There are certain situations where a beneficiary can enroll in Medicare outside of the normal enrollment periods, this is known as the Medicare Special Enrollment Period, or SEP. An SEP gives you the opportunity to enroll in Medicare Part B outside of the General Enrollment period or outside your Initial Enrollment Period.
You can make changes to your Medicare coverage when certain life events occur, there’s many different types of SEPs available and the rules are different for each one. Your new Medicare coverage will begin on either the first day of the month you enrolled or the following month.
Medicare Special Enrollment Periods for Part B
To be eligible for a Medicare Special Enrollment Period for Part B, you must answer yes to the below three questions:
- Are you eligible for Medicare because of a disability?
- Were you enrolled in either Medicare Part B or an employer group health plan when you first became eligible for Medicare?
- Have you had continuous coverage by either Medicare Part B or a group health plan since you became eligible for Medicare up until now?
How long is the Medicare Special Enrollment Period?
Incarceration Medicare SEP Rules
When institutionalization or incarceration comes to an end, Medicare SEP rules state you should act immediately to enroll in Medicare and seek supplemental insurance.
Medicare SEP Enrollment for New Citizens
New citizens may become eligible as soon as they complete the naturalization process. If any of these changes apply to you, talk to our counselors about your next step for Medicare SEP Enrollment.
Medicare Special Enrollment Period Rules for Change in Status in Other Government Programs
A change in Medicaid status may give you a two-month SEP in which you can determine appropriate changes in your Medicare coverage. After that, you may get assigned to something without your prior approval. In addition, different coverage may be needed after enrollment or disenrollment in PACE, the Program of all inclusive Care for the Elderly. Likewise, you may need coverage if you enroll in a Special Needs Plan or are dropped from a SNP. Medicare also has an exceptional circumstance clause which may make you eligible for a SEP. Since these situations are complicated, it pays to find out the facts.
Medicare SEP Guidelines for Dis-enrolling from my Medicare Advantage or Part D Plan
If you aren’t eligible for a special enrollment period, the only safe time to change Medicare Part D plans is October 15 through December 7. Likewise, the only safe time to change Medicare Advantage plans is during its open enrollment (January 1 – February 14). Be aware that if you stop paying premiums, you could find yourself owing the unpaid balance to a collection agency.
For a list of all the different types of Medicare Enrollment Periods, click here.
Find Out if You’re Eligible 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:
- CMS 40B
- CMS L564
Once you enroll in Medicare 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% as well as deductibles, coinsurance and copayments. If you want to compare rates now, click here to fill out our online quote form.