There are certain situations where a beneficiary can enroll in Medicare outside normal enrollment periods, this is known as the Medicare Special Enrollment Period (SEP).
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.
Medicare Special Enrollment Periods for Part B
You may wonder what the Medicare Part B Special Enrollment Period for the Working Aged is, well this question is about to be answered.
To be eligible for a Medicare Special Enrollment Period for Part B, you must answer yes to the following:
- Are you eligible for Medicare because of a disability?
- Did you have Medicare Part B or an employer group health plan when you first became eligible for Medicare?
- Were you covered 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?
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. If you inform the insurance company after the move, then you’ll have the month you tell your plan in addition to 2 more months.
When you lose Medicaid coverage your SEP Medicare lasts for 3 full months, beginning on the date you’re no longer eligible or notified, whichever is last.
If you discontinued your Medicare Supplement for the first time to join a Medicare Advantage plan, then you have 12 months to buy a Medigap plan with special buying rights.
Those that enroll in MA coverage, having the same effective date as Part A and B, can enroll in Medigap with GI rights within 12-months of the effective dates.
After those 12 months, you may need to go through medical underwriting. If you’re in this situation, call and speak to a licensed agent now.
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 you’ll be granted Guarantee Issue rights for a Medicare Supplement. This is an exciting time for anyone new to Medicare, this is 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 Medicare Part D; however if you don’t have a prescription drug plan, you can enroll during your Initial Enrollment Period. Although, you may incur a Part D late enrollment penalty if you waited to enroll.
Medicare Special Enrollment Period for Moving
If you qualify for a Medicare Special Enrollment Period for moving, you have one month before and two months after the move to switch. If you’ve moved out of your insurance company’s designated 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.
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’ll have 2 full months to select a Medicare Supplemental coverage and a Part D plan.
Working Past 65
Many seniors reach the age of Medicare eligibility and decide to keep working. If this is you, start building a relationship with the benefits coordinator in the office that you work. You may need to enroll in Medicare still, even with employer coverage.
However, in some cases, you can delay enrolling in Part B and D as well as avoid any late enrollment penalties. You need to receive confirmation of creditable coverage from your benefits administrator.
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 in order to enroll in Original Medicare. You need to be a United States Citizen and resident for at least 5 years.
When you’ve worked fewer than the needed hours for premium-free Part A, you’ll need to pay for that coverage. Additionally, you’ll want to enroll in Parts B and D.
Then you can select a Medicare Supplement that covers what Original 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, as long as you receive Social Security Disability or Railroad Retirement Board benefits for 24 months. You may also qualify if you have end-stage renal disease or amyotrophic lateral sclerosis.
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 dis-enrollment 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 an 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.
SEP Guidelines for Medicare Advantage
If you aren’t eligible for a Special Enrollment Period, the only safe time to change Medicare 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 Open Enrollment Period which runs from January 1st – March 31st. This enrollment period replaced the MADP that ran annually between January 1st and February 14th.
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.
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 Medicare 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 paying for Medicare Part D, 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. If you made a change, the new policy will go into effect the first day of the next month.
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%. In addition to that, you need to cover deductibles, coinsurance, and copayments.
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