MEDICARE SPECIAL ENROLLMENT PERIOD

Unavoidable circumstances call for unavoidable changes. Make the changes you need for your Medicare Plans outside the regular Enrolment Periods in the Special Enrollment Periods (SEPs).

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Get the most out of your Medicare Special Enrollment Period

Who can make use of the Medicare Special Enrollment Period?

If you qualify for the Medicare Special Enrollment Period, you can enroll in Original Medicare, Parts A and B outside of your Initial Enrollment Period (IEP) and the General Enrollment Period (GEP).

You (Or anyone in your household) can make use of the special enrolment period to sign up for Part A and/or Part B in situations like,

  • If you are 65 or older and are covered under a group health plan, either from your own or your spouse’s current employment, you have a Special Enrollment Period during which you can sign up for Medicare Part B without having to wait for the GEP and without the 10% premium penalty for late enrollment.
  • You have newly-gained access to an individual coverage Health Reimbursement account (HRA).
  • You or anyone in your household in the past 60 days got married, had a baby, adopted a child, or placed a child for foster care, got divorced or legally separated and lost health insurance or died.
  • Changes in residence like moving to a new home in a new ZIP code or county, moving to the U.S. from a foreign country or United States territory; if you’re a student, moving to or from the place you attend school; if you’re a seasonal worker, moving to or from the place you both live and work, moving to or from a shelter or other transitional housing.
  • You or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days.
  • You or anyone in your household newly gained access to an individual coverage HRA or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) in the past 60 days OR expects to in the next 60 days.

You can also make changes to your existing coverage due to a special circumstance which would also trigger an SEP. You can make changes to your Medicare Advantage or Part D Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage.

Get the most out of your Medicare Special Enrollment Period

Medicare Part A, B, C, D – Special Enrollment Periods

The special enrollment period to enroll for Part A and/or Part B is anytime you are still covered by the group health plan through you/your spouse’s current employment or the 8 months following the month the employer health coverage/the employment ends (whichever is first). 

The special enrollment period to enroll for Part C (Must enroll in Part A and/or B) is anytime during the 63 days after the employer/group health coverage ends or when the employment ends (whichever is first).

The special enrollment period to enroll for Part D (Must enroll in Part A and/or B) is anytime during the 63 days after the employer/group/veteran’s administration coverage ends or when the employment ends*. (whichever is first).

If you do not enroll in Medicare by the end of the eight-month period, you will have to wait until the next General Enrollment Period, which begins January 1 of the next year. You also may have to pay a higher premium for Medicare Part B. If you don’t qualify for premium-free Medicare Part A, you may owe a late-enrollment penalty for Part A as well.

Get the most out of your Medicare Special Enrollment Period

FAQs on Medicare Special Enrollment Period

What is a Medicare Special Enrollment Period (SEP)?

A Special Enrollment Period (SEP) allows a Medicare beneficiary to join, switch, or drop their Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan (MA or MAPD or SNP) outside of the Annual Open Enrollment Period (AEP). If you are eligible for an SEP, your coverage will be effective on the first day of the month following your new Medicare plan enrollment.

What is the 5-star Special Enrollment Period?

If a Medicare Part D or Medicare Advantage plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period (SEP) for a once-a-year opportunity to switch from your current Medicare plan to a Medicare plan with the “5-star” quality rating. The 5-star SEP is available to you at any time during the plan year.

Is there any risk associated with using the 5-star Special Enrollment Period?

Maybe. The key is that you must be aware of the type of Medicare plan you currently have and what type of 5-star Medicare plan you are choosing as part of the 5-star Special Enrollment Period (SEP) – because it is possible to lose your prescription drug coverage by joining a 5-star Medicare Advantage plan that does not include prescription drug coverage.

What are the Medicare Part D Special Enrollment Periods (SEP)?

A Special Enrollment Period (SEP) allows a Medicare beneficiary to join, switch, or drop their Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan (MA or MAPD) outside of the Annual Open Enrollment Period (AEP) that runs from October 15th through December 7th. If you are eligible for an SEP, your coverage will be effective on the first day of the month following your new Medicare plan enrollment or plan change.

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