Understanding Special Enrollment Periods on Medicare

Understanding Special Enrollment Periods on Medicare

Special Enrollment Periods for Medicare are known as SEPs. There are a variety of reasons why a Medicare enrollee would be eligible for a SEP. Having the information needed to utilize a SEP when necessary will save you problems getting Medicare coverage when you need it. please email your resume to Christina Dailey at CDailey@senior.com. She can also be reached 949-454-2418. Understanding Special Enrollment Periods on Medicare
Navigating the Medicare system does not have to be complicated. If you have with the right information and resources, you will avoid the complications of missing your SEP and being without coverage, which could be devastating for you and your family. Understanding Special Enrollment Periods on Medicare

Who Qualifies and When?

The qualifications for a SEP are as follows:
If you are:

  • 65 or older
  • still employed or your spouse is still on the job
  • you have health insurance through your – or your spouse’s – employer
  • eligible for Medicare because of a disability

You can qualify for a SEP:

  • while you still have an employer or employment union health plan
  • eight months following the last month of employer or union group health coverage, or when you or your spouse no longer work, whichever comes first.

If your group coverage, provided by your employer, ends and you neglect to sign up for Medicare Part B during the SEP, you then must wait until the General Enrollment Period (GEP) to sign up for your Medicare plan. You may pay a penalty of a higher Part B premium because of late enrollment.

What About if You Relocate?

Relocation is a fact of life for many on Medicare. Moving to be near family, for financial reasons, for a change of scenery or other circumstances happens all the time. You won’t lose your Medicare coverage, but there are issues to manage:

  • If you live in the United States or its territories, you can keep your Original Medicare Part A and Part B coverage.
  • Make sure to have your medical records transferred from your previous doctors to the doctors you find in your new hometown.
  • If you are covered by a Medicare Advantage plan or a Medicare Part D Prescription Drug Plan, moving to a new state may qualify you for a Special Election Period (SEP).
  • During your SEP, you can enroll in a plan offered in your new service area.
  • If you have a Medicare Supplement plan (also known as Medigap) and relocate to a new state, it’s likely you will be able to keep that coverage, because the plans are the same in most states (Minnesota, Massachusetts and Wisconsin have their own Supplement programs).
  • Keep in mind that costs may vary from state to state, since Medigap plans are provided by private insurers.

What if You’re Incarcerated?

If you are incarcerated after enrolling in Medicare, it’s best to maintain your coverage for Parts A & B, if you can. Medicare does not cover your treatment while in prison, but keeping your coverage will ensure that when you are released, you will maintain your Medicare insurance coverage and not have to pay penalties, which can be permanent.

What if You Qualify for Extra Help for Prescription Coverage?

If your financial status qualifies you for aid with prescription drug expenses, you are eligible to enroll anytime for Medicare Prescription Part D. There is no SEP in this case.

What if Your Medicaid Status Changes?

If your Medicaid status changes, there are some scenarios that may apply to you, including:

  • You may be eligible for a two-month SEP during which you can assess your needs. If you wait longer than that, you may be assigned coverage without your input.
  • If you are covered by PACE, the Program of All-inclusive Care for the elderly, you may need different coverage.
  • If your coverage is dropped from a Special Needs Plan (SNP), you may need coverage.

These situations can be difficult to navigate within the Medicare system, so it’s best to find out how the facts apply to you. Don’t hesitate to reach out to a Medicare specialist if you are overwhelmed by the details.

How to Find Out if You Qualify for a Medicare Part B SEP

Eligibility for a Part B SEP can be determined by filling out these forms, available through the Social Security Administration office:

  • CMS 40B
  • CMS L564

After you have enrolled in Medicare Part B, it’s important to look into a Medigap or Medicare Supplement Plan. Medicare only covers 80% of your medical care, which means you will be paying the remaining 20% as well as deductibles, coinsurance, and copayments. A Medigap plan can cover those expenses.

Understanding Special Enrollment Periods on Medicare

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About the Author

Jagger Esch

Jagger Esch is the President & CEO of Elite Insurance Partners and MedicareFAQ, a senior healthcare learning resource center. As a young entrepreneur and seasoned insurance expert, he has a passion for helping people. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. Jagger lives in the Florida sunshine state and loves boating with his family on the weekends.

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