Medicare Special Enrollment Periods

There are certain situations where a beneficiary can enroll in Medicare outside regular enrollment periods. When you can join outside of a standard enrollment period, this is a Medicare Special Enrollment Period (SEP).

A Special Enrollment Period allows you to enroll in Part B outside of the General Enrollment Period or the Initial Enrollment Period.

You can make changes to your Medicare coverage when certain life events occur. Many different types of Medicare Special Election Periods are available, and there are different qualification standards for each.

New Medicare coverage will begin on either the first day of the following month. So, if you used a Special Election Period in February to apply for coverage; then, your coverage can begin in March.

How long is the Medicare Special Enrollment Period

The amount of time you have to enroll in a new policy depends on the specific Medicare SEP guidelines.

For example, if you move out of the plans service area, then you’ll have two full months after you move. Inform the insurance company after the move; then, you’ll have the month you tell your plan and two more months.

When you lose Medicaid coverage, your SEP Medicare lasts for three full months, beginning on the date you’re no longer eligible or notified, whichever is last.

If you discontinued a Supplement for the first time to join an advantage plan, then you have 12 months to return to Medigap with Guarantee Issue.

Those that enroll in Part C can join in Medigap with Guarantee Issue rights within 12-months of the effective dates.

After those 12 months, you may need to go through medical underwriting. The length of time allowed for SEP Medicare changes depends on the specific enrollment period you’re eligible for using.

If I have Medicare Due to Disability, will I have a Special Enrollment Period When I Turn 65?

When you turn 65 Guarantee Issue rights for a Medicare Supplement become available, this is an exciting time for anyone new to Medicare.

Many beneficiaries choose this time to enroll because you can get a Medigap plan without answer any health questions. Meaning you get the best possible premium rates available to you.

There is no need to change your Part D;. However, those without a drug plan can enroll during your Initial Enrollment Period. Although, you may incur a Part D late enrollment penalty when you wait.

Working Past 65

Many seniors reach the age of Medicare eligibility and decide to keep working. Talk to the benefits administrator at your place of employment.

You may need to enroll in Medicare still, even with employer coverage. However, in some cases, you can delay obtaining in Part B and Part D as well as avoid any late enrollment penalties.

You need to confirm creditable coverage from your benefits administrator.

Medicare Special Enrollment Period for Moving

Those that qualify for a Medicare Special Enrollment Period for moving; you have one month before and two months after the move to switch.

Those moving out of your insurance company’s service area, it’s imperative to seek a SEP and get new coverage.

Here is a list of tips for moving to another state with Medicare.

Your New Home Address isn’t in your Plan’s Service Region

If you end up moving to a different state that happens to fall outside the service region, you can change to a new plan. Those with a Medicare Advantage Plan can switch back to Medicare.

Tell the plan before the move; then, the SEP begins the month you move and extends two months. However, tell the company after the move, and the SEP begins the month you notify them plus two months.

Your New Home is Still Within your Plan’s Service area, but New Plan Options are Available

If your new house is within the service area but with new plan options, you can select a new plan. Your SEP starts the month the company knows of the move and lasts for two months after.

You’ve Recently Moved Back int the United States

If you were living in another country and move back to the U.S., you can enroll in a new plan for up to two months.

You’ve Moved into or Out of a Health Facility

If you recently moved into, currently reside in, or recently moved out of a nursing facility, you have several options. Choose to join a new plan if you don’t have one, or switch your current policy.

Also, you may choose to drop your Advantage plan and return to Medicare, or you can drop Part D. If you are continuing to live within the nursing facility, you can join, switch plans, or even drop your coverage.

You can do this for up to two months after you move out of the health facility.

Incarceration Medicare Special Enrollment Period Rules

When institutionalization or incarceration comes to an end, Medicare SEP rules state you should act immediately to enroll in Medicare. You can enroll in a new plan upon release of jail and can do so for two full months.

Medicare Special Enrollment Period Enrollment for New Citizens

If you’re a United States citizen and over the age of 65, you should be eligible for Medicare. You’ll need to reside in the United States to enroll in Medicare.

You need to be a United States Citizen and resident for at least five years.

When you work fewer than the necessary hours for premium-free Part A, you’ll need to pay for that coverage. Also, you’ll want to enroll in Parts B and D.

Then you can select a Supplement that covers what Medicare leaves for your responsibility. It’s important to note that if you meet the citizenship and eligibility requirements, you can enroll in Medicare at any age.

You must get Social Security Disability or Railroad Retirement Board benefits for 24 months.

Those with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis may qualify.

Special Enrollment Period Guidelines for Medicare Advantage

If you aren’t eligible for a Special Enrollment Period, the only safe time to change Part D plans is October 15th through December 7th during the Annual Enrollment Period.

As of 2019, the only safe time to change Medicare Advantage plans is during the Medicare Advantage Open Enrollment Period, which runs from January 1st – March 31st.

Be aware that if you stop paying premiums, you could find yourself owing the unpaid balance to a collection agency.

Medicare Part D Special Election Period Guidelines

If you have a chance to get prescription drug coverage through TRICARE, then you need to get it. You won’t need Part D because TRICARE is considered creditable coverage.

If your Part D plan changes its contract with Medicare and doesn’t renew, you can change plans between December 8th and the last day of February.

When you qualify for Extra Help, you also qualify for a continuous SEP. You can drop, join or switch plans one time during each period; January through March, April through June, and July through September.

