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What is the Medicare Special Enrollment Period?

by My Senior Health Plan
written by My Senior Health Plan

Right now, we’re in Medicare’s Open Enrollment Period (OEP). But what happens if a major disaster strikes and you’re not able to take advantage of OEP? Don’t worry, you’ll still be able to change your plan if you need to. The Medicare Special Enrollment Period (SEP) extends the Medicare enrollment period during extenuating circumstances.

For example, you might find yourself in the midst of a life-altering weather event that prevents you from selecting coverage during OEP. Or you might need to move to a new state and discover that your previously selected coverage is not offered in your new state of residence. You can’t go without coverage, so a SEP allows you to choose a new plan.

Life changes, and sometimes your coverage has to change as well. SEPs can be difficult to understand, but we’re here to help you understand what you need to know about Medicare SEPs and how you can take advantage of this important enrollment period.

Am I eligible?

There are several circumstances for qualifying beneficiaries for SEPs. The most common are FEMA-designated natural disasters and changes in residence.

Extreme weather event or natural disaster

In order to initiate a SEP, the Federal Emergency Management Agency (FEMA) must officially declare an area affected by an emergency or a major disaster. This includes but isn’t limited to, extreme rain and flooding events, hurricanes, tornadoes, wildfires, man-made environmental catastrophe and more.

If you were planning to initiate or alter coverage during a predesignated enrollment period, like OEP, but weren’t able to because of the FEMA-designated disaster, you may take advantage of the SEP.

One extra benefit is that it doesn’t have to be you that lives in the disaster area to qualify. The SEP takes into consideration that many seniors rely on a family member to assist with their Medicare coverage selections. If the family member or caregiver charged with this duty lives in a FEMA-designated area, the same principle applies.

Change of residence

You may not have realized that moving can impact your Medicare coverage. For example, if you live in Arizona and selected a plan during last year’s OEP, but you now need to move to California to be closer to family, you will also need to also change your coverage. Different Medicare plans service different areas, and if you move into a state not serviced by your current plan, you’ll need to take advantage of this SEP.

You’ll want to take advantage of the SEP to find better coverage options in your new state that wasn’t available in your previous area of residence.

How long are SEPs?

The length of SEPs varies based on the circumstances. If you have a qualifying change of residence, you have two months to alter coverage. In the case of extreme weather or natural disasters, the SEP begins the day the disaster strikes and runs for four full calendar months thereafter.

This is almost always the case, but there have been a few cases when FEMA-designated SEPs were extended beyond four months. Hurricane Katrina, for example, made U.S. landfall on August 25, 2005 before pummeling the Gulf Coast for several days thereafter. The SEP for this natural disaster was extended through December 31, 2006—more than 16 months.

What can I change during SEP?

During SEP, you can enroll in, disenroll from, or switch Medicare health or prescription drug plan. Essentially, you can add, update, change, or drop both medical and prescription drug coverage during the SEP period.

Usually, if you need to take advantage of a SEP, you’re experiencing some significant life change. During these times, the last thing you want to worry about is your Medicare coverage.

If you need help or have questions about SEP, visit our website or call (877) 255-6273. You’ll be able to talk to a knowledgeable member of our team who will help you navigate SEP and find your best coverage options.

You may also seek assistance from Medicare by calling (800) MEDICARE (1-800-633-4227).

 

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Understanding Special Enrollment Periods on Medicare
Health Insurance

Understanding Special Enrollment Periods on Medicare

by Jagger Esch
written by Jagger Esch

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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