including:

  • Losing drug coverage that was as good as or better than Medicare's.

  • Changes in employer or union health coverage.

  • Moving in or out of a care facility.

  • Eligibility changes in state pharmaceutical assistance programs, Medicaid, or Medicare Savings Programs.

  • Disenrollment from a Medicare Advantage plan within the first 12 months.

  • Enrolling in or disenrolling from PACE.

  • Moving to a new residence.

  • Release from incarceration.

  • Changes in Special Needs Plan eligibility.

  • Plan contract violations or non-renewals.

  • Enrolling in a five-star rated Medicare plan.

  • Enrollment in a low-performing plan.

  • Substantial changes in a plan's provider contracts.

  • If your situation doesn’t fit the standard SEPs, you can request a unique SEP from the Centers for Medicare and Medicaid Services (CMS).

How to Enroll in a Medicare Advantage Plan During a SEP

To determine your eligibility for a SEP or to compare available plans, you can speak with a licensed insurance agent. An agent can answer your questions and help you explore the benefits, costs, and coverage options in your area. Contact us today to get started for free.

Get a 100% FREE 20 Page Guide to Medicare Basics:

 
Previous
Previous

Medicare Frequently Asked Questions

Next
Next

“I’m New to Medicare”: Where to Start