You can’t make changes from October through December with this Special Enrollment Period. When making a change, the new policy will go into effect on the first day of the next month.

If you are unaware you would lose creditable coverage, you could join a new drug plan up to two full months after getting the error notice.

Medicare Special Enrollment Period When Losing Coverage

There are several instances in which you may find you lose your current coverages. When a person loses coverage, that is an indication of eligibility for a Medicare Special Enrollment Period.

You lose Employer Health Coverage

When you lose health coverage from an employer or union, you can join a different Medicare plan up to a full two months after.

You Lose Creditable Prescription Coverage, or it Changes Dramatically

Losing drug coverage equal to Medicare’s means you can switch to another plan with drug coverage or a stand-alone Part D.

The Medicare Special Enrollment Period continues for two full months after the month you lose your drug coverage, or you get a notification.

You Leave a Medicare Cost Plan

If you have Part D through a Cost Plan and you end up leaving that plan, you can enroll in a new policy for up to two months.

Your PACE Coverage Drops

Dropping your coverage in your PACE Plan means you can enroll in a new plan for two months

Obtain other Coverage through a Medicare Special Enrollment Period

Below is a list of the instances in which you will see the need for a Special Enrollment Period.

Employer-Offered Coverages

You can enroll in another health coverage that’s offered by your current employer or workers union. To do this, you would drop your current Medicare coverage and would join in a private plan offered by your workplace.

You can do this whenever your employer advises you can make changes to your plans.

Prescription Drug Coverages

If you’re enrolling in a drug plan that is just as good as Medicare, you can drop your current Medicare plan at any time.

PACE Plan

If you decide to enroll in a PACE plan, you can drop your current Medicare plans at any point in time.

Service Area

If there is a 5 star Medicare Advantage plan in your area, you can enroll in this once between December 8th and November 30th, unless you select this coverage during AEP.

Encounter Changes in Medicare Plan’s Contract

What are your options if you deal with changes with your plan’s contract with Medicare?

Sanctions and Medicare

If Medicare ends up taking official action because of an issue with your plan, and this affects you, you can switch your Medicare plan. Medicare may review making this switch for you, depending on the situation at hand.

Plan’s Contract Comes to an End Early

Those that have a health plan coming to an end in the middle of the contract year can switch to another Medicare plan two months before the contract ending and up to one full month after it ends if the policy isn’t for another contract year.

Also, those in this position, you can switch to a different Medicare plan between October 15th – the end of February.

Changes because of Other Circumstances

You may find yourself in a position where you face a different set of circumstances. What are your options in that scenario?

No Longer Qualify for Extra Help

Those no longer eligible for Extra Help in the upcoming year have several options. You can choose to join a new plan or switch your plan.

Further, you can drop your Advantage plan and return to Medicare, or you can choose to decline your drug coverage.

You can make changes to your policy for three months from the date in which you’re no longer eligible, or the notification date.

Ineligible for Medicaid

Those no longer eligible for Medicaid coverage can enroll in a new plan, switch plans, drop advantage plan and return to Medicare, or even drop Part D.

You can make these changes up to three months from the date that you’re no longer eligible for Medicaid, or when you get a notification.

Special Enrollment Period for Medicare and Medicaid

When eligible for Medicare and Medicaid, you can choose to change plans, whether it be switching, joining, or dropping plans. Changing plans is an option because dual-eligibility and low-income subsidy qualify you for a Medicare Special Enrollment Period.

You can do this once throughout the following dates:

·         January-March

·         April-June

·         July-September

You Receive Extra Help

Those getting extra help can make changes once during:

·         January-March

·         April-June

·         July-September

Enrolled in an SPAP Program

You can choose to join a Medicare plan once during the calendar year.

Enrolled in an SPAP Program and you Lose Eligibility

You can choose to join a new Medicare plan. You can do this either the month that you lose your eligibility or when you get the notification.

Suffer from a Severe Condition

If there’s a Special Needs Plan and you have a severely disabling condition, you can join into a Medicare Chronic Care SNP at any time.

Errors by a Federal Employee

If you join a plan or decide to not participate because of a mistake by a federal employee, you have a few options.

You can choose to enter a new Medicare plan, switch from your current policy to a new one, drop your Advantage plan and return to Medicare, or drop your drug coverage.

These changes can take a full two months after the month you get notification of the error.

Medicare Special Enrollment Periods for Part B

Do you wonder about the Part B Special Enrollment Period? Well, we’re going to give you the answer.

To be eligible for a Special Enrollment Period for Part B, you must answer yes to the following:

1.       Do you get Medicare because of a disability?

2.       Did you have Part B or an employer group health plan when you first became eligible for Medicare?

3.       Were you covered by Part B or a group plan since eligible for Medicare, up until now?

Lack of Part A Coverage

If you lack Part A coverage and you enroll in Part B during the General Enrollment Period, you can opt into joining a Medicare drug plan between April 1st-June 30th.

Find Out Eligibility for a Part B SEP

To find out if you’re eligible for a Part B SEP; contact the Social Security Administrations office and request the following two forms:

1.       CMS 40B

2.       CMS L564

Once you enroll in Part B, contact one of our agents to get enrolled in a Medicare Supplement plan. Medicare only covers 80% of your medical care, leaving you responsible for the remaining 20%. In addition to that, you need to cover deductibles, coinsurance, and copayments